scruffy-puppyEvery few weeks I get a call or an email about travel-associated rabies exposure concerns. It’s usually from someone traveling to southeast Asia or India who has been bitten by a stray dog. Most of the time, it’s an unvaccinated person and the dog isn’t available for monitoring or testing. Since rabies is endemic in dogs in those areas and there’s no way to rule it out if the dog isn’t identified, it has to be considered a possible rabies exposure and is an indication for post-exposure prophylaxis (PEP). Sometimes PEP can be done in the country being visited, but often it’s done when the person gets home. In most situations, rabies exposure is best considered a medical urgency not a medical emergency. The incubation period for rabies is pretty long, and as long as PEP is started in a reasonable period of time, rabies is virtually 100% preventable. There are some situations where very prompt treatment is indicated, such as a bad bite to the head or neck, since rabies virus can move through the nerves to the brain much quicker in such a case given the close proximity.  With most exposures, there’s usually ample time to organize things and get home for treatment, often without needing to change travel plans.

Unfortunately, lack of awareness leads to rabies deaths. That’s a big problem in developing countries where the virus is endemic and thousands die ever year, but public awareness of what to do is still poor.

It’s also an issue with travelers. People often don’t go to travel clinics before visiting these regions or if they do, they don’t want to pay the rather expensive cost of pre-exposure rabies vaccination. Most often, they get away with it. However, travel associated rabies deaths occur occasionally.

A recent example is a person from Virginia who contracted rabies from a dog bite in India. I haven’t seen many details about the case, but I expect more information will come in the form of a CDC publication in the future.

Regardless, it’s a reminder that this disease is a major concern in many parts of the world, particularly areas in Asia, India and Africa. Vaccination isn’t cheap, but it’s a highly effective preventive measure for an almost invariably fatal disease.

It’s also a reminder that travelers need to know the risks and what to do. Without vaccination, rabies is still almost completely preventable if post-exposure prophylaxis is started, even weeks after exposure.

Thinking about things that can kill you isn’t at the forefront of people’s minds when planning a trip, but a little prevention can go a long way.