What is rabies?
Rabies is a serious illness caused by a virus of the Rhabdoviridae family.
The virus attacks the central nervous system causing progressive inflammation of the brain and spinal cord.
Rabies occurs in warm-blooded mammals (both domestic and wild) and is spread to humans mostly through a bite or scratch from an infected animal, usually a dog.
Rabies is preventable if the correct post-exposure treatment is provided quickly. Tragically, many people fail to access this treatment.
Rabies is estimated to cause 59,000 human deaths annually. Children are at particular risk. Due to their size and stature, children are often bitten around the face or head. Bites in this area are expected to have a shorter incubation period.1
The following is a summary about the disease. For further details speak to your local pharmacist or GP.
Rabies virus is found in the saliva of an infected animal. The virus is spread to humans by a bite or scratch, or when saliva from an infected animal comes into contact with broken skin or mucous membranes (eyes, nose, or mouth). Infection does not occur through intact skin.
Infection may occur from droplet spread. This is of concern when venturing into caves inhabited by bats.
It can also be spread via organ transplantation from an undiagnosed donor may result in rabies in the recipient, although this is rare.2
The risk of developing rabies after a bite by a rabid animal varies with the site and severity of the wound.
Following exposure, the virus travels to the central nervous system. It replicates in the brain and spreads to many different tissues.
Not all individuals exposed to rabies virus develop the disease but, once symptoms occur, rabies is almost invariably fatal.1
Rabies exists on all continents except Antarctica, although some countries are rabies-free (including the UK). The risk of human cases is highest in countries where the virus circulates in dogs.
According to the World Health Organisation (WHO), more than 95% of human cases occur in Africa and Asia, mainly in rural communities where measures to prevent dog to human spread have not been implemented.3 The limited availability of treatment in some countries contributes to the high death rates.
Further details for rabies risk can be found here.4
The incubation period of rabies is usually between 3-12 weeks (in rare cases it can be as short as 4 days or as long as 19 years).
Early symptoms are often non-specific and can include:
The disease can develop into the ‘furious’ form or ‘paralytic’ form.
Symptoms of furious rabies can include:
Paralytic rabies accounts for about 30%of human cases. With this form of rabies:
Once the symptoms of rabies have appeared, the disease is always almost fatal.
All travellers who have had a possible exposure to the rabies virus should seek medical attention without delay.
Preventative therapy for rabies include:
Receiving rabies vaccination before travel does not eliminate the need for additional doses if exposed to the virus. However, it does simplify and shorten the post-exposure prophylaxis regimen and eliminates the need for rabies immunoglobulin which is in short supply in many countries. Additionally a tetanus vaccine may be necessary.
Symptomatic rabies is almost fatal and the treatment aims to alleviate suffering and support vital functions.6
All travellers visiting rabies endemic areas should be aware of the risk of rabies and be advised to avoid contact with both wild and domestic animals (including bats, particularly dogs and cats).
Travellers should be advised:
Children are more vulnerable to rabies than adults as they are less likely to comprehend the risk of animal contact, less able to defend themselves from an animal attack and may not report a potential exposure.
All travellers to endemic areas should be aware of immediate wound care and advised to seek medical attention immediately if they suspect risk of infection.
More information regarding rabies awareness can be found here.7
In the UK, people whose work puts them at risk of rabies are advised to get vaccinated against rabies. This is available on the NHS and includes people who:
In addition, travellers visiting a high risk area of rabies may be advised to have the vaccine. This is not available on the NHS and must be paid for. This includes:
There are two rabies vaccines available in the UK, both of which are inactivated. The vaccine is highly effective. It stimulates the body to make antibodies against the rabies virus. These antibodies protect against illness should infection with the virus occur.
Pre-exposure prophylaxis for travellers include 3 or 4 doses given on:
This is the preferred schedule where there is sufficient time to complete the 21-28 day course
A single booster dose is given opportunistically at any time from one year after the initial primary course. The need for boosters will depend on the activities being undertaken by the traveller, the rabies risk in the country being visited and the ability to access post-exposure medical care and rabies biologics. A booster may also be considered for those travellers with primary vaccination more than five years previously.
Post-exposure prophylaxis: this may be 2 or 5 further doses of the injection (depending on the level of risk and immunisation status).
If no previous complete immunisation has been obtained, an additional injection of human rabies-specific immunoglobulin (HRIG) will also be required. This protects from rabies for a short time, giving time for the body to produce the antibodies.7,9
|Rabies exposure risk||Unimmunised or not completely immunised||Fully immunised|
|None||No immunisation||No further immunisation|
|Low||5 doses rabies vaccine on days 0, 3, 7, 14 and 28-30||2 doses on days 0 and 3-7|
|High||5 doses rabies vaccine on days 0, 3, 7, 14 and 28-30
PLUS HRIG on day 0 only
|2 doses on days 0 and 3-7|
This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government. Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/
Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, Emis, Public Health England, the NHS or the Department of Health and Social Care.