Rabies
Rabies is a disease that most backpackers don't quite
know how to deal with - i.e. to vaccinate or not(?)
The reality is
that it's a judgement-call based on where you're headed, what you're
up to and your understanding of the rabies vaccine, which doesn't
work in the way you might think ...
Rabies is an infectious disease caused by a virus usually entering the
body from an animal bite, scratch, or when an animal licks you on cuts or
broken skin. Most people get infected by stray dogs, but the disease can
be spread by bats, cats or just about any warm blooded animal.
Rabies is found in almost all developing countries, however the majority
(95%) of infections occur in Africa & Asia, with India being the
country with most fatalities.
If untreated, rabies is a very deadly disease, once it reaches the
central nervous system (i.e. when symptoms appear) survival is
rare, the death-rate for untreated rabies is >99%
With such a high mortality rate you’d think that almost all backpackers
would be vaccinated for rabies, but I’d say that the majority of
independent travellers don’t get the Jab. And you’ll see from my
Vaccination Card
that I’m one of the people who chose not to get it.
Being vaccinated for Rabies isn’t as straight forward as for other
inoculations, the vaccine itself consists of 3 injections taken in the
arm (not in the stomach as some urban myths would have you believe) the
injections are taken over a period of a month; on Day 0, Day 7 and Day
28, so three visits to the nurse/surgery are required. This initial
dosage will give protection for 2* years, after this 2 year period, a
booster will provide a further ~5* years of protection.
(* Depends on the brand of vaccine taken).
Unfortunately, simply getting vaccinated for rabies isn't quite the end
of the story…
Because individuals who have been vaccinated still need to take
action if they get bitten by a rabid animal – the vaccine effectively
buys you time and allows a simpler post-infection treatment regime
to be administered.
Here are the 2 scenarios:
If you have been vaccinated for Rabies and you subsequently get
bitten by an infected animal, your post-exposure treatment is to: wash
the wound under a running tap, clean with antiseptic or alcohol, see a
doctor and receive 2 further doses of vaccine, one immediately and a
further dose within 7 days.
If you have not been vaccinated for rabies and you subsequently
get bitten by an infected animal, the treatment is more complex; again
you would clean and disinfect the wound, but you would then need an
injection of rabies immunoglobulin antibodies (giving you instant protection,
preventing the virus travelling to your nervous system). Then 5 doses of
the vaccine over the following month; on Day 0, Day 3, Day 7, Day 14 and
Day 30. One further issue with this scenario is that rabies
immunoglobulin can be difficult to find in developing countries; which
may require you to pack-up shop and take an emergency flight home.
With rabies, an awareness of the incubation period is crucial to
understanding the disease:
The incubation period (i.e. the time it takes for symptoms to emerge
after a person has been bitten or otherwise infected) is usually 2-12
weeks(*). During this time the disease is treatable, with an excellent
success rate, using the standard vaccine and/or rabies immunoglobulin
treatments described above. The treatment must be administered during the
incubation period. Once the incubation period is over and symptoms start
to appear, rabies is more or less incurable and that’s the point at
which there’s a > 99% chance you’ll die from the disease.
Taking action when the disease is in it’s incubation phase is critical
and the most important thing you need to be aware of with rabies.
(*) In extreme cases, the incubation period for rabies can be a short as
4 days or as long a 2-3 years.
The rabies vaccine is expensive (USD $180 for the 3 shots) and doesn’t
actually guarantee you anything, but it does buy you time,
gives you and your family peace of mind and it’s certainly worthwhile for
those people travelling/working in high risk areas. If I was volunteering
in an animal rescue centre in India, I would certainly get vaccinated for
rabies, if I was just backpacking through Asia I probably wouldn’t bother.
You pays your money …
