Rabies

Latest update: - Authors: Mieke Croughs, Nele Alders, Ula Maniewski-Kelner

Rabies is a viral infection that causes brain infection which results in death. 

The symptoms usually occur after two or three months,  but the incubation can vary between one week and several years.  A fatal outcome can only be prevented by taking immediate action after a possible infection (see below).

Infection occurs by contact with the saliva of an infected mammal through a bite or scratch wound or by a lick on mucous membranes or on a wound. Bat bites can even go unnoticed. Bats can bite during your sleep and are often hard to spot afterwards.
To date, there have been no reports of human cases of rabies caused by bites from rodents, such as rabbits, hares or mice.

For travellers, high-risk incidents mainly occur with dogs, cats and monkeys.

Risk areas

Rabies occurs all over the world.

On the Indian sub-continent, Southeast Asia, Africa and parts of Latin America, rabies can occur in pets, such as dogs (see map). The risk for travellers is highest in these countries.

In North America and parts of Eastern Europe, rabies only occurs in wild mammals.

In other regions, such as Western Europe, the disease only occurs in bats.

Only New Zealand, Antarctica, large parts of Oceania, Japan, a number of European countries and some islands are free of rabies.

Prevention

Avoid contact with animals

Stay far away from mammals that may be infected. 

Never touch animals, even if they are dead. 

Do not stroke them, feed them or play with them, even if they look healthy and cute.

Preventive rabies vaccination

Actions after risk contact

Wash the wound thoroughly with soap and water for 15 minutes, because the virus is very sensitive to cleaning agents.

Then disinfect the wound thoroughly with iodine (for example iso-Betadine®) or ethanol 60-80%.

Consult a doctor as soon as possible to determine the post-exposure policy (PEP), even if you have been vaccinated. 

Call the travel assistance insurance for advice on reliable medical facilities. The vaccines and RIG are not always available in tropical and subtropical countries, meaning that urgent repatriation is sometimes required. The International Society of Travel Medicine (ISTM) publishes a list of travel clinics offering rabies vaccination and anti-rabies immunoglobulins.

Post-exposure vaccination

After a high-risk contact, a doctor will determine if you need post-exposure (PEP) vaccination.

For people who have not received pre-exposure prophylaxis (PrEP) for rabies, this consists of a series of four or five vaccinations and sometimes the administration of anti-rabies immunoglobulins (MARIG or HRIG).

People with normal immunity, who did have rabies PrEP, need only receive two booster vaccinations.

Did you wake up with a bat in your room?

Bites caused by bats often go unnoticed. Bats can transmit rabies. Consult a doctor as soon as possible to determine the further policy.

In case of symptoms

Seek medical advice if you suffer any symptoms.

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