RABIES
What is Rabies?
Rabies is a virus infection. In humans it’s always fatal, once symptoms have developed. Humans usually catch
rabies when they are bitten, licked or scratched by an infected pet or by a stray wild warm-blooded mammal.
The contact introduces the rabies virus into a wound. Infected animals can often behave unpredictably - a
normally friendly pet may turn very aggressive, or a usually timid wild animal may become apparently tame.
Such unusual behaviour poses particular dangers for young children, who may become delighted by the
‘friendliness’ of an infected wild creature. The animal that bites, scratches or licks you on broken skin
(eczema, dermatitis, abrasion or scratches) may appear to be normal but could still be carrying the rabies
virus in its saliva.
How is Rabies caught?
Infection is from the saliva of an infected or rabid animal, usually a dog, bat, cat or a monkey (? big rat).
In most cases infection results from a bite or scratch but just a lick on an open cut, sore, or even the eyes or
mouth could be enough. A human case of rabies can also infect other people in the same way. Some animals,
particularly dogs, carry the virus but can appear unaffected; it is postulated, for up to 6 months. NOTE: carrying
food may attract some animals to you.
What is the incubation period (time from exposure to first symptoms)?
This varies. Usually it takes 2-8 weeks, but can be as short as 5 days, or as long as 10 years or more.
How is Rabies diagnosed?
Usually diagnosis is based on the typical symptoms including signs and symptoms like:









Fever
Headache
Vague sensations at the bite site
Weakness
Paralysis
Spasm of swallowing muscles (hydrophobia) leading to fear of drinking water
Delirium
Convulsions
Bizarre behaviour
All the signs and symptoms gradually progress to death, which usually occurs, from the paralysis of breathing, in
under a week.
What is the treatment?
Once symptoms develop, death is (to all intent and purpose) inevitable. There is no cure. Treatment consists of
first aid management to the initial wound and then and vaccine administered promptly following exposure, and
before symptoms develop. This vaccine may have to be given together with a specialised human immunoglobulin
immunisation at the first visit following exposure to rabies.

First Aid Management: URGENT – Now, not in a few hours. To stop the virus getting into the nerve
endings in the flesh!
o Vigorously wash and flush the wound site with soap and water, OR detergent OR water
alone. This is important. “Ten Minute wash”. World Health Organization says 15
minutes.
o Apply either ethanol OR tincture or aqueous solution of iodine. 10% Providone Iodine
“Betadine” solution is ideal.
o Seek the advice of local medical authorities, informing them of any vaccine you have already
had. PHONE INSURANCE
o If possible, take the name and address of the owner of the animal or get the local police to
trace the animal urgently.
o If possible, try and find out if the animal is healthy and if vaccinated against rabies.
o GO TO THE BEST HOSPITAL IN THE COUNTRY WITHIN 48 Hours- Sometimes not the
country you are in! Many Third World countries do not have rabies immunoglobulin.

Post-exposure Vaccination:
There are two vaccine administration regimes depending on whether the person has had pre-exposure
immunisation (see Vaccination below).
If patient has been
previously vaccinated with 3
pre-exposure vaccine doses





Started If patient has NOT
been previously vaccinated
before exposure








After exposure 2 further doses are needed
on ASAP- best started within 48-72 hr. and
then on that day and 3 days later.
Dose is 1 standard intramuscular dose in the
arm
Postpone suturing of the wound
Begin anti-tetanus (if needed) and antibiotic therapy
No Human Rabies Immunoglobulin is
needed.
Medical attention needs to be sought within
24-48 hours of any injury or exposure
Full course of 5 vaccine doses in the arm
day 0, 3, 7, 14, (28) PLUS
Human Rabies Immunoglobulin (RIG) is
needed as soon as possible –injected around
the wound.
Postpone suturing the wound
Begin anti-tetanus( if needed) and
antibiotic therapy
RIG Must be given Day 0 or within 7 days
of first post exposure vaccine
Both the vaccine and RIG can be very
difficult to obtain in many developing
countries.
Even if they are available they may be very
expensive.
How is Rabies prevented?
The only sure way is to avoid getting bitten! Discourage children from contact with unknown animals. Be aware
that rabies is in developed as well as developing countries. High risk areas include, but are not specifically
limited to: Mexico, El Salvador, Guatemala, Peru, Colombia, Ecuador, India, Nepal, Philippines, Sri Lanka, China,
Thailand, Vietnam, Bali, Indonesia.
IS THERE A VACCINATION / IMMUNISATION AGAINST THE DISEASE?
In the event of contact with the rabies virus, pre-exposure immunisation does not prevent rabies nor does it
eliminate the need for administration of rabies prophylaxis; it does reduce the number of vaccine doses required
and lengthen the amount of time available to seek medical help. In New Zealand and Australia there are
appropriate vaccines against Rabies: The Human Diploid Cell Vaccine ( HDCV ), and Verorab ( PVCV ). They
are World Health Organization (WHO) approved and are excellent, safe vaccines with these advantages:









They offer protection against unnoticed exposures
The delay in further treatment is not so serious, though should be at the EARLIEST possibility.
HRIG (Human Rabies Immunoglobulin) which is necessary after exposure for those who have NOT
been pre-exposure vaccinated, is not universally available in many third world countries. It does not
need to be given to those who have previously been vaccinated. It can be administered up to day 7-8
after exposure to the disease.
Vaccines in some countries are made from brain tissues of animals, and are more likely to cause side
effects and may be less effective, Worldwise Travellers Health Centres do not recommend any vaccine
derived from animal brain.
Pre - exposure immunisation may be offered to people over one year of age who are:
Working in a Rabies infected country.
Spending time in a foreign country where Rabies is a constant threat. Children are particularly
vulnerable to animal bites.
Being away from a major medical centre, for any length of time i.e. trekking.
Working with animals, e.g. veterinary surgeons.
Pre-exposure vaccination schedule: Same dose for adults and children (over 1 year old).





3-dose schedule of
1 ml intramuscular or subcutaneous dose, on days 0, 7, 21/28; immunity 30 days after full series;
booster recommended at 1 year although many recommend only boostering at 2-3 years. In general,
Travellers Health Centres recommend blood serological testing to determine if any booster dose is
necessary.
If off label ID doses are used you are advised to have blood test for rabies serology 2 or more
weeks after third dose.
Deltoid muscle for older children and adults, antero-lateral thigh for young children and infants.
We use Verorab vaccine.
Reactions:
Reported reactions
none of which are life
threatening



pain, redness, swelling and itching at the
injection site
headache, nausea, abdominal pain and muscle
ache
Generalised itching, skin rashes, joint pains,
nausea, vomiting, and fever
Post exposure vaccine for children: Worldwise Travellers Health Clinics have experience of injecting children
as young as 6 months, post-rabies exposure.
In other countries, the following vaccines are WHO approved for administration against Rabies: Rabivac,
Rabipur, Lyssavac, Imovax.