Rabies Vaccine for travellers – who needs it?November 25th, 2012
Rabies vaccine is a dilemma to many Australian travellers. Travellers seek advice from many sources, (eg doctors, Google, travel agents, fellow travellers etc) and often receive conflicting information about rabies. Some sources say have rabies vaccine, some say do not have rabies vaccine… Below is a typical question I receive..
My daughter, leaves for a GAP year placement in 8 weeks. She will be on her placement in Malawi for 7 months and possibly travelling within Africa afterwards. I am receiving mixed messages from our local GP and the travel doctor we have consulted in about the need for vaccination for rabies.I am wondering if you can give me your opinion on this issue?.
I act as an advisor to one of the GAP placement organisations, and this question came from one of the parents.
I will try to answer the question (of whether to have rabies vaccine or not ) in an unbiased fashion, but, in my clinic, I must declare that I see too many persons who have been bitten by potentially infected animals, to be very relaxed about travelling without the rabies vaccine into the poorer parts of the world.
The local GP (…with greatest respect as I love GP’s and the work they do) … will probably not have the expertise necessary to advise on this rabies – he or she do not get the special training, and will seldom be exposed to patients who have had animal bites in Africa, so they often underestimate the problem. The GP’s may also not realize that the required treatment for a potential rabies bite is not readily available in most parts of the developing world, especially Africa.
My opinion on the above question is I would not send my child to Malawi for 7 months without rabies vaccine (.. For the record, I have two daughters aged 17 and 19)
Rabies Treatment is not easy to access
If a traveller is bitten or licked by an animal and has NOT had rabies vaccine in the past, then in order to treat them they requires TWO things; rabies vaccine and ‘RIG’ (Rabies Immune Globulin)- ideally within 24 hours.
The Rabies vaccine takes two weeks to be effective so RIG is like a quick infusion of instant antibodies. RIG keeps you safe while the vaccine helps your immune system to makes its own antibodies. RIG is a blood product ( scary thought in Africa ) and costs big dollars, so is not readily available in Malawi, or many other parts of the world where resources are poor. (RIG is sometimes in short supply even in Australia.)
If complete rabies treatment is not given correctly and on time, i.e. immediately after a bite, and a traveller were to wait until rabies symptoms develop – it would be too late…. established rabies is untreatable and universally fatal. We have no drugs that work against rabies. The only thing that stops the rabies virus is a well trained immune system.
Risky Bites are not uncommon
The odds of being bitten are hard to estimate – A recent study found the risk of being bitten in Asia was 1.11 per 100 travelers per month and the risk of being licked was 3.12 per 100 travelers per month. Both bites and licks are potential risks for rabies. The odds of being bitten are low but not zero. For the record, our figures show the highest risk age group for rabies exposures are 20-29 year old travellers. Most people I see bitten in my clinic are not ‘patting dogs’ – they are just being tourists ….walking in a temple or in the street, lying on a beach, sitting in a restaurant, taking a photo etc. If you have the rabies vaccine before you go, you are pre immunised for life.
The pre immunisation rabies vaccine course is three doses over a month, ( day 0, 7 and 28). That means if you ever receive an animal bite or lick, you would only need two doses of vaccine ( relatively easy to access ) in order to be safe. Persons who have had vaccination in the past have a head start. They have a ready made supply of rabie-killing-‘bullets’ so they do not need RIG ( the blood product ) if they are bitten.
Persons who are pre immunised only need two booster doses of vaccine – which is relatively easy to access in most parts of the world. Pre immunisation makes treatment of an animal exposure much simpler, safer, and less disruptive of ones travel plans.
So the choice is
3 vaccines before you go and if bitten while away – have 2 booster doses of vaccine
no vaccine before you go, and if bitten while away – travellers need an injection of RIG into the wound ( if they can find some on the day of the bite ) and 4-5 vaccines: one each – given on the day of the bite, 3 days later, 7 days later, 14 days later and possibly 28 days later.
Rabies Vaccine may be a very a good idea
Whether or not the rabies vaccine is recommended depends on where you visit in the world, and what you plan to do, and how far you will be from medical care, your medical history, and your risk tolerance.
Rabies vaccine before a trip is not mandatory, ( mandatory vaccines are designed to stop diseases spreading from place to place eg like Yellow Fever )
Rabies vaccine is merely ‘recommended’ for some travellers for protection and peace of mind.
Some travellers say they hate needles – but if you get an animal bite overseas and are not pre immunised you may need 10 mls of RIG injected into the wound – that could be your your finger – that is a lot worse than a needle in the upper arm.
Some travellers complain that the vaccine is too expensive. Travel clinics can give the vaccine by a special technique – into the surface of the skin ( intradermally ) which makes the course cost roughly $130. Which is really not so bad when you consider how dangerous the disease is.
It really boils down to your appetite for risk….mine is very low when it comes to preventable problems, especially with my kids.
Don‘t forget the humble soap
An interesting thing about the rabies virus is that soap kills it, so anyone bitten by an animal in a rabies endemic country, needs to gently wash the wound with soap and water (never scrub), and then seek skilled medical attention to get rabies vaccine.