Am I at risk for Rabies in South East Asia? All you need to know before making a decision.

Introduction

Rabies is an extremely dangerous disease caused by a virus. This virus affects the nervous system of a human and leads to deadly complications. The annual number of people dying from rabies exceeds 59,000. About 95% of those deaths are reported in Africa and Asia.

What areas are the most dangerous?

Over 150 countries of the world are affected by rabies. 3 However, some countries (especially rural areas of those countries) are considered “high-risk” areas for the disease. From the existing high-risk countries, eight are located in Southeast Asia. Those are:

• Burma (Myanmar)
• Cambodia
• Indonesia
• Laos
• Malaysia
• Philippines
• Vietnam
• Thailand

The number of rabies deaths per country in Southeast Asia.

The table below presents the number of rabies cases for each disease-endemic country of Southeast Asia (Global Health Observatory data repository, 2017 estimates).

How many tourists contracted rabies?

Even though rabies contraction is rare among tourists, the risk of infection still exists. Over the period of 1990 to 2013, the total number of travelers being infected with rabies during their trip was 63, from which 16 | were US residents. Asia was the most common site of exposure.
Overall, rabies resulted in 36  deaths of US travelers in the last 6 decades (from 1960 to 2018).

What is the probability of getting rabies?

Approximately, 1.4 billion individuals residing in South East Asia are at increased risk of rabies acquisition. 8 However, the probability of exposure during the one-month trip equals 0.4% roughly.

What activity the most dangerous and why?

People get the virus from an infected animal. The transmission happens when the saliva of the animal enters the person’s body through the bite or scratch. Also, the animal may transmit rabies when licking the damaged skin. In rare cases, a person may get the virus through organ transplantation. That is why the organs of those died from rabies should never be transplanted. 10 Any activity that increases the chance of contact with an animal presents a risk of rabies acquisition. Some of those activities are:

• Spending a lot of times outdoors (for example camping, caving, biking)
• Working with animals ( being veterinarian or wildlife professional)
• Traveling to a high-risk region for a long period of time

The probability of being bitten by an animal is 4 times higher for kids compared to adults. They spend more time outdoors and like to spend time with animals. Parents should take the latter fact into consideration when traveling to rabies endemic site with their kids.

Which animal is to watch for in Southeast Asia?

In the majority of cases (96%), the humans gets rabies from an infected dog. However, the disease may also result from other animals such as:

• Monkeys
• Cats
• Bats
• Foxes
• Jackals
• Wolves
• Mongooses

How should the rabies be prevented?

There is an anti-rabies vaccine, which is known to be the most effective disease-preventive tool.13 However, if someone chooses to not get the vaccine, it is essential to avoid animal bites. Even the most innocent animals and pets are a potential source of infection. People should never touch an animal, including injured ones. It is recommended to supervise the kids when they are outdoors. Also, it is not suggested to bring an animal to your country from the high-risk rabies region.

About the vaccine against rabies

There are 2 types of vaccine available in the US, namely “Human Diploid Cell Vaccine (HDCV)” and “Purified Chick Embryo Cell Vaccine (PCEC)”. 13 Either of them is administered to those who are at increased risk of being infected (those traveling to rabies-endemic site for a period of 1 month or more, wildlife professionals, veterinarians, laboratory workers that diagnose rabies, and rabies biologist). The vaccine is also given once the person is exposed to the virus or when there is a risk that he/she has been exposed to it (has been bitten by an animal whit an unknown rabies status).
The vaccine should not be administered to allergic people. Also, it should be administered to pregnant women exclusively when it is highly needed.

How many shots of the vaccine will guarantee my full protection?

Three doses of the vaccine should be received by a traveler with a following schedule:

According to the Centers for Disease Control and Prevention (CDC), those who received all of the vaccine shots are not 100% protected from rabies and they should still get 2 booster doses once exposed to the virus.

The possible risks of the vaccine

The probability of vaccine-related severe health complications is extremely low. The list of dangerous complications includes serious allergic reactions and some nervous system conditions like Guillain Barré syndrome. In case of severe allergy, it is recommended to call 9-1-1. Moderate complications occur in six percent  of cases. This include: joint pain, fever, and hives. The mild complications are relatively common (occur in 5-74% of the cases). Those include: local problems (redness, soreness, and itching), headache, pain in abdomen, nausea, and pain in muscles.

What percentage of people in the USA get rabies shots before traveling?

According to Samantha B. Dolan et al. 2014, only 3%  of the US travelers get the rabies vaccine before visiting a high-risk rabies country.

What can be done after exposure?

In case of possible exposure, it is important to prevent the interaction of a virus with the nervous system of the host. This will save the victim from the rabies-associated unpleasant health outcomes. The table below summarizes the post-exposure recommendations.

The post-exposure vaccination schedule

According to the Center for Disease Control and Prevention, those who have been exposed to the virus, (regardless of the previous history of the rabies immunization) need to be vaccinated against rabies. Those who have not been vaccinated before should also receive the human rabies immune globulin. The post-exposure vaccination schedule is presented below.

What is the incubation period?

It may take from five days to several weeks from the moment of the exposure until the rabies manifestation. However, usually, rabies has an incubation period of 20-60 days. 14Different factors determine the duration of the incubation period.
Those factors are:

• Bite’s severity
• Immune status of the person that has been bitten
• The amount of spread virus
• The part of the body that has been bitten (people who have wounds close to the head and neck area, tend to experience a shorter incubation period).

Rabies-related symptoms and health complications

The list of the rabies symptoms includes:

• Local pain and itching
• Local burning, tingling and pricking
• Hyperactivity
• Fear of water
• Fear of fresh air
• Fever
• Headache
• Behavioral changes (anxiety, depression, anger)

Once a person develops rabies-related symptoms, it will not be able to cure him/her. Unfortunately, in that case, a rabies-positive patient will die within 2 weeks from the inevitable health complications.

How available is the vaccine in a risky area?

The vaccine is available in the majority of Southeast Asia’s popular travel destinations. However, according to the CDC, the available vaccines in those areas may substantially differ from ones used in the USA. In that case, the patient should undergo an additional treatment course once he or she returns to the US.

What is the best place to get shots in those areas?