Disease Information Sheets
Rabies is a viral infection of the central nervous system (brain and spinal cord). All wild and domestic mammals can be infected, including humans, although it primarily infects carnivores and insectivorous bats. The rabies virus is transmitted in saliva from an infected animal which usually enters through a bite wound or scratch. If treatment is not administered in time and the disease becomes fully established it is nearly always fatal. Safe and effective vaccines exist for both people and animals.
How common is it?
Rabies occurs in more than 150 countries, and at least 55,000 people die of rabies each year worldwide. More than 95% of these deaths occur in Africa and Asia, and most are as a result of the bite of infected dogs. Every year over 15 million people receive post-exposure vaccination having been bitten by an animal suspected of having rabies, and this is estimated to prevent hundreds of thousands of deaths.
Bat bites anywhere in the world are considered potentially infective.
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Countries with high or medium risk of rabies
Are travellers and/or expat workers at risk?
Yes. Travellers and expat workers are at risk if they may come into contact with rabies-infected animals, or there may be difficulty accessing medical care. This is most likely if you are:
Working with animals (for example, volunteering at an animal shelter or working at an animal research project)
Living, travelling frequently to or spending long periods in a country with rabies
Running or cycling in risk areas
Staying or visiting rural areas (particularly if you are working/spending time outside) where access to appropriate medical care may be delayed
There is a global shortage of rabies immunoglobulin, an essential component of the treatment you need if you are bitten and have not had a full course of pre-travel vaccinations (three injections). If you may experience delay in accessing high quality medical care you should consider pre-travel vaccination, even if your plans are low risk.
Rarely, rabies can also be spread from infected bats via aerosol (through contaminated saliva droplets in the air). If you plan to explore caves where bats may live you should seek specialist advice before you travel.
What is the illness?
If you are in a rabies risk country and are bitten, scratched or licked on an open wound (e.g. cut, graze or patch of eczema) or an animal spits in your face, you are at risk. Signs usually appear 20-90 days after being bitten or scratched, but can be delayed for several years. Symptoms start with fever, headache, muscle ache, extreme tiredness ad numbness/tingling at the wound site. Both animals and humans can then develop either furious or dumb rabies:
Anxiety, confusion, hallucinations, hyperactivity
Aggression, unpredictable behaviour
Fear of water, throat spasms and extreme terror
Seizures, coma and death
Weakness and paralysis spreading across the body from the site of the wound
Muscle paralysis, coma, heart/lung failure and death
Can it be treated?
Once symptoms have developed there is no effective treatment. However, prompt treatment immediately after the bite/scratch can prevent the disease. In all cases, the wound should be washed aggressively with soap and water for at least 15 minutes, and then disinfected with pure alcohol or iodine. This is to try to remove the saliva from the wound. The wound should not be covered, and pressure should not be applied.
In all cases, prompt medical treatment should be sought - regardless of whether you have had vaccinations before travel. Post-exposure vaccination will be required, plus immunoglobulin therapy if you’ve not had a full three-dose course of pre-exposure vaccinations.
How can it be prevented?
Avoid contact with animals - don't feed them, touch them, stroke them or pose for photos with them, even if they seem friendly
Avoid wild animals that seem unusually tame - this can be a sign of rabies
Keep your camp impeccably tidy so as to avoid attracting rodents and carnivores
If approached by an animal, don't attempt to run away unless you are certain you will reach safety in time (for example in a building or vehicle), instead stand still with arms crossed and look up towards the sky
If you plan on staying in or exploring caves with resident bat populations, seek specialist advice before travel