RABIES.

Rabies is one of those conditions that strikes fear into most people. Why is Rabies The stuff of Horror Movies?

• Rabies is almost always fatal.
• The time from first contact to symptoms is usually 3 to 8 weeks – an agonising wait.
• The Neurological symptoms of ‘furious rabies’ are famous.

Now let’s put this into context. The chances of getting rabies when sensible precautions are taken is, for most people, very small.

The issue is more that a scratch from a stray dog or monkey in a rabies area will, at the very least, cause a lot of hassle & anxiety.

Post Exposure Prophylaxis (PEP) may require an injection of rabies immunoglobulin. The problem is that there is a persistent worldwide shortage of Rabies Immunoglobulin. This is not a theoretical issue – but an ongoing issue that often requires an early return to Australia.

In NSW alone there were 489 assessments completed by public health units for potential exposure to rabies following overseas travel. Of the 489 assessments, 467 required post-exposure injections.

Each year, around 1,000 Australians return on the next flight home for an urgent Rabies exposure assessment.

Which wild animals carry Rabies?

Rabies is carried by mammals with dogs the main culprits amongst local populations. Dogs are immunised against Rabies in Europe and North America. Wild animals that carry rabies include foxes & Racoons. Bats are an important source of rabies in Australia.

Which Countries are most reported in Australia for animal bite or scratches in returning travellers?

The 2015 NSW report gives the frequency of location for an animal bite or scratch that required a Rabies Assessment:

• South East Asia (76%) of which Bali formed 44% of reports, and Thailand 21%.
• India, Sri Lanka, Nepal and Bangladesh make up for another 10%

Which countries near Australia are Rabies-Free?

A Rabies-free country can be thought of as a country where rabies does not circulate in mammals other than bats.

Australia, New Zealand, Japan, PNG and Pacific island nations are currently free of rabies. However, rabies is carried by bats in PNG (and Australia).

Rabies is present in Indonesia. Bali was considered rabies-free until an outbreak in 2008 that involved dogs and humans. There have been regular outbreaks since 2012, with over 12 people dying in 2015.

What can I do to reduce the risks?

• Do not let young children play or feed or pet animals. Kids are at higher risk of exposure to Rabies.
• Consider Rabies vaccination prior to travel.
• Know what to do if you’re scratched or bitten by an at-risk animal.
• Do not feed or touch monkeys – and be prepared for feeling pressured into doing this in tourist areas.
• Avoid any contact with bats.

Around 700,000 people visit the four main monkey temples in Bali each year, and at least 6% are bitten by macaque monkeys.

Feeding monkeys is the activity most often leading to scratch or bites.

If you have been bitten or scratched by an animal that potentially carries rabies then you should:

• Wash the wound immediately and thoroughly with soap and water – for at least 10 minutes.
• Then apply an antiviral antiseptic such as iodine tincture or alcohol.
• Seek medical attention as soon as possible.

What happens if I’ve been bitten or scratched and haven NOT had a course of Rabies Vaccine?

There are three categories of Rabies exposure:

• Category 1: saliva on intact skin – All good and no post exposure treatment is required.
• Category 2: minor scratch, nibbling of skin, or abrasion without bleeding.
• Category 3: bite or scratch through the skin, licks on broken skin, or contamination of mucous membrane from saliva.

Category 2 exposure will require A course of 4 rabies vaccinations started immediately.

Category 3 exposure will require the immunoglobulin as well as the 4-course vaccines. In Australia, Rabies Immunoglobulin is sourced from public health units after following stringent clinical protocols. This is injected in and around the wound with the rest given into muscle.

What happens if I’ve been bitten or scratched and HAVE had a course of Rabies Vaccine?

It’s important to know that If you’ve previously had a course of Rabies vaccine then you still need post-exposure vaccination for category 2 or 3 exposure.

However, you will only need 2 rather than 4 vaccines. The first vaccine is given as soon as possible, and the second vaccine is 3 days later. The good news is also that you won’t need  the 3rd and 4th doses of vaccine, nor will you need the hard-to-get Immunoglobulin.

What is The Rabies Immunisation Schedule?

Three vaccines are given over a 21 to 28 day period.

The Australian National Immunisation Handbook states:

“Travellers to rabies-enzootic regions … should be advised about pre-travel rabies vaccination ..”

Please go to Our Rabies Vaccination section for details.