Health

Trav­ellers of­ten ask if pre-trip ra­bies im­mu­ni­sa­tions are ‘worth it’, but their true value is pretty in­escapable, says Dr Jane Wil­son-howarth

Wanderlust Travel Magazine (UK) - - CONTENTS -

Ra­bies in­jec­tions may be pricey, but as trav­ellers ques­tion their worth, can you re­ally af­ford not to?

To pay or not to pay, that is the ques­tion

Ra­bies is one of the few dis­eases that scares the pants off me. Once symp­toms be­gin, it is un­treat­able. Not only is there ab­so­lutely no hope of sur­vival but the virus stim­u­lates the brain’s fear cen­tres so vic­tims are scared to death – ter­ri­fied even of their own saliva.

Pre-travel jabs avoid the painful Ra­bies Im­mune Glob­u­lin (RIG) in­jec­tion that is needed (with five other in­jec­tions) post ex­po­sure but may not be avail­able at your des­ti­na­tion. Thus pre-travel ra­bies not only hugely re­duces risk from the dis­ease and wor­ries about sub­stan­dard treat­ment over­seas but cuts nec­es­sary post-bite in­jec­tions from six to two.

The vac­cine’s bad rep­u­ta­tion is per­haps be­cause of the 14 in­jec­tions that were once given into the ab­domen daily af­ter a bite. These have long been su­per­seded, though, and now im­mu­ni­sa­tion isn’t any more painful than other travel jabs. The only down­side is the cost. The pre-travel sched­ule is jabs on days 1, 7 and 21 at around £60 each. It is likely, though, that once you have had one such pri­mary course (plus one booster), you will be im­mune for life. Al­though when­ever there has been con­tact with a po­ten­tially ra­bid an­i­mal, two more in­jec­tions are rec­om­mended.

Un­like dis­eases that are spread in air droplets, you will prob­a­bly know if you risk ra­bies. The com­mon­est route is from a dog bite or a scratch or nip from a bat, but any mam­mal can carry ra­bies. A wild an­i­mal that is in­ex­pli­ca­bly tame is sus­pect, and even a lick on an area of in­flamed skin (for ex­am­ple, eczema or sun­burn) could lead to in­fec­tion.

The al­ter­na­tive

Some peo­ple de­cide that they won’t bother with ra­bies pro­tec­tion but will plan to seek clin­i­cal help if bit­ten or scratched. That strat­egy is prob­a­bly okay, but only if you are on a short trip or are vis­it­ing a coun­try where clin­i­cal stan­dards are high and such clin­ics and hospi­tals are ac­ces­si­ble. If, how­ever, you will be head­ing down­river in the Ama­zon or into the high Hi­malayas, then ex­cel­lent clin­ics in the cap­i­tal won’t re­ally be much help to you.

Medics ad­vise that af­ter any bite, a vic­tim should find a clinic im­me­di­ately, but many peo­ple de­cide to risk it, and then, think­ing it is too late to get the jabs, don’t ever ac­cess med­i­cal help. The in­cu­ba­tion pe­riod for ra­bies – which is also the in­ter­val in which pre­ven­ta­tive treat­ment is ef­fec­tive – is very vari­able: it is some­where be­tween four days and per­haps three months or more. It de­pends on the sever­ity of the bite, whether the virus has been de­posited in or very close to a nerve, and also the dis­tance from the bite to the brain. For ex­am­ple, a man nipped on a fin­ger­tip by a bat in Texas died six weeks later.

The fi­nal word

Ra­bies im­mu­ni­sa­tion is al­ways worth con­sid­er­ing, and I would en­cour­age trav­ellers to spread the word. It is never too late to seek ad­vice if you have been bit­ten or scratched on your trip, and the po­ten­tial dan­gers of not do­ing so far out­weigh any ex­cuses not to. Dr Jane Wil­son-howarth and four fel­low trav­ellers have just launched their an­thol­ogy 50 Camels and She’s Yours, which is avail­able on Ama­zon; de­tails at www.wil­son-howarth.com

Just a lit­tle prick! Bats are just one po­ten­tial car­rier of ra­bies you might en­counter, al­though any mam­mal can carry the dis­ease; ( right) mod­ern post-bite ra­bies jabs are far less painful than the 14 in­jec­tions to the ab­domen that trav­ellers used to get

Howarth lives in Dr Jane Wil­son- read her blog at Nepal; you can com www.wil­son-howarth.

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