Rabies is an acute viral infection that causes inflammation of the spinal cord and the brain (encephalomyelitis). It is usually spread through an infected bite or scratch from a rabid animal, most commonly through a dog bite. In other parts of the world other animals such as bats, monkeys and cats are a source of potential exposure to the disease. Very rarely, the disease has been spread through body fluids and transplant tissues.
Rabies is found in all continents of the world except Antarctica. There are more human cases of the disease in Asia, Africa and South and Latin America.
The incubation period for the disease is usually between 3 to 12 weeks but may range from 4 days to 19 years in some cases. The virus causes headache, fever, general weakness and numbness or tingling around the wound site. The disease progresses to muscle spasms, hydrophobia (fear of water) and convulsions. Death is the usual outcome if infected with the rabies virus.
There is no specific treatment available for rabies once symptoms develop.
Vaccination is recommended for all travellers who will be living or travelling in endemic areas and who maybe exposed to rabies because of their travel activities i.e. trekking, working or living in rural areas. Two vaccines may be used in the UK to protect against rabies: Rabies Vaccine BP and Rabipur.
Some individuals may require vaccination based upon their occupation. Such occupations include bat handlers, those working in animal quarantine centres and certain HM revenue and customs officers.
It is imperative to seek medical attention within 24 hours if a bite or scratch is sustained in any rabies endemic area even if pre-travel vaccination has been given.
Saliva should be thoroughly washed off with soap and water and the wound irrigated with iodine solution or alcohol. This is very effective in removing virus from the bite site, providing it is prompt and thorough. Suturing of the wound site should be avoided and tetanus vaccination should be considered.
A thorough risk assessment should be carried out by the attending doctor where appropriate treatment should be given.
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