rabies

It always comes down to risk assessment donkey. RIG is in very short supply and clinicians experienced in administering post exposure regimes can vary form place to place. Yes pre-exposure vaccine gives you more time to seek treatment and availability of RIG is less significant, it also means the post exposure treatment is almost guaranteed to be successful. Whether pre exposure vaccine has been received or not the first aid treatment you described is still paramount and is the most important thing and you should give this in writing as with the travax advice sheet. Making patients aware of the risk is the main thing for a week in Sharm. If the last UK traveller who was in GOA for a shortish stay had been given appropriate advice and taken appropriate actions she may well still be alive even though she had not been pre-vaccinated.

When I was in Sharm in Nov I had no intention of taking any trips. However I did in the end. I took a rickety 21 hour bus [no air con] to Cairo as it was the only way I could afford to see the pyramids. The bus stopped at two rest breaks in less than pleasant surroundings and there was a pack of dogs at one stop which looked very ill and I stopped at least 20 tourists from all inclusive hotels going near them. [sluggish obviously neurologically affected dogs and one of them looked dead] They were about 5 feet away from the bus as we disembarked. At the second stop there were at least 12 cats roaming free and starving trying to get tourists to feed them and they scratched one of the guides. [I won't tell you what the guide did to the cat but it was horrible!] He was pre vaccinated but obviously most of the tourists were not.

This opened my eyes. I will still not push rabies vaccine for these tourists for 1-2 weeks in Sharm, but I will push awareness and 1st aid. I especially warn families with children to keep their kids in view, especially when taking trips outside of the admittedly well guarded complexes where roaming animals would be rare. Kids rarely report if they have been exposed or may be too young to verbalise it effectively. Hospitals are good in Sharm and some RIG was available in Nov but enquiries I made suggested this is not always the case.

I do recommend rabies for anyone visiting an area for one month or more or who travel regularly whereby their accumulative risk would be equal to long stays, VFRs who will often be exposed to neighbourhood animals and where rabies is particularly prevalent especially India, SE Asia, Africa, parts of South America etc. I might also recommend it for short stays if activities put travellers at more risk. A recent example was someone going on a cycling trip. Although they were only in India for two weeks, bikes attract dogs and routes are usually rural and transport to medical facilities can be difficult. Another family work as volunteers for one week each year with stray dogs in Bangkok. Thus it is not always the duration, that matters but what they are doing whilst there and how far away they are from treatment if required and what treatment is available.

There have been some problems with squirrels and tourists recently in Bali according to colleagues on the ISTM listserve. While there is no reported case of a traveller get rabies from a squirrel, squirrel autopys have shown them to positive for rabies. They are plaguing tourists in some of the best hotels, so warn anyone you have going there that just as with the monkies elsewhere, best not to feed them.

I am passionate about rabies control and regularly receive the ARC news letters which if anybody else is interested can be registered for on the following site. I proudly wear my rabies awareness t shirt every sept and promote cause when I can!
http://www.worldrabiesday.org/



Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen


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