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RABIES

An acute viral infection affecting the nervous system. of animals. It can be transmitted to humans by a bite or the exposure of broken skin to the animal's saliva or inhalation of the urine vapour of cave bats.

Source of infection:- mostly dogs & cats, (even minor scratch or lick of graze) monkeys, bats (bite or inhalation of urine vapour from cave exploration). but skunks, raccoons, foxes, and other animals can also be rabid. There are an estimated 15,000 cases of rabies worldwide each year. Cyclists are at risk from attack from dogs & other animals. Children over 12 months are particularly at risk as they will often befriend animals and not report a bite. Vaccination should be considered more often as disease is 100% fatal.

Rabies remains a serious problem in all continents with the exception of:
Americas:- Bermuda and many of the Caribbean islands (but not Cuba, Grenada,Haiti,Puerto Rico and Trinidad.)
Europe:- Denmark, Finland, Gibraltar, Greece, Iceland, Ireland, Malta, Monaco, Norway (except islands of Svalbard), Portugal, continental Spain, Sweden, United Kingdom.
Asia/Pacific:- Australia*, Bahrain, Bali (not Lombok), China (province of Taiwan), Kuwait, Japan, Malaysia, New Zealand, Papua New Guinea, Singapore and the Pacific islands and some islands of the Indian ocean (Mauritius, Reunion, Seychelles). (p58. WHO & p33 Travel Safe).
* In Australia, a rabies -like virus, bat lyssa virus, is established in fruit and insectivorous bats. Persons in close contact with bats should consider vaccination and contact the relevant State Health Authority.

America & Western Europe have extensive rabies control programmes and disease is mostly restricted to feral animals. (racoons, foxes, skunks and wolves).
Incubation period 10 days to 10 years. (Av. 2-8 weeks)
The virus travels from the wound along nerve pathways to the brain where it causes inflammation that results in the symptoms of the disease. N.B. 6% of stray dogs have rabies in Bangkok

If immunisation is given within 2 days of the bite, rabies is usually prevented. Once the symptoms appear, few people survive the disease. Death from respiratory failure usually occurs within 7 days.

Be wary of all animals whether tame or not.

Rabies Vaccine :
Vaccination is very safe and effective, and should be more widely considered
CDC Rabies Vaccine information statement (risks, side-effects) .. copy (pdf)

Human diploid cell rabies vaccine (HDCV): 3 doses (days 0, 7, 28)
often 0.1ml given by intradermal route to save cost. Pregnancy is not a contraindication.

NB. Once vaccinated booster vaccinations are reserved for a select high risk group

• Pre-exposure prophylaxis is recommended for anyone at continual, frequent or increased risk of exposure to rabies virus, either by nature of their residence or occupation.
• Recommendations for post-exposure depend on the type of contact with the suspected rabid animal. For category I exposure (touching or feeding animals, licks on intact skin), no prophylaxis is required; for category II (nibbling of uncovered skin, minor scratches or abrasions without bleeding), immediate vaccination; and for category III (single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks, licks on broken skin, exposures to bats), immediate vaccination and administration of rabies immunoglobulin are recommended.
• Periodic booster injections are recommended as an extra precaution only for people whose occupation puts them at continual or frequent risk of exposure. If available, antibody monitoring of personnel at risk is preferred to the administration of routine boosters.

Post-exposure vaccination recommendation as above

Travellers should be instructed to wash the wound immediately with soap and water, disinfect with Iodine if available (Betadine) and have post-exposure vaccine as soon as possible (preferably within 48 hours but still worthwhile on return from overseas) if they were to be bitten by a potentially rabid animal.
Try to gather as much information about the animal as possible. Animal bite wounds usually should not be sutured. The wound should not be scrubbed as this may increase the viral entry into nerve endings.

SYMPTOMS
low-grade fever (102 F or lower)
pain at the site of the bite
swallowing difficulty (drinking produces spasms of the larynx) or swallowing difficulty with liquids only
muscle spasms
convulsions
loss of muscle function
loss of feeling in an area of the body
drooling

SIGNS AND TESTS
If a person has a history of animal bite, the animal will be observed for signs of rabies. Immunofluorescence (fluorescent antibody test) performed on the suspect animal may show that the animal has rabies.

See also New York Health Department sheet

Information mostly taken from: "International Travel and Health" (WHO year book - internet only)
Australian Immunisation Handbook, 8th Edition - 9/2003 - Part1 - Part 2 & Part 3 (large pdf files)
Centre for Disease Control, USA -  www.cdc.gov/travel Travel Health Seminar Oct 96, June 97,Feb 98, March 99, May 2000, August 2002 & March 2005 - Victorian Medical Postgraduate Foundation.
Manual of Travel Medicine, Melbourne, Oct 2004. Updated 06/09/2006.  Additional references & disclaimer.