Key Concepts
- Rabies is universally fatal in humans.
- Primary prevention is highly successful
- Pre-exposure immunization should be considered for those at high risk or when residing in regions with limited access to appropriate post-exposure treatment
- Post-exposure treatment has proven to be extremely effective when initiated in a timely manner
Rabies
Rabies is the only viral infection that is universally fatal, transmitted to humans by animal bites. While all mammals are believed to be susceptible, dogs and bats are the usual source of infection in travellers.
Incubation Period
- Highly variable, usually 20 to 60 days
Symptoms
In its early stages, rabies exhibits flu-like symptoms – fever, headache, and fatigue. As the disease progresses, central nervous system symptoms become more predominant, and death quickly ensues.
At risk
Risk varies based on travel destination, duration and purpose of visit, and access to post-exposure treatment.
- Rabies occurs worldwide, but is especially prevalent in Africa and Asia. (Map of rabies risk by country".)
- Children are at high risk, as they often play with animals and are less likely to report bites and scratches.
- Animal workers and spelunkers are considered high risk.
- Those in remote areas are at greater risk because of limited access to post-exposure treatment.
Prevention
- Avoid contact with all animals unless they have been vaccinated
- Do not pet any animal, especially dogs, regardless of how healthy they appear.
- Immunization
- Pre-exposure immunization is recommended for those at risk for inadvertent exposure (veterinarians, animal workers), those at greater than average risk of exposure based on duration and destination of trip, and those travelling to regions with limited access to WHO-approved post-exposure treatment
- A full series involves 3 doses of the vaccine on days 0, 7, and 21-28
- Post-exposure immunization is recommended in the event of exposure to suspect animals.
- Pre-exposure immunization is recommended for those at risk for inadvertent exposure (veterinarians, animal workers), those at greater than average risk of exposure based on duration and destination of trip, and those travelling to regions with limited access to WHO-approved post-exposure treatment
If Bitten
If bitten or scratched by any animal:
- Clean the wound immediately by vigorously washing it with soap and water followed by a disinfectant (70% ethanol solution, tincture of iodine, or povidone iodine) for at least 15 minutes
- Seek immediate medical attention
- Call your travel health insurance provider for advice
- Upon return to your country of origin, inform your healthcare provider about your exposure and any treatment you have received.
Treatment
Post-exposure prophylaxis (shots given after exposure to rabies) is effective preventive treatment if administered immediately after exposure to suspect animals. Once symptoms manifest, rabies is untreatable.
Approved protocols for post-exposure treatment:
- Those who have completed pre-exposure immunization series require two doses of a modern tissue-culture vaccine on days 0 and 3.
- Those who have NOT completed pre-exposure immunization series require at least 4 doses of the vaccine on days 0, 3, 7, and 14.
- In addition, rabies immunoglobulin (RIG) should be administered at the site of injury in the event of a skin penetrating bite, deep scratches from the animal, licks on broken skin, or exposure to bats.
For more information:
Public Health Agency of Canada: www.phac-aspc.gc.ca/tmp-pmv/info/rage-eng.php
World Health Organization: www.who.int/mediacentre/factsheets/fs099/en/
Committee to Advise on Tropical Medicine and Travel: www.phac-aspc.gc.ca/publicat/ccdr-rmtc/02pdf/acs28-4.pdf
Centres for Disease Control and Prevention: wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/rabies.aspx
