Rabies

Rabies is a viral infection that affects the central nervous system, and that if left untreated will result in severe pain, convulsions, and death. While untreated rabies invariably means death, the disease can be very effectively prevented from developing in humans with a proven combination of preventative measures and appropriate immediate treatment.

Cause and risk

Bites, scratches or even licks from dogs, cats and feral animals, and even the urine of bats, have all transmitted the rabies virus to humans. Dogs are the main reservoir of the disease in many developing countries, but all animal bites should be evaluated. Annually there are over 6000 human deaths from rabies worldwide.

Few countries are free of rabies, with increasing numbers of rabid animals (including pets) occuring in almost all destinations throughout Asia and Africa, Latin America, and Eastern Europe.

Immediate treatment

Animal bites should receive prompt attention. Any animal bite or scratch should be thoroughly cleansed with a lot of soap and water, and then cleaned with alcohol. This treatment significantly reduces the risk of rabies. Even if the animal is not rabid, all bites should be treated seriously as they can become infected or can result in tetanus.

Local health authorities should be notified immediately if you have been bitten. You will need rabies vaccination injections to prevent the disease, as well as a tetanus injection.

Pre-exposure vaccination

Pre-exposure vaccination is recommended for travelers visiting for more than 30 days foreign areas where rabies is known to exist. These include most countries in Central and South America, the Indian subcontinent, Southeast Asia, and most of Africa. Most island countries in the Caribbean and Oceania are free of rabies.

Pre-exposure vacclnatlon greatly simplifies but does not nullify the need for post-exposure vaccination, by reducing the number of injections. A very effective and safe course of three low-dose intradermal injections over four weeks will provide the traveler with good pre-exposure protection. The same vaccine is then given as a booster shot to treat bites etc from suspect animals. The vaccine acts to provide active protection by stimulating the body's immune system to produce antibodies against the rabies virus.

Your destination and planned activities are vital in determining your risk level and the value of a pre-exposure vaccination course. Veteranarians and animal handlers, spelunkers; and certain laboratory workers, are at greater risk.

Post-bite treatment

Without the pre-bite vaccination 'pre-arming' your immune system, a longer course of the vaccine with higher doses of vaccine is used to try and provide active protection after the event. However, as the response to the vaccine is a delayed process, in these post-exposure treatment cases it may also be necessary for rabies immunoglobulin to be given along with the first rabies vaccination. In such situations there is always concern about the traveler being able to find an appropriate treatment center which has the rabies immunoglobulin and the rabies vaccine readily available.

Upon returning to the United States contact your physician or state health department.

Diseases