RABIES
Rabies is a preventable viral disease that infects the
central nervous system and if left untreated is almost
always fatal.
Rabies is a zoonotic disease (a disease that is
transmitted to humans from animals) usually
transmitted to humans through the infected saliva of
warm-blooded animals (both domestic and wild), most
commonly via a bite. Non-bite exposure can also lead
to infection i.e. scratches to the skin, licking over
broken skin or mucous membranes (nose, eye,
mouth). Although many animals carry rabies, there is no doubt that dogs pose the
greatest risk to travellers. Other animals which are reported to carry the virus are:
bats, wild foxes, cats, raccoons, skunks, jackals, monkeys and wolves.
Risk for Travellers
The World Health Organisation (WHO) estimates that 55,000 people die of rabies
each year and more than 15 million people worldwide receive post exposure treatment
to avert the disease. About 95% of human deaths occur in Asia, Africa, the Indian
subcontinent and Latin America. About 30% to 60% of the victims of dog bites are
children less than 15 years of age. Children often play with animals and are less likely
to report bites or scratches. In developed countries rabies continues mainly in wild
animals.
Wound cleansing and immunisations administered as soon as possible after a suspect
contact with an infected animal, and following WHO recommendations, can prevent
the onset of rabies in virtually 100% of exposures.
Speak to the travel Nurses to discuss the level of risk for the countries you are visiting
and recommendations for vaccination.
Prevention
You are advised to avoid any contact with wild or domestic animals during your trip.
In areas where rabies is known to be present, do not approach any animals, do not
stroke or kiss any obviously sick animal and do not let the animal lick you. Do not
attempt to pick up an unusually tame animal. Do not attract stray animals by offering
food or littering. Unexpectedly friendly animals may well be suffering from rabies and
might attack without provocation.
Recommendations for Vaccination
If you require pre exposure immunisation for Occupational Health (OH) purposes or
for part of your course, please contact the OH department to arrange this.
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RABIES
If you are travelling to rabies endemic areas, you are recommended to complete the
pre exposure vaccine course:
• Especially if post-exposure treatment at your destination is lacking, in short supply or
not safe
• If you are undertaking higher risk activities such as cycling or running
• If you are living or staying for more than one month
Pre-exposure schedule:Primary Course:
3 Doses
Dosage/Route:
1ml intramuscular injection
Interval:
Days 0, 7 and 21 or 28
Boosters: For infrequent travellers to high risk destinations, a booster dose can be
considered at 10 years post primary course if you are travelling again to a high risk
area.
What to do if you are bitten
This is an emergency. Wash the wound immediately by flushing under a running tap
for several minutes. Clean the wound thoroughly with water, soap or detergent and
allow it to bleed. Apply a disinfectant i.e. Iodine or neat alcohol 40-70% (gin, vodka
and whisky contain 40%). Cover with a simple dressing. Salivary exposure to mucous
membranes such as eyes, nose or mouth should be washed thoroughly with clean
water ASAP. Avoid suturing until post exposure prophylaxis has commenced as this
may increase the risk of introduction of rabies virus to the nerves. Seek medical
attention immediately.
It may be helpful to assess the risk for rabies exposure if the following information is
available:
• The site and severity of the wound
• The circumstances of the bite (provoked or unprovoked)
• The species, behaviour and appearance of the animal
• Health of the animal in the days/weeks following the bite
• The vaccination status of the animal
• The origin of the animal, the country, the location of the incident and the incidence of
rabies in that species
• Whether the animal can be safely captured and tested for rabies
• Any pre exposure immunisations you have received- dates and type of vaccine
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Post exposure treatment
You will always need post exposure treatment, even if you have received preexposure vaccinations. The first dose of vaccine should be given as soon as
possible after the suspected contact.
You may find it difficult to access safe, effective vaccine
in low income countries. In some areas it may only be
obtained privately or in specific rabies treatment centres.
Human Rabies Immunoglobulin (HRIG) is frequently
difficult to acquire and only available in major citiessomething to bear in mind if you staying in remote or
rural areas. HRIG is only necessary if you are not fully
immunised with a pre exposure course of rabies vaccine.
Treatment may need to be continued after your return to
the UK.
Note HRIG is a blood product. Developing countries with high prevalence of HIV and
other blood borne viruses may have substandard screening for blood products so
transmission of blood borne viruses may be of serious concern.
Signs & Symptoms
Symptoms usually start between 3-12 weeks after the initial bite, but may range from 4
days to 19 years. In more than 93% of patients, the onset is within one year of
exposure.
Clinical rabies can present in two forms: furious and paralytic:

Furious rabies is the most common form (two thirds of all reported human
cases). Rabies transmitted by dogs is usually the furious form. Furious rabies is
characterised by confusion, hallucinations, seizures, fear of water and inability
to drink due to throat spasms. Coma and death occur after several days.

Paralytic rabies. In this form of rabies, patients remain conscious and
symptoms may include weakness and paralysis spreading across the whole
body. Respiratory failure and inability to swallow occur prior to death 1-3 weeks
following exposure.
Rabies is almost always fatal ending with either abrupt death from cardiac or
respiratory arrest. There is no specific treatment other than supportive care. Once the
neurological symptoms start, treatment is ineffective.
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Advice

Stay away from all animals in rabies endemic countries, especially if there
is an outbreak in your area.

If you do get scratched or bitten, follow the ‘what to do if you are bitten’
advice immediately.

Seek urgent medical advice and treatment as soon as possible. Don’t
forget it’s a medical emergency.

Remember you always need post-exposure treatment in the event of a
suspected rabies contact no matter what you pre-exposure immunisation
status may be.
Rabies
Risk
No Risk
Low
Risk
Unimmunised/
Incompletely immunised*
None
2 doses (each 1ml ampoule of 2.5 IU)
rabies vaccine on days 0, 3, 7, 14 and 30
High
Risk
Fully immunised
None
2 doses (each 1ml ampoule
of 2.5 IU) rabies vaccine on
days 0 and 3-7
2 doses (each 1ml ampoule
of 2.5 IU) rabies vaccine on
days 0 and 3-7
5 doses (each 1ml ampoule of 2.5 IU)
rabies vaccine on days 0, 3, 7, 14 and 30,
plus HRIG (Human Rabies
Immunoglobulin) within 7 days of starting
the course of vaccine
* Persons who have not received a full course of pre or post-exposure tissue
culture rabies vaccine.
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