A recent edition of Morbidity and Mortality Weekly Reports described a case of travel-associated rabies in a Virginia man. The man was diagnosed with rabies in October 2009. Treatment with the “Milwaukee protocol” (a rabies treatment protocol that resulted in survival of a single patient with rabies but which has not had much success since then) was instituted, however the man died after 25 days in hospital. Thirty-two people who had had close contact with him received post-exposure treatment.

According to his family, the man had an "encounter" with a dog three months earlier in India. The nature of the encounter was not known, and family members didn’t know whether he had received rabies post-exposure prophylaxis. (Considering post-exposure prophylaxis is pretty much 100% effective, I think it’s safe to assume that he didn’t). The rabies virus variant that was isolated was consistent with the strain found in dogs in India, providing more support to the suspicion that the infection was associated with this incident.

Travel-associated rabies is an important problem. This is the 7th case of rabies (and 7th death) in the United States acquired abroad since 2000. While rabies is rare in the US (and many other developed countries) it still kills tens of thousands of people each year, most of whom are infected by dogs. Rabies is endemic in dogs in many regions, including India.

People who are traveling need to be aware of the infectious disease risks in their intended destinations, be it yellow fever, malaria, rabies or others, and take appropriate precautions. Rabies vaccination is not indicated for travelers unless they are going to be working with wildlife or feral animals. The key for travelers is to understand that rabies exposure is a risk, that they must avoid contact with stray animals, and what to do if they are bitten. Access to rabies post-exposure prophylaxis may be limited in some regions, and people who are bitten by a suspicious animal may need to travel home to get proper treatment.

Rabies exposure is considered a medical urgency, but not an emergency, meaning you usually don’t need to sprint to the airport and get treated within a few hours. Rather, it means get to a physician as soon as possible – so don’t continue the rest of your vacation and then head to a physician a week or two later. The more severe the bite and the closer to the head that the bite occurs, the shorter the incubation period might be, so there are some situations where "urgency" and "emergency" are hard to differentiate, but the key is to be aware and get proper care as soon as is reasonably possible.

Image source: Humane Society of the United States (HSUS) (click for source)