Are pre-trip rabies immunisations worth investing? Dr Jane shares her advice on the cost of jabs and how valuable they can be in saving your life, even when you don't think you're at risk...
Rabies is one of the few diseases that scares the pants off me. Once symptoms begin, it is untreatable. Not only is there absolutely no hope of survival but the virus stimulates the brain’s fear centres so victims are scared to death – terrified even of their own saliva. Pre-travel jabs avoid the painful Rabies Immune Globulin (RIG) injection that is needed (with five other injections) post exposure but may not be available at your destination. Thus pre-travel rabies not only hugely reduces risk from the disease and worries about substandard treatment overseas but cuts necessary post-bite injections from six to two.
The vaccine’s bad reputation is perhaps because of the 14 injections that were once given into the abdomen daily after a bite. These have long been superseded, though, and now immunisation isn’t any more painful than other travel jabs. The only downside is the cost. The pre-travel schedule is jabs on days one, seven and 21 at around £60 each. It is likely, though, that once you have had one such primary course (plus one booster), you will be immune for life. Although whenever there has been contact with a potentially rabid animal, two more injections are recommended.
Unlike diseases that are spread in air droplets, you will probably know if you risk rabies. The commonest route is from a dog bite or a scratch or nip from a bat, but any mammal can carry rabies. A wild animal that is inexplicably tame is suspect, and even a lick on an area of inflamed skin (for example, eczema or sunburn) could lead to infection.
Some people decide that they won’t bother with rabies protection but will plan to seek clinical help if bitten or scratched. That strategy is probably okay, but only if you are on a short trip or are visiting a country where clinical standards are high and such clinics and hospitals are accessible. If, however, you will be heading downriver in the Amazon or into the high Himalayas, then excellent clinics in the capital won’t really be much help to you.
Medics advise that after any bite, a victim should find a clinic immediately, but many people decide to risk it, and then, thinking it is too late to get the jabs, don’t ever access medical help. The incubation period for rabies – which is also the interval in which preventative treatment is effective – is very variable: it is somewhere between four days and perhaps three months or more. It depends on the severity of the bite, whether the virus has been deposited in or very close to a nerve, and also the distance from the bite to the brain. For example, a man nipped on a fingertip by a bat in Texas died six weeks later.
Rabies immunisation is always worth considering, and I would encourage travellers to spread the word. It is never too late to seek advice if you have been bitten or scratched on your trip, and the potential dangers of not doing so far outweigh any excuses not to.
Dr Jane Wilson-Howarth and four fellow travellers have just launched their anthology 50 Camels and She’s Yours, which is available on Amazon; details at www.wilson-howarth.com
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