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Overseas information: www.cdc.gov/ncidod/diseases/Index.htm
WHO Rabies - www.who.int/immunization/topics/rabies/en/index.html
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
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 (no longer free of rabies), 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
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,
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
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.
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
loss of muscle function
loss of feeling in an area of the body
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 -
Australian Immunisation Handbook, 8th Edition - 9/2003 - Part1 - Part 2 & Part 3 (large pdf
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 3rd edition 2011. Additional references & disclaimer.