Increasing awareness of an under-reported and deadly disease
About Rabies Infection
Rabies is a viral infection that is transmitted by the saliva of infected animals. The virus enters the body through a bite or lick onto broken skin. From the wound, the virus spreads to the brain and nervous system. The incubation period from infection to symptoms can range from 7 days to 1 year, but on average takes 2-3 months.
If treatment is not sought, the disease is invariably fatal. To date, the only survivors of the disease have received rabies vaccine before the onset of illness.
The disease presents as either:
Furious Rabies – the most common presentation with symptoms of agitation, hydrophobia (fear of water), which then progresses to coma and death within a few days.
Paralytic Rabies – this presents with gradual paralysis of the muscles leading to death from respiratory failure.
Children are much more vulnerable as they are more likely to approach animals and are less likely to report bites and obtain urgent lifesaving treatment. Additionally, the virus does not have far to travel from any wound to the brain so symptoms are more likely to develop leading to invariable fatality.
The Statistics (WHO data)
Rabies causes 1 death every 15 minutes worldwide
1 in 4 bites and deaths occur in children under 15 years of age
Rabies is found in over 150 countries and in every continent except Antarctica. However, 99% of the deaths occur in Asia and Africa and the majority of cases are due to dog bites
In the Americas, Western Europe and Australia, transmission is mainly through bats.
Around 29 million people seek lifesaving treatment worldwide each year to prevent rabies.
Vaccination before exposure consists of a 3 dose course given at day 0, 7 and 21 or 28 days. After completion of the three dose course, travellers have protection for 10 years, following which, single booster doses only are required.
The vaccine was first used by Louis Pasteur over 100 years ago and is safe and well tolerated. It is an inactivated vaccine and can be used for all ages from birth.
Full three dose vaccination prior to exposure or bite simplifies the post exposure treatment to a further 2 doses of the vaccine. Without pre-exposure vaccination, a 5 dose vaccination course is required as well as possible administration of Rabies immunoglobulin – a life-saving blood product which is in short supply and can be difficult to obtain in many areas.
It is very important that urgent medical attention is sought if a potential rabies bite occurs. The wound should be washed immediately with soap and water for 10-15 minutes and a disinfectant such as Iodine or alcohol should be applied. Rabies infection is 99.9% fatal without treatment, but is 100% preventable with vaccination.
Pilgrims attending Saudi Arabia for Hajj or Umrah are required to provide a certificate showing proof of vaccination against Meningitis Strains A, C, W and Y to obtain a Visa.
About Meningitis ACWY
Meningitis is caused by the bacteria, Neisseria Meningitides, of which there are several strains. The combined vaccine provides protection against 4 strains; A, C, W, and Y, which are encountered worldwide.
The infection is spread by coughing, sneezing, kissing and sharing cutlery and utensils.
Japanese encephalitis is a viral infection that is found throughout South and South-East Asia, where transmission can be seasonal (usually May-October coinciding with the rains) or all year long.
The virus is spread by the Culex mosquito (vector) and the hosts for the virus are water fowl and pigs. Humans are the end host. Consequently, the disease is mainly found in rural areas, around rice paddies, farmlands (especially pig farms). However, it is important to note that outbreaks can and do occur in urban locations.
There is no treatment for the disease and it can cause fatality or permanent disability.
Therefore, all travellers at risk of this of exposure to this illness should carry out Mosquito bite prevention, which includes insect repellent, mosquito nets, insecticide infused clothing (if necessary) and strongly consider Vaccination.
Ixiaro is the licensed vaccine against Japanese Encephalitis and it is safe to administer from 2 months of age.
Previously there was one schedule, the STANDARD Schedule, which required two doses of the vaccine given 1 month apart (day 0 and 2nd dose day 28). Full protection against the disease is only achieved 7 days after the second dose. Therefore, if you were travelling to an “at risk” destination in less than 1 month and thus, unable to get two doses, you would not be covered against the illness.
There is now an ACCELERATED schedule, which can be used for travellers who do not have enough time to complete the standard course. This is licensed for use in adults aged 18-65 years and consists of two doses given 1 week apart (day 0 and 2nd dose day 7). This schedule provides the equivalent protection 7 days after the second dose as the standard schedule.
Additionally, the Department of Health guidance advises that clinicians can use this ACCELERATED schedule “off license” in children aged 12-17 years also, if there is genuinely insufficient time before travel.
Booster doses should be given at 2 years if there will be further exposure to the illness. After this, in those between 18-65 years of age, a second booster should be given at 10 years.
News from National Health and Family Planning Commission in China.
Case Report of a man who was found to have confirmed yellow fever in Beijing, China.
The man in question had returned from Luanda, Angola with symptoms of a high fever. There is currently a large outbreak of yellow fever in Angola.
It is important to remember China has yellow fever vaccination certificate requirements for all those over the age of 9 months. Although there is no actual yellow fever in China, the risk of a potential outbreak is there, because of the presence of the mosquito vector – Aedes Aegypt. An outbreak would require first an infected individual to enter the area and then subsequently to be bitten by the vector mosquito.
Make sure you attend your local Travel Clinic for yellow fever at least ten days before departure. The vaccination lasts for life and the certificate for a minimum of 10 years.
Yellow fever is a live vaccine and there are a number of contraindications so its important you attend a registered yellow fever travel clinic for expert advice. Yellow fever vaccination is contraindicated in those with a true egg allergy.
Guidance CDC Providing Care Women following Zika Virus Exposure
New Travel Health guidance from the CDC regarding the provision of care for women of child bearing age after Zika virus exposure. The latest recommendation is for health care professionals to provide serology screening to those pregnant women without symptoms and have travelled to geographical regions with Zika virus cases.
Zika Virus Facts
Zika virus transmission is continuing to spread
Mainly transmitted by Aedes aegyptimosquitoes,
Associated with congenital microcephaly and other central nervous abnormalities
There is currently no preventable Travel vaccination or treatment
World Health Organization declared Public Health Emergency on Feb 1 st 2016.
Mosquito Bite Prevention
Travellers to areas with Zika virus prescence, are reminded of the importance of bite prevention.
Main methods include-
Wear long sleeved clothing and trousers.
Use permethrin soaked clothing.
Use adequeate strength DEET repellent. 50 % or greater.
DEET should be applied after the Sunscreen and may reduce in effectiveness because of the sunscreen, so may need to be re-applied.
Mosquitos spread also
Rift Valley Fever
West Nile Fever
Protection yourself before travelling by attending your local Travel Clinic at least 6 weeks before travel. Ensure you are up to date on all essential vaccinations and obtain the necessary general pre travel advice for your specific itinerary.