Rabies

Rabies is a serious viral infection which affects the brain and nerves. The virus is spread through the saliva of infected animals, usually following a bite or scratch.

Overview of Disease

Rabies is an acute viral infection that infects the spinal cord and the brain. Rabies virus is present in the saliva of infected animals. People are usually exposed to rabies:

• through a bite or scratch from a rabid animal
• when an infected animal licks an area of broken skin or licks your eyes, nose or mouth

Dogs are the most common animal that infects humans. Other animals such as monkeys and cats may also spread rabies Bats from all countries are considered to be a rabies risk.

Rabies is found in all continents of the world except Antarctica. Most human cases of rabies occur in Asia and Africa.

Recommendation for travellers

Before you travel, you should:

• check if rabies is a risk at your destination
• see UK Health Security Agency: Rabies risks by country
• determine if there will be any reliable medical facilities at your destination
  
  
• a worldwide list of doctors and medical facilities is available from the Foreign, Commonwealth & Development Office
• see a travel health professional (at least 4-6 weeks before you travel) if you think you might need a rabies vaccine course or booster dose
• be aware what to do if you think you have been exposed to rabies virus

If you are travelling to a country where rabies is considered a risk, you should:

• avoid contact with animals, especially dogs, cats and monkeys
  
  
• some animals can be infected with rabies without being aggressive or behaving strangely
• be aware that children are more likely to approach animals
• check them for wounds, and encourage them to tell you if they are bitten, licked or scratched by an animal
• see the animal bites page for advice on how to prevent being bitten by bats and animals 

Vaccination

A full 'primary' course of rabies vaccines (before travel) consists of three doses given over 3 to 4 weeks.  

• A more rapid schedule of vaccination may be possible if you are due to travel before you can complete the course, you can discuss this option with your travel health practitioner.

If you complete a full 'primary course' of rabies vaccines before you travel you will develop antibodies in your blood against the rabies virus. These will help protect you if you have a rabies exposure, but you must still seek medical attention after a rabies exposure and do immediate wound care.

• After a rabies exposure you only need 2 extra doses of rabies vaccine given over 3 days:
• These are booster doses to ensure your antibody levels are high enough to combat the rabies virus.
• You will not need Human Rabies Specific immunoglobulin (HRIG).

You should consider a course of rabies vaccinations before you travel (pre-exposure) if you:

• will be living in, or travelling to, a country where rabies is considered a risk
• are planning on undertaking activities such as trekking, cycling or running in a 'high risk' country, as these increase your risk of being attacked or bitten by an animal
• will be working or living in remote or rural areas with no easy access to medical facilities
• will be working with, or regularly handling animals or bats, as part of your job or activities
• those animals who have been vaccinated will develop antibodies in their blood against rabies virus.

Available vaccines

The vaccine available in the UK against rabies is:

• Rabipur
• Verorab

The illness

Without treatment, rabies symptoms may appear around 3-10 weeks after exposure, but may start much sooner or later than this. Once symptoms appear, rabies is almost always fatal.

Early symptoms of rabies might include:

• a headache
• a high temperature (fever)
• feeling weak or generally unwell
• pain, numbness or tingling at the site of the bite

Symptoms usually progress a few days later and may include:

• muscle spasms
• seeing or hearing things (hallucinations)
• confusion or aggressive behaviour
• inability to move (paralysis)

Treatment

There is no specific treatment available for rabies once symptoms develop, except for making the person as comfortable as possible.