Rabies is an acute and fatal viral infection that causes inflammation of the spinal cord and the brain (encephalomyelitis). It is found in over 150 countries around the world and an estimated to cause tens of thousands of deaths in endemic countries. Children are especially vulnerable to rabies and 40% of bites occur in children under the age of 15 years. 95% of deaths from rabies occur in the Indian Subcontinent, Africa and South East Asia.
Rabies virus is spread through contact with the saliva of an infected mammal. This is usually from a bite or scratch or from a licking broken skin. Although any mammal can spread rabies (including humans), the majority of cases are contracted from dogs. This is especially true in the Indian Subcontinent and South East Asia. In other countries, rabies can be spread by bats, monkeys and cats. Both domesticated and wild mammals can spread rabies infeciton.
The incubation for symptoms of rabies infection to develop varies considerably. The average duration is 1-3 months, but symptoms can develop in less than one week or more than 1 year from being bitten. Bites to the head and neck have a shorter incubation period than bites the the extremities.
Once symptoms have developed rabies is 100% fatal.
Rabies infection starts within non-specific early symptoms of fever, headache, muscle ache and loss of appetite. This is followed by either:
- Furious rabies-the common form characterised by fear of water (hydrophobia), confusion, hyperactivity and death after a few days.
- Paralytic rabies-slow paralysis of the muscles starting from the site of the bite followed eventually by death.
Once symptoms occur, there is no treatment for rabies. The aim of medical management following a bite is to prevent the virus from entering the brain and spinal cord. This is known as post exposure prophylaxis and needs to be started as soon as possible after being bitten.
Post exposure prophylaxis:
- Immediate wound care
- Rabies Immunoglobuin-a blood product, usually obtained from human sources, containing rabies antibodies.
- Active Rabies vaccination
Rabies is entirely preventable. There is a safe and effective vaccine against rabies, which if the course is completed given prior to exposure, will:
- Prevent the risk of death by slowing virus progression to the brain and spinal cord.
- Eliminates the need for Rabies immunoglobulin-as you will have formed your own antibodies
- Reduce the number doses of vaccine (2 versus 5).
It is important to remember that any bite or scratch from a mammal in an endemic country could pose a risk of rabies infeciton. Therefore, avoid contact with domesticated and wild animals while traveling. Rabies infections causes animals to behave more aggressively and thus they are more likely to bite. It is particularly important to keep children away from animals and ensure that older children understand that they must report a bite as soon as possible for post exposure prevention to be carried out.
The rabies vaccine is an inactivated vaccine containing dead virus. It cannot cause the disease in the vaccinated individual, but allows effective antibodies to form against the virus which can defend the body quickly if exposure to rabies virus occurs. As time is of the essence when dealing with potential rabies infection, vaccination provides this. Although, it is important to bear in mind that it does not eliminate the need for urgent medical attention.
Vaccination prior to travel (pre-exposure) should be considered for anyone going to live in or who are travelling to high risk countries. This is particularly important if their travel activities are likely to increase the risk of exposure, such as trekking or travel in rural areas. It should also be considered if travelling to countries or areas where post exposure medical care may not be accessible within 24 hours.
The rabies vaccine should be considered for all children traveling to high risk areas to the increased chances of them being exposed and developing symptoms very quickly. The rabies vaccine can be given safely from birth onwards.
|Age range||Vaccine Brands||Method of Administration||Number of Doses||Interval Between Doses|
|From Birth onwards||Rabies BP|
|Intramuscular injection to the thigh or deltoid depending on age||3 doses||2nd dose given minimum 7 days after first and third dose given minimum 14 days after 2nd dose.|
It is imperative to seek medical attention as soon as possible if a bite or scratch is sustained in any rabies endemic area even if pre-travel vaccination has been given. Saliva should be thoroughly washed with soap and water for 10 mins and the wound irrigated with iodine solution or alcohol. This is very effective in removing virus from the bite site, providing it is prompt and thorough. Suturing of the wound site should be avoided and tetanus vaccination should be considered. If you have returned back to the UK having suffered a bite/scratch in a rabies endemic area, your case will need to be discussed with Public Health England. This is the case even if you have started a post exposure exposure rabies course after a bite abroad and have been advised to complete in the UK, you will need to attend your local GP or AE, who can discuss your case directly with the Public Health England.
At CityDoc, we are not able to provide post exposure vaccination as this is done through Public Health England.
The rabies should not be given if you have:
- History of severe allergic reaciton to a previous dose fo rabies vaccine or any of the components of the vaccine (see FAQ section)
- Acute illness with high fever (greater than 38.5 degrees Celsius)
Due to the severity of rabies infection, vaccination can be given to pregnant women if there is a high risk of exposure and rapid access to post exposure management not available. Inactivated vaccines have not been show to cause harm in pregnancy.
Due to the severity of rabies infection, vaccination can be given to breast feeding mothers if there is a high risk of exposure and rapid access to post exposure management not available.
Common Side Effects
Local reactions at injection site-redness, swelling, pain.
Less commonly-headaches, muscle aches and fever
Interactions with Other Vaccines
The rabies vaccine does not interact with any other vaccines. Thus, it can be given at the same time or any time before or after all other vaccines, including yellow fever, hepatitis A, hepatitis B and typhoid vaccines.
Frequently Asked Questions
1) Is the vaccine safe?
The rabies vaccine is made form killed virus and cannot cause infection in the vaccinated individual. The vaccine has been around for a long tine and there is extensive clinical data as well as post marketing data on rabies vaccine.
Severe reactions to the vaccien are very rare. The main concern is allergic reaction, which can occur with any vaccine or drugs. Cases of Guillain Barré syndrome (GBS), a neurological disorder have been reported after rabies vaccine, but this happens so rarely that it is not known whether they are related to the vaccine.
2) What are the contents of the vaccine?
The two rabies vaccines we use are Rabies BP from Sanofi Pasteur and Rabipur from Novartis.
Rabies BP contains the following ingredients:
- Human albumin solution.
- Solvent: Water for Injections (1 millilitre).
- traces of the antibiotics, neomycin and betapropiolactone may be present as these are used in the manufacturing process
Rabies BP does not contain any egg products, latex, gelatin or thiomersal.
- Sodium chloride
- Disodium edetate
- Water for injections
- Chick embryo cells are used to make the virus
- Traces of polygeline (a stabilizer), amphotericin B (antifungal treatment) chlortetracycline and neomycin (antibiotic) may be present as they are used in the manufacturing process.
Rabipur does nor contain gelatin, thiomersal or latex.
3) What happens if I cannot receive all three doses of the rabies vaccine prior to travel?
One or two doses of the rabies vaccine removes the need for rabies immunoglobulin to be administered post exposure. As this can be difficult to obtain in many countries and needs to be administered as soon as possible, even one dose of the rabies vaccine is worth having prior to travel. However, you would still require the full course of post exposure vaccines (5 doses).
If you do have 1 or 2 doses prior to travel, you can complete the course whee you left off on your return without needed to restart the vaccination course. This would provide you with 10 years of protection for future travel.
4) If I get bitten while travelling, can I receive my post exposure treatment through CityDoc
It is important that once you are bitten, post exposure management is instituted immediately in the country you are in. At CityDoc, we do not provide vaccination post exposure. This is because all potential bites and cases of rabies are managed by specialists at Pubic Health England (or Health Protection Scotland). They will carry out a detailed risk assessment and send the vaccination and/or immunoglobulin to your GP or NHS setting and will follow up afterwards.
Therefore, if you have returned to the UK and sustained a bite while travelling, please let your GP know urgently to attend A+E.
Rabies is a fatal illness. Do not ignore any bite or scratch or lick to broken skin from an animal while travelling. Aways seek medical help immediately.
5) Can vaccine courses be completed with different rabies vaccine brands?
Yes-the rabies vaccines available are all interchangeable to one another Therefore, course started with rabipur can be be continued with Rabies BP and vice versa.
6) Can I have the vaccine if I feel unwell?
The vaccine can be given following assessment by a clinician in minor illnesses where there is no fever. However, if there is a high temperature associated with the illness, then vaccination should be postponed until you are recovered
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