Prevention

Contact with wild or domestic animals during travel should be avoided. Travellers should be advised:

• not to approach animals

• not to attempt to pick up an unusually tame animal or one that appears to be unwell

• not to attract stray animals by offering food or by being careless with litter

• to be aware that certain activities can attract dogs (e.g. running, cycling)

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Pre-exposure vaccine should be given to travellers at continuous, frequent or infrequent risk, according to UK guidance.  A record of vaccination should be carried and shown to those administering emergency treatment in a post-exposure situation.

 

Receiving rabies vaccine prior to travel does not eliminate the need for post-exposure medical evaluation and additional doses of rabies vaccine.

 

Advice should be given to all travellers regarding first aid in the case of a possible rabies exposure:

• This is an emergency. 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 an iodine solution (tincture or 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/or rabies vaccination and possible antibiotics to prevent a bite wound infection.

• Tetanus vaccine may be necessary if the traveller is not up-to-date.

• Primary suturing of the wound should be postponed until post exposure prophylaxis has started [19].

 

Interrupted or accelerated courses

Ideally, those at risk should receive pre-exposure vaccination with three doses of rabies vaccine before travel. The 0, 7 and 21 day schedule can be given using either product, where there is less than four weeks before departure. 

If there are time constraints to the full pre-exposure course, a single dose is likely to prime the immune system; travellers should complete the pre-exposure course of vaccine during their travels. A record of vaccination should be carried as this will be useful during post-bite evaluation.

 

Travellers need to understand that if less than the recommended three doses of vaccine have been administered pre-exposure, in the event of a possible exposure, a full post-exposure course of vaccine will be required. However, rabies immune globulin (RIG) will not usually be necessary.

 

Expert advice may be needed for individuals who have previously received an interrupted or incomplete course of vaccine and who are travelling to an area where they may be at risk.

 

Contraindications

• Acute febrile or other infectious illness

• Allergy to any constituent of the vaccine

• Individuals who develop symptoms suggestive of hypersensitivity after vaccination should not receive further doses of the same vaccine

• Rabipur vaccine is propagated on chick embryo cell, and is therefore contraindicated for those with have a known anaphylaxis to egg.

 

Reference and more information from http://www.nathnac.org/pro/factsheets/rabies.htm