Mentioning rabies can strike fear into many a heart. Dr Jane Wilson-Howarth debunks the myths and offers practical advice
In December 2007, a Dutch tourist died from rabies. A little knowledge would have saved this woman’s life, proving just how vital it is that every traveller is aware of how to protect themselves against this invariably fatal infection.
Any bite from any mammal should be regarded as carrying a risk of rabies: theoretically even an elephant or a sheep could pass it on. Globally, the domestic dog is the animal most likely to transmit rabies to a human victim.
Rabies is transmitted when an infected animal bites a victim. The virus can also be transmitted if a rabid animal licks broken skin – if there is already a cut, graze, eczema or sunburn. However, rabies cannot penetrate intact skin. From the wound-site, the virus slowly progresses along the nerves until it reaches the brain. Once in the brain symptoms start; treatment is hopeless – death is inevitable.
There is an excellent vaccine that seems to protect absolutely against rabies and the related bat lyssaviruses. It causes very little reaction or side effects but it isn’t available free on the NHS – it will cost about £45 per dose and you need three doses.
Those going on wildlife trips, people who plan on entering caves, and other adventurous travellers – especially those going to remote areas, the Indian subcontinent or Thailand – would be wise to get immunised. Being bitten when not immunised causes an enormous amount of stress and anxiety.
Rabies may not be transmitted by a bite, but people have one hell of a horrible wait before finding out – and people who try to soothe victims into not worrying can do considerably more harm than good. The alternative to the ‘wait and see’ approach, which is to abandon the holiday to find a clinic with vaccine, is more time-wasteful and frustrating.
One risk of seeking treatment in clinics in remote corners of some resource-poor countries is that bite victims may be offered the relatively ineffective and dangerous Semple vaccine, made from homogenised rabies-infected sheep brains. It is best to get to a capital city or come home rather than accept this option.
According to the World Health Organisation (WHO), rabies in wildlife has been eliminated in the Western European countries that conducted oral vaccinations.
The WHO is also reassuring about the fact that Britain is rabies-free: scant consolation for Donald McRae, a Scottish bat handler who achieved fame by being the first person for more than a century to die from rabies caught in the UK.
He was infected with European bat lyssavirus (a strain found throughout Europe) and died of the disease in 2002. Bat lyssavirus may be distinguishable by virologists from rabies acquired from a dog bite, but it kills just as efficiently. It makes the bats ill too: they often have hind-limb paralysis.
Canada’s last case of human rabies occurred in 2000, when a nine-year-old boy was bitten by a bat in Québec. It was the first case reported since 1985 and the country’s 22nd rabies-related death since 1925.
In more-developed countries, then, rabies is rare (the tropical Americas, India and Thailand are among the most dangerous destinations), but bat bites are not good news, even in countries that WHO describes as ‘rabies free’. Australia, for example, has been considered free from rabies for many years, yet there have been two deaths following bat bites there in the past 12 years.
Everyone should be aware that a bite or scratch by a bat – anywhere in the world – carries a risk of rabies. Travellers need to think the same way about bat bites as they do about dogs – fortunately, most people are aware that they must seek medical attention after a bite from a canine. Lives are saved by good first aid and post-bite injections – which must be given before symptoms start.
