Avoiding animal bites
Contact with wild or domestic animals (including bats) during travel should be avoided. Animals that appear to be behaving normally can still be infectious. Travellers should be advised:
- Not to approach any animals/bats.
- Not to attempt to pick up an unusually tame animal/bat 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 may attract dogs (e.g. running, cycling).
- Any bat found in the room of a sleeping person or an individual who cannot give an accurate history of an exposure should be considered a potential contact.
Pre-exposure vaccines are recommended for individuals considered to be at risk of exposure to rabies virus (see below). A record of vaccination should be carried and shown to those administering emergency treatments in a post-exposure situation. Pre-exposure rabies vaccine reduces both the number rabies vaccine treatment doses needed after a bite, and the need for rabies immunoglobulin in most circumstances, which is in short supply in many countries.
Action following a possible rabies exposure
All travellers should be advised to perform first aid treatment and to seek medical advice as soon as possible if bitten, scratched, or spat at by any animal/bat abroad or if an animal/bat licks open skin.
Although modern rabies vaccines and rabies immunoglobulin may be available in major cities of most developing countries, availability is variable depending on geographic region.
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 flush the wound/area under a running tap for several minutes, then thoroughly wash with soap/detergent and water to remove saliva.
- Apply a suitable disinfectant to the wound such as 70 percent alcohol or tincture/aqueous solution of povidone-iodine.
- Apply a simple, loose dressing to the wound.
- If any animal/bat saliva gets into eyes, nose or mouth (i.e. if the animal coughs, spits or sneezes close to face), wash face thoroughly with clean water as soon as possible.
Get urgent medical help, even if the wound or incident seems very trivial. Seek medical attention locally, do not wait until you return to the UK. If advised, you should start rabies post-exposure treatment (PET) abroad and not wait until you get back to the UK. Prompt PET is needed, even if you have already had a full pre-exposure vaccine course, as further vaccine doses are required for full protection. - Suturing of the wound should be postponed until PET has started.
- Tetanus vaccine may be necessary if you are not up to date as animal bites may be considered tetanus-prone wounds. Antibiotics may need to be prescribed to prevent a wound infection.
Keep photos or written records of any rabies treatment given abroad including details on the name and type of vaccine and immunoglobulin if possible. Some countries stock rabies vaccines which are not always directly compatible and therefore additional doses of vaccine may need to be given upon your return to the UK. If you have any questions about rabies PET you received in another country, speak to your medical insurance provider for advice and contact a health professional on your return to the UK. If you had rabies vaccination before you travelled, make sure you carry your vaccine record with you.
If you did not have or did not complete a rabies vaccine course before travel, you may need treatment with a blood product called rabies immunoglobulin (which may be unavailable in some world regions), as well as a full vaccine course. PET (with rabies vaccine) should be started as soon as possible, whether or not immunoglobulin is available.
You may need to travel to a nearby major city or possibly another country for appropriate treatment and vaccines. One study found that 204 countries out of 240 had limited or no access to rabies immunoglobulin.
Information taken from NaTHNac https://travelhealthpro.org.uk/factsheet/20/rabies