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Human rabies cases are often unreported so it is difficult to provide reliable figures on the incidence worldwide. The disease is estimated to cause 59,000 human deaths annually. Rabies is rare in travellers with only 25 human deaths in the UK from imported rabies between 1902 and 2005.
Although rabies cases are rare in travellers, animal bites and scratches are common. It is important that travellers visiting areas where rabies occurs are aware of the risk and know what to do if they are bitten or scratched. The disease is preventable if the correct post exposure prophylaxis (PEP) is provided quickly. PEP can be expensive and difficult to obtain in some areas.
Contact with wild or domestic animals during travel should be avoided. Travellers should also be advised:
Be aware that certain activities may attract dogs (e.g. running, cycling)
The following advice can be given regarding first aid following a possible rabies exposure:
Urgent action is required; treatment should be commenced as soon as possible after the exposure
Immediately wash the wound with detergent or soap and running water for several minutes
Apply a disinfectant to the wound such as an iodine solution (tincture or an aqueous solution of povodone-iodine) or 40-70% alcohol
Apply a simple dressing to the wound
Seek immediate medical advice about the need for PEP and possible antibiotics to prevent a wound infection
Tetanus vaccine may be necessary if the traveller is not up-to-date Suturing of the wound should be postponed until PEP has started
All those who are at continuous or frequent risk of exposure should be offered the pre-exposure vaccine. Groups in these risk categories include:
Most international travellers to rabies affected areas are considered to be at ‘infrequent risk’, but pre-exposure vaccines are recommended for those whose activities put them at increased risk.
