Rabies

Rabies is one of the oldest and most feared infectious diseases in the world — and with good reason.  Caused by a virus that attacks the central nervous system, rabies is almost universally fatal once symptoms develop.  It is present in over 150 countries and territories worldwide, and the majority of human deaths occur in Africa and Asia, where access to prompt post-exposure treatment can be limited.

For travellers, the risk of rabies comes primarily from animal bites, scratches, or licks on broken skin from infected mammals, most commonly dogs, bats, monkeys, and foxes.  Pre-exposure vaccination does not eliminate the need for medical attention after a potential exposure, but it significantly simplifies and improves the effectiveness of post-exposure treatment.  At Jasins Pharmacy in Hounslow, our travel health team can assess your risk and administer the pre-exposure rabies vaccine course quickly and conveniently before your trip.

 

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How Rabies is Transmitted

Rabies is caused by the rabies virus, a member of the Lyssavirus genus, and is transmitted to humans almost exclusively through contact with the saliva of an infected animal.  The virus travels from the site of exposure along nerve pathways to the brain, where it causes a rapidly progressive and invariably fatal encephalitis once symptoms appear.

The most common routes of transmission include:

• A bite from an infected animal, which breaks the skin and introduces infected saliva directly into the wound
• A scratch from an infected animal, particularly if the scratch is deep or the animal has been licking its claws
• Saliva from an infected animal coming into contact with an open wound, cut, or mucous membrane such as the eyes, nose, or mouth
• Contact with bats, which are a significant reservoir for rabies variants even in countries where dog rabies has been eliminated

 

Dogs are responsible for the vast majority of human rabies deaths globally, accounting for up to 99% of all cases.  However, any warm-blooded mammal can carry and transmit rabies, including monkeys, cats, foxes, jackals, and raccoons.  Travellers who interact with animals — whether intentionally or accidentally — in rabies-endemic regions face a real and serious risk of exposure.

 

Symptoms of Rabies

One of the most alarming aspects of rabies is that by the time symptoms appear, it is almost always too late for treatment to be effective.  The incubation period — the time between exposure and the onset of symptoms — can range from a few days to several months, depending on the site of the bite and the viral load introduced.  Bites to the head, neck, or hands tend to result in shorter incubation periods.

Early symptoms of rabies include:

• Pain, tingling, or itching at the site of the original bite or scratch
• Fever and headache
• General malaise and fatigue
• Nausea and loss of appetite

 

As the disease progresses into its acute neurological phase, symptoms become dramatically more severe and may include:

• Extreme agitation, anxiety, and confusion
• Hydrophobia — a fear of water caused by painful throat spasms triggered by swallowing
• Aerophobia — an extreme sensitivity to air currents or draughts
• Hallucinations and aggressive behaviour
• Paralysis, coma, and ultimately death

 

Once the acute neurological phase begins, survival is exceptionally rare.  This is precisely why immediate post-exposure treatment after any potential exposure is critical, and why pre-exposure vaccination before travel is so strongly encouraged for those visiting high-risk destinations.

 

The Pre-Exposure Rabies Vaccine

The pre-exposure rabies vaccine is given as a course of injections before travel and works by priming the immune system to recognise and respond to the rabies virus.  Crucially, vaccination before exposure means that if you are subsequently bitten or scratched, your immune system can respond much more rapidly — and the post-exposure treatment you require is considerably simpler, involving fewer doses and no need for rabies immunoglobulin (RIG), which can be extremely difficult to obtain in many parts of the world.

• Standard pre-exposure course — three doses of vaccine given on days 0, 7, and 21 (or 28); all three doses should be completed before travel
• Timing — ideally begin the course at least four weeks before departure to allow the full schedule to be completed comfortably
• After a potential exposure — vaccinated individuals still require two further doses of vaccine (on days 0 and 3) but do not need rabies immunoglobulin, which is often unavailable in remote or resource-limited settings
• Booster doses — those at ongoing risk (e.g. frequent travellers to endemic regions, veterinary workers) should have their antibody levels checked periodically and receive boosters as advised
• Suitability — the rabies vaccine is suitable for adults and children of all ages; speak to our pharmacist about appropriate dosing for younger children

 

It is important to be clear that pre-exposure vaccination does not mean you can ignore an animal bite abroad.  Any potential exposure still requires urgent medical assessment and additional doses of vaccine.  However, being vaccinated beforehand gives you a critical advantage — more time to reach medical care, a simpler treatment protocol, and far greater protection in settings where rabies immunoglobulin is unavailable.

 

Who Should Consider the Rabies Vaccine?

Pre-exposure rabies vaccination is not routinely recommended for all travellers, but it is strongly advised for a significant number of people depending on their destination, planned activities, and the nature of their trip.

The rabies vaccine is particularly recommended for:

• Travellers spending extended periods in rabies-endemic regions, particularly in rural or remote areas where access to post-exposure treatment may be delayed
• Children travelling to high-risk destinations, as they are more likely to approach or be bitten by animals and less likely to report a bite promptly
• Adventure travellers, trekkers, cyclists, and those whose activities bring them into closer contact with wildlife or stray animals
• Travellers visiting destinations where access to rabies immunoglobulin and post-exposure treatment cannot be guaranteed
• Volunteers, fieldworkers, and those involved in animal handling, wildlife conservation, or veterinary work abroad
• Travellers on short trips to high-risk areas who may not have time to complete post-exposure treatment before returning home

 

Our pharmacists at Jasins Pharmacy in Hounslow will help you assess your personal level of risk during your travel health consultation and advise on whether pre-exposure vaccination is the right choice for your trip.

 

Possible Side Effects

The rabies vaccine used in the UK is well established and has an excellent safety record.  The vast majority of people who receive the pre-exposure vaccine course experience no significant side effects at all.

Where side effects do occur, they are typically mild and may include:

• Temporary soreness, redness, or swelling at the injection site
• Headache
• Fatigue or general tiredness
• Mild nausea
• Dizziness

 

These effects usually resolve within a day or two without any intervention.  Serious allergic reactions are very rare.  If you have a history of allergies or are taking any regular medications, please mention this during your consultation so our pharmacist can advise accordingly before administering any doses.

 

Frequently Asked Questions

 

What is rabies and how serious is it?

Rabies is a viral disease that attacks the central nervous system and is almost universally fatal once symptoms develop, making it one of the deadliest infectious diseases known to medicine.  It is present in over 150 countries and kills tens of thousands of people every year, the vast majority of whom are in Africa and Asia.

 

If I am vaccinated, do I still need treatment after a bite?

Yes, absolutely — pre-exposure vaccination does not remove the need for urgent medical attention after any potential rabies exposure.  However, it does mean your post-exposure treatment is significantly simpler, requiring only two additional vaccine doses rather than a full course plus rabies immunoglobulin, which is often unavailable in many parts of the world.

 

Which countries carry a rabies risk?

Rabies is present in over 150 countries worldwide, with the highest risk in parts of South Asia (particularly India), Southeast Asia, Sub-Saharan Africa, and Latin America.  A small number of countries are considered rabies-free, including the UK, Australia, New Zealand, Japan, and most of Western Europe — your pharmacist will confirm the risk status of your specific destination.

 

How many injections does the rabies vaccine course involve?

The pre-exposure rabies vaccine is given as a course of three injections, administered on days 0, 7, and 21 or 28.  You should ideally begin the course at least four weeks before your departure date to allow the full schedule to be completed and to give your immune system sufficient time to respond.

 

Is the rabies vaccine suitable for children?

Yes — the rabies vaccine is suitable for children of all ages and is particularly important for young travellers, who are statistically more likely to approach or be bitten by animals and less likely to report a bite promptly.  If you are travelling to a rabies-risk destination with children, pre-exposure vaccination should be considered as a priority.

 

What should I do if I am bitten or scratched by an animal abroad?

Wash the wound immediately and thoroughly with soap and running water for at least 15 minutes, then seek urgent medical attention without delay — even if you have been vaccinated before travel.  Time is critical with rabies exposure, and prompt post-exposure treatment is highly effective when administered before symptoms develop.

 

Don’t Take Chances With Rabies

Pre-exposure vaccination is one of the most important steps you can take before travelling to a rabies-risk destination.  Book a travel health consultation at Jasins Pharmacy in Hounslow today and give yourself the best possible protection before you go.