Rabies and Rabies Vaccination, Rabies… to vaccinate or not?
Rabies is a very serious topic. We often get asked by bikers who are preparing to come on a cycle tour with Escape Adventures if they should be immunised for rabies. It’s not really for us to say if you should or shouldn’t… but we can offer you some information and facts. Here are our responses to the most frequently asked questions we get about rabies.
First up… a little Disclosure Statement
We, at Escape Adventures, are not medical professionals and are not qualified to give advice about vaccines for your travel plans. Please consult a qualified travel doctor when planning your trip for specific advice on vaccines. In this article we are going to share some facts about rabies that might help inform you, but this is not a substitute for professional medical advice.
What is rabies and how is it spread?
Rabies is a viral disease. It is spread by a human being scratched, bitten or licked on open skin by a rabid animal. Animals most likely to carry and spread the disease are dogs, cats and monkeys. Lions are also carriers of rabies. (However, if you are attacked by a lion there is probably more immediate life threatening things for you to worry about.) For humans, once symptoms are evident, it is normally fatal within a week. Although, in some cases, it can go undetected for several years before symptoms develop.
What countries is rabies present in?
Rabies is present almost everywhere in the world. It doesn’t discriminate. It is present in developed countries, like the USA, and also in developing nations. However, it has never been reported in New Zealand (Yay! We’re winning at the ‘No Rabies’ competition). Rabies is present in almost all the countries that Escape Adventures run cycle tours in – Kenya & Tanzania, Kyrgyzstan, China & Tibet, Cambodia and Colombia. The only tour where rabies has not been reported is in the Fiji Islands. Just a note on the use of the word ‘reported’ used in the above paragraph. This means there has been no documented cases. It means ‘there is no rabies present that we are aware of.’
What is the treatment for rabies?
Should you be bitten, scratched or licked on open skin by a rabid animal the course of action is different depending on whether or not you have been immunised. This section is therefore broken into those categories.
Not Immunised
Post exposure treatment as outlined by the World Health Organisation for an unimmunised person, consists of:
- Extensive washing and local treatment of the wound as soon as possible after exposure
- A course of potent and effective rabies vaccine that meets World Health Organisation standards
- The administration of Human Rabies Immune Globulin (HRIG)
To add to the above, here is what the Travel Clinic North Shore have to say on their website about a potential rabies encounter when not previously immunised.
“If you are scratched, bitten or licked and unimmunised ie. no antibodies, this is almost certainly a trip ruining experience as the treatment is a lot more dramatic! You have to stop what you are doing and travel to a centre where the appropriate post-exposure therapy is available; and request human rabies immune globulin HRIG which needs to be injected into the bite wound to prevent early entry of the rabies virus into nerve endings, then try to time 5 x rabies IM vaccinations required on days 0, 3, 7, 14, and 28 around your remaining travels.”
Previously Immunised
If you have already been immunised for rabies and are bitten, scratched or licked on open skin by an infected animal you still need to seek medical treatment immediately. However the treatment is not as urgent or intensive. Post exposure treatment for a previously immunised person, according to the World Health Organisation consists of:
- Extensive washing and local treatment of the wound as soon as possible after exposure
- A course of potent and effective rabies vaccine that meets World Health Organisation standards
Here is what Travel Clinic North Shore have to say about post exposure treatment for previously immunised people.
“Preferably make your own antibodies by immunisation in New Zealand, so if ever you are bitten, scratched or licked by a dog, monkey, cat, bat, you will need only two rabies vaccinations (which is easily obtainable) on days 0 & 3 after the animal bite, but you will never need any human rabies immunoglobulin ie. a blood product injected into the bite wound.”
Is Human Rabies Immune Globulin easily accessible around the world?
According to Worldwise (Travelers Health and Vaccination Centers), human rabies immunoglobulin can be “incredibly difficult to get worldwide and can be very expensive”. In our experience most hospitals in the major cities where we travel intend to have rabies immunoglobulin on hand, however due to the difficulty of getting it and the frequency of rabies incidents there is no guarantee that it will be available. In other words, it may have already been used up before more is acquired.
How does Escape Adventures respond if biker is scratched or bitten by an animal while on tour?
All of Escape Adventures tour leaders are highly trained and well supported by our team at head office. There is an action plan in place for every stage of every tour should there be an emergency. We treat every bite or scratch from an animal as if it is rabies infected. Whether you have been immunised or not, we immediately take you to the nearest, best medical facility for appropriate treatment. Whether you continue the cycle tour will depend on individual circumstances, if you have been previously immunised, and the severity of the wound.
How much does the rabies vaccine cost?
The price of getting a rabies vaccination will vary depending on where you are and what medical centre you go to. We have seen prices ranging from NZD $75 dollars per dose, to $154 per dose. You may need several doses for full immunisation. You may also find that it is a requirement to have an appointment with a travel doctor in order to receive the vaccination, in my case this was an additional $82.
So… we’ve established that getting immunised for rabies is a bit of a financial investment. Which is good to be aware of in advance so you can budget for it if you are planning on getting it. But it is likely that it is a one off expense, read below for more on this.
How long does the rabies vaccination last?
Information available about how long the vaccination lasts differs. The majority of information points to a full course of pre exposure to vaccination lasting for life. Traveldoctor’s website says the vaccination lasts 10 years and is possibly for life. Check with a travel doctor if you want more definitive information on this.
What is the risk of coming in contact with rabies while on an Escape Adventures cycle tour?
Children have a higher risk
Children are at a higher risk of coming in contact with rabies as they are more naturally drawn to animals and may have less awareness of the dangers associated with handling animals. Escape Adventures have family cycle tours that run in Kenya & Tanzania, Cambodia and Fiji. If you are planning on bringing your family on an Escape Adventures cycle tour, we recommend having a conversation with your children about rabies and how it is spread. A ‘no touching animals’ rule may seem harsh, but might prevent their trip ending unnecessarily early should they be scratched or bitten.
On Tour
As mentioned above, rabies is present in most of the world. The geographical areas where rabies seems to be the most prolific is Africa and Asia. Escape Adventures have a Kenya/Tanzania cycle tour in Africa. In Asia we have, China/Tibet, Cambodia and Kyrgyzstan cycle tours.
In the past 20 years of running cycle tours we have never witnessed a rabid animal. We have had one incident where a rider was scratched by a monkey in Cambodia (read more about that below). We encourage people to refrain from getting up close and personal with animals while on tour. Remembering that cats, dogs and monkeys are the most common carriers helps us be on high alert when associating with these animals. As monkeys are thieving they often get shooed away, however the action of waving your hand can cause them to react with a swipe, which could lead to getting scratched.
Case study
In 20 years of running Escape Adventures cycle tours we have only had one incident where rabies was concerned. A rider was lightly scratched on the ankle by a monkey during our Cambodia tour. Fortunately, the biker had been previously immunised. We went to a medical center and the biker received treatment. She was able to continue on the tour with us by bringing follow up treatments with her and having them administered at medical centers along the way. This is really a ‘best case’ scenario. The fact that the biker had already been immunized and that appropriate medical services were nearby made it possible for this rider to get treatment and continue the tour.
Summary
Truthfully, we can’t tell you what the risk is… if we could, it wouldn’t be called a ‘risk’. You will have to ask yourself the hard questions around the probability of coming in contact with rabies versus the cost and inconvenience of getting the vaccine.
If you would like more information regarding rabies, check out the World Health Organisations fact sheet. We strongly recommend that you visit a travel doctor for advice on vaccines before traveling.