A STAMARIL Center
Rabies is a 100% fatal brain infection caused by a virus transmitted by the bite
of a mammal, almost always a bat or other carnivore (in the US, usually bats,
raccoons, foxes, coyotes and skunks). The distribution of rabies among
potentially biting animals, both in and outside the US, varies depending on
geography. Outside the US, rabies is usually transmitted by domestic or stray
dogs, wolves and other carnivores. Bites from dogs are the main source of rabies
in developing countries. 1
Rabies is present in all parts of the world except Uruguay, United Kingdom, Austria, Belgium, Cyprus, Czech Republic, Denmark, Finland, France, Gibraltar, Greece, Iceland, Ireland, Isle of Man, Italy, Luxemburg, Netherlands, Norway, Portugal, Spain (except Ceuta/Melilla), Sweden, Switzerland and these Asian countries: Hong Kong, Japan, Kuwait, Lebanon, Malaysia (Sabah), Qatar, Singapore, United Arab Emirates. Most smaller island nations off the mainland of Africa, the Caribbean and Pacific Oceania are believed to be rabies free. Bat rabies may exist on some of these islands. You may wish to review of more complete information from the CDC.
People at increased risk for rabies transmission include wildlife workers, veterinarians, laboratory technicians working with rabies virus, bicyclists, spelunkers, campers, backpackers and expatriates. Tourists are at lower, but not zero, risk.
Common sense dictates that travelers should not approach animals, including monkeys at temple sites. ESPECIALLY AVOID PETTING STRAY ANIMALS NO MATTER HOW CUTE THE KITTEN OR PUPPY MAY BE! Even some pets may carry rabies and appear healthy.
There is a vaccine which may be used in one of two ways:
1. Prior to travel, a series of three vaccine doses over a month will prepare the traveler for possible rabies exposure (pre-exposure prophylaxis). If a bite occurs, two prompt subsequent vaccine doses provides complete protection.
2. Without the three dose series before travel, protective care following the bite is more complicated, more expensive and may not be available in developing countries. This care should include four doses of HDCV or PCEC rabies vaccine (not duck or other egg derived vaccine) as well as immediate administration of human (not equine) rabies immune globulin - HRIG (post-exposure prophylaxis). In this situation, receiving the vaccine without HRIG has resulted in fatalities. There is currently a shortage of HRIG worldwide and it may not be available in underdeveloped countries.
Without pre-exposure prophylaxis, treating a possible rabies-contaminated bite in an underdeveloped country, or when far from medical care, may be problematic. In these situations, starting treatment is urgent, best same day or within 1 days. Appropriate biologicals may not be available or prescribed by local medical caregivers. Consider consulting www.CDC.gov for details should you have an exposure.
Rabies shots are usually recommended before visiting a remote area for months. This is the policy of the Peace Corps. If there is a small (less than 1%) chance of a bite, your trip is short and not remote, it is reasonable to defer the pre-exposure series. If you are bitten by a mammal and have not received rabies vaccine before departing, going to a modern health facility or terminating your trip and returning home immediately may be life-saving. As a lay person, the problem will be (and you may have no way to answer this question definitively at that moment): "How will I know whether the treatment I have been offered is modern and effective?" Following a bite from a mammal, immediately contact a US Consulate for recommendations in finding a modern health care facility.