Rabies

There is no available treatment for rabies once symptoms have started. Prevention is the only way to avoid rabies infection. If you are bitten or scratched by a land mammal overseas, especially a dog, seek urgent post-exposure management to prevent potential rabies disease.

Rabies infection in humans causes a serious illness which results in paralysis, delirium, convulsions, and death. The time from exposure to the start of symptoms is variable, ranging from weeks to years. It is very important to seek urgent medical attention even if some time has elapsed since the potential exposure.

Post-exposure management may include:

• wound care (including tetanus vaccination)
• rabies vaccine
• human rabies immunoglobulin (HRIG) if required.

Post-exposure management is recommended for anyone who has potentially been exposed to the rabies virus, even if they have previously been vaccinated. This includes people who may be allergic, pregnant or breastfeeding.

Wound care

If you are bitten or scratched, or if saliva (spit) gets into breaks in the skin, immediately wash the wound gently and thoroughly with soap and clean water for at least 15 minutes to reduce the risk of infection. If available, an antiseptic with anti-virus action such as povidone-iodine or alcohol (ethanol) should be applied after washing. If animal saliva gets in your eyes, nose, or mouth, flush the area thoroughly with water for several minutes.

Rabies vaccine

The vaccine is only effective in preventing rabies before the symptoms appear, so there should be no delay in getting medical care. A course of rabies vaccine is commenced as soon as practicable after potential rabies exposure, ideally within 48 hours but can be given at any time following exposure.

Side effects— rabies vaccine

All medications and vaccines have side effects. Approximately 20% of people complain of redness at the injection site or a sore arm following a rabies vaccine. Other possible side effects include, fever, headache, stomach upset, muscle aches and pains, and rash. A small number of people (1 in 10,000 vaccinations) can have a severe allergic reaction that causes difficulty breathing or swelling of the throat. Your doctor will ask you to stay in the clinic for at least 15 minutes after your injection to monitor you for symptoms of an allergic reaction.

Human Rabies immunoglobulin (HRIG)

HRIG is usually given at the same time as the first dose of the rabies vaccine to give short-term immunity while the vaccine takes effect. HRIG is given as soon as practicable after potential rabies exposure. HRIG may interfere with some vaccines, and you may need to be re-vaccinated. Tell your doctor if you have had any other vaccines in the last 4 months.

Side effects—HRIG

Side effects of HRIG can include pain and discomfort at the injection site, and fever and chills. Severe allergic reactions are rare. In Australia HRIG is prepared from human blood. Australia’s blood supply is very safe. There have been no reports in Australia of any blood-borne disease in people who have received HRIG.

Overseas travellers

If exposure occurs while abroad, wherever possible you should seek treatment as soon as possible in that country. HRIG may be difficult to obtain in some countries, but vaccine is usually available.

Be sure to get documentation of any treatment received overseas including the following details (preferably in English):

• contact details for the clinic attended (telephone and email address)
• batch and source of HRIG used (note: equine RIG rather than human HRIG may be used in some countries and in Australia if HRIG is in short supply)
• volume of HRIG administered
• type of vaccine used
• vaccine batch number
• the number of vials used
• route of vaccine administration
• date(s) of HRIG and/or vaccine administration.

Upon returning to Australia, you should see a doctor to reassess the rabies exposure risk and complete the course of treatment where required.

Rabies is spread from animals to humans when the saliva of an infected land mammal enters the human body through breaks in the skin, an open wound or through mucous membranes (the eyes, inside the nose or mouth). This is known as a “potential exposure".

The rabies virus is mostly found in land mammals in Asia and Africa, and less commonly in North and South America and parts of Europe. Animals that have the potential to be infected with the rabies virus include:

• dogs
• cats
• bats
• monkeys
• foxes
• coyotes
• wolves and jackals
• skunks
• racoons
• mongooses

Dogs are the most common animal affected by rabies in developing countries.

Avoid contact with domestic or wild land mammals overseas. This includes domestic dogs and cats, zoo or pet animals, and particularly monkeys who are used to being fed or photographed by people, for example at tourist attractions. Monkeys are unpredictable and frequently bite for no reason. Avoid going near them, especially with food. Be aware of animals when out walking, running, or cycling.

Do not touch or feed any wild animal, particularly if it looks sick, injured, or would not normally be found around people or be active during the day. Do not let young children feed, pat, or play with wild animals. Children are more vulnerable to high-risk bites to the face or head.

Pre-exposure vaccination

If you are intending to travel, live or work in a country where rabies is known to be a risk, speak to your doctor about being vaccinated against rabies before you leave Australia. A risk assessment can be completed to consider the availability of post-exposure prophylaxis, or the likelihood of rabies exposure based on your planned activities and accommodation.

A rabies vaccine course should be started at least 6 weeks before departure where possible. A course of 3 rabies vaccine injections is given over a one-month period. Consult your travel doctor for more advice on travel vaccinations

• Australian bat lyssavirus fact sheet
• Rabies (healthdirect.gov.au)

If you are in an emergency situation, call 000.

If you think you have been potentially exposed, or for further information, please contact your local doctor or nearest public health unit or the 13HEALTH information line (13 432584).