Rabies

Symptoms of rabies can occur months after infection, but earlier symptoms are non-specific and can include a headache, cough, fever, nausea, tiredness, and pain, itching or tingling in the wounded area. Later symptoms affect the nervous system, such as anxiety, confusion and agitation. Some people also experience hallucinations, muscle spasms, insomnia and hydrophobia (inability to drink and swallow). The final stages of rabies can include paralysis, convulsions and coma. Rabies almost always results in death, and although treatment can alleviate symptoms, there is no cure.

Avoid physical contact with all domestic or wild animals in any setting unless you are absolutely certain the animal has been well vaccinated. The need for vigilance, particularly when travelling with children, cannot be overstated. You may have received rabies vaccination as part of your travel medicine consultation.

The Australian Immunisation Handbook has endorsed a condensed two-dose regimen for PrEP (pre-exposure prophylaxis) against rabies. Before travelling, individuals can opt for just two doses of registered rabies vaccine, administered seven days apart. For continued travel to high-risk countries, a booster dose after 12 months is advisable.

In case of exposure (such as being bitten or scratched), the PEP (post-exposure prophylaxis) regimen for these travellers remains consistent with the standard three-dose PrEP, involving two doses of rabies vaccine administered three days apart, with no requirement for RIG (rabies immune globulin).

Healthcare workers skilled in intradermal vaccination can administer a schedule of intradermal PrEP doses, although this method isn't suitable for individuals aged 50 years and older.

Immunocompromised travellers or those embarking on extended overseas stays should adhere to the standard three-dose PrEP vaccine schedule, given on days 0, 7, and 21-28.

Aside from the booster recommendation for the accelerated PrEP course, routine booster doses aren't advised. An exception applies to immunised individuals with ongoing occupational exposure to lyssaviruses, who should receive a booster if their rabies antibody test results fall below 0.5 IU/ml during their biennial testing.

Rabies is almost always fatal once symptoms appear, so immediate first aid followed by post-exposure treatment is essential if you sustain a scratch or bite from a mammal.

First aid

Wash the wound gently but thoroughly with soap and water for at least 15 minutes. Further clean the wound with an alcohol solution (40–70%) before applying povidone iodine, if available. Seek medical advice as soon as possible regarding post-exposure treatment, wound management, and possibly antibiotic therapy. If required, a booster shot to prevent tetanus should also be given. 

Post-exposure treatment

If you have NOT received the full course of rabies vaccinations before departure or before a previous trip, post-exposure treatment involves:

• Rabies immunoglobulin injected around the site of the wound.
• Four doses of cell-culture vaccine on days zero, three, seven and 14 after the exposure. A fifth dose on day 28 is used in some countries and in people with a depressed immune system. 

Note: Modern cell-culture vaccines should be used. 

In many countries, getting rapid, effective post-exposure treatment for rabies can be problematic. Rabies immunoglobulin, a blood product, is expensive and often difficult to obtain. Travellers may be advised to cut short their trip and return to Australia. If rabies immunoglobulin is not available, cell-culture vaccines should still be administered, and immunoglobulin should be sought elsewhere within one week of starting the vaccination course.

IMPORTANT: Treatment following a bite is considerably simpler for travellers who have been previously immunised, and rabies immunoglobulin is not required. However, they should still receive two booster doses of the rabies cell-culture vaccine as soon as possible after the exposure. These booster doses are given three days apart.