Rabies Immunisation

What is rabies?

Rabies is a disease caused by a virus. It causes spasms, fear of water, madness, paralysis and usually death. Symptoms usually start 2-8 weeks after being bitten or scratched by an animal (usually a dog) carrying the rabies virus. However, symptoms may occur months or even years after a bite from an infected animal. The virus passes through the cut skin and travels (gradually) into the nervous system.

At present, the UK is virtually free of rabies. There had been no reported cases in the UK for over 100 years until 2002 when a man died of rabies in Scotland after been bitten by a bat. As far as we are aware, there have been no cases since, and no cases in the UK for over 100 years caused by bites from other animals. The strict quarantine regulations for imported animals helps to keep rabies out of the UK.

However, rabies is present in most of the rest of the world. Worldwide, there are about 50,000 human cases each year, most commonly in India. Foxes are the main carriers of the disease but dogs, cats, cattle, horses, badgers, deer, raccoons, bats and skunks can be affected. A bite from any of these animals from any country outside the UK should be taken very seriously.

Who should be immunised against rabies?

• People whose work might bring them in contact with rabid animals such as zoo keepers, quarantine workers, vets, etc.
• Travellers to remote parts of the world where medical treatment might not be available.
• Travellers to parts of the world for over a month where rabies is particularly common in animals.
• Health care workers who come in contact with patients with rabies.
• People working with the rabies virus in laboratories.
• Health workers who are at risk when dealing with patients with confirmed rabies.
• People working abroad (eg veterinary staff or zoologists) who may be in contact with animals with rabies.
• Inspectors appointed by local authorities under the Animal Health Act.
• People who regularly handle bats in the UK.

The vaccine

Three doses of vaccine are usually given. The first injection, a second injection seven days later and a third injection 21-28 days after the first injection. The vaccine is very effective - almost 100%. The vaccine stimulates your body to make antibodies against the rabies virus. These antibodies protect you from rabies should you become infected with this virus.

Booster doses may be required after one year and then every 2-5 years for people who continue to be at risk. People who are at intermittent risk by travelling again into areas with rabies may need a booster after two years. People who work with rabies may need a blood test to confirm they are immune from rabies.

Who should not be immunised against rabies?

• If you have an illness causing a high temperature it is best to postpone immunisation until after the illness.
• You should not have a booster if you have had a severe reaction to this vaccine in the past.
• You should not have one of the rabies vaccines, Rabipur®, if you are allergic to eggs. The other rabies vaccine is safe to have even if you have an egg allergy.

If you are pregnant or breastfeeding you may still be advised to have the vaccine if the risk of exposure to rabies is high.

Are there any side-effects from the vaccine?

Local redness and swelling at the site of the injection may occur for 1-2 days. Mild fever and muscle aches with nausea (feeling sick) occur rarely and soon pass without leaving any problems. Severe reactions are extremely rare.

What if I am bitten by a suspect animal?

You should avoid any contact with wild or domestic animals when travelling abroad. If you are bitten by an animal in an 'at risk' country then:

• Wash the wound immediately with running water (and soap if possible) for at least five minutes. Disinfectant and a simple dressing may be applied to the wound.
• Seek medical attention as soon as possible even if you have been previously immunised as treatment may be given to reduce to risk of infection to a minimum.

There is an effective anti-serum (antidote). You may also be given a series of immunisations (even if you have been previously immunised).

Further information

Health Advice for Travellers.

From the Department of Health. You can get a free copy from main post offices.

Information on immunisation

Web: www.immunisation.org.uk
From the NHS aimed at the general public.

Patient UK Travel Health Page

Web: www.patient.co.uk/showdoc/38/
Has a comprehensive list of links to UK websites on travel health.