27 September ▷Do I have to get vaccinated against rabies before traveling to another country…? 10 points to know

“Do I have to get the rabies vaccine before traveling…?” It is a very frequent question among international travelers and workers.

The answer will depend on multiple factors such as where you are going, how long you will spend there, what activity you will develop, how far-sighted you want to be…etc.

But… What is rabies and what types exist?

It is a viral zoonotic disease, that is, a naturally animal infection that, due to various circumstances, ends up reaching us.

Depending on the development of the disease, rabies can be:

• Furious (the most frequent).
• Paralytic.

Depending on the reservoir, that is, the animal where the virus is hosted, rabies can be:

• Urban.
• Wild.

Who is the usual reservoir of the rabies virus?

Mainly, bats.They can be asymptomatic carriers and present latent infection. Basically, they can contribute to the spread of the rabies virus without it being lethal to them.

However, they are not the only ones or the ones that have caused more incidents throughout history. We have on the list, first of all, dogs, representing the main reservoir in some low-income countries, followed by cats and to a lesser extent, foxes and primates, among others.

Humans are merely an accidental reservoir.

Where is the highest prevalence of rabies?

Roughly, in Africa and Asia. In some countries of Latin America it is still a problem, although the situation has improved considerably in recent years.

In Europe and North America, it can be said that we are lucky, since it is practically eradicated (although the virus still exists in bats... but it is not usually a cause of concern). The nearly virus elimination has been achieved thanks to high canine vaccination rates. It is very important to be responsible with the vaccination of our animals, since it is the best prevention to cut the cycle.

How is the rabies virus spread and what is its evolution?

Through saliva of an infected animal. It can be from contact with a wound or mucous membranes of the human being or from direct bite. Sometimes, although less commonly, it can be spread through a transplant or by laboratory inhalation.

Once the virus is inoculated, there is a incubation period ranging between 20 to 90 days, but in some cases it can even last a year (depending on the point where the person was bitten and the viral load).

The most common symptoms are:

• Hydrophobia, aerophobia, hypersalivation, pupil dilation, sweating, agitation, hallucinations... (furious rabies).
• Paralysis of muscles, rigidity, among others (paralytic rabies).

The last stage will be coma and then death.

What is the treatment of the rabies virus?

There is no treatment. That is why PREVENTION (vaccinating dogs and cats) is so crucial. The possibility of dying after being infected with rabies is extremely high. The real problem is that it will not be diagnosed until the first symptoms appear (clinical phase). Once these appear...the rabies will be LETHAL almost in 100% of the cases.

From 1970 to today, only about 15 unvaccinated people have survived the rabies virus…so you can imagine the seriousness of the matter.

For whom is the pre-exposure vaccine recommended?

The pre-exposure vaccine serves as prevention and is recommended in:

• Veterinarians, laboratory staff in contact with the virus and workers in connection with certain animals in rabies areas.
• Travelers going to places where there is a high prevalence of rabies and where access to health services is expected to be difficult. Actually, cases in travelers are not so frequent, but it can happen...

How do I proceed if I decide to get vaccinated against rabies before traveling?

• First of all, you have to do it at least one month before.
• Always go to a international vaccination center for advice. In Spain, the vaccination and travel assistance centers of each Autonomous Community can be consulted on the website of the Ministry of Territorial Policy.
• In situ, they will inform you of the pre-exposure vaccination guidelines existing. Continuing with the example of Spain, the best known has been: 3 doses on days 0, 7 and 21 or 28 (intramuscular, usually in the deltoid muscle). However, the latest WHO recommendations indicate 2 doses on days 0 and 7 (intramuscularly) or 4 doses (intradermal), 2 on day 0 and 2 on day 7.
• But attention…they are not the only ones, there are other pre-exposure vaccination guidelines.

What do I do in case of a bite during my trip or stay?

• The very first and immediate, wash with soap and water (better under pressure) the wound for 5 minutes at different times (at least 3 times).
• Disinfects the wound well.
• Analyze the situation:
  • It's a wild animal or dog/cat of unknown origin (with symptoms or not)? Yes —> Go to the emergency services.
  • Does the animal lacks vaccine against rabies? Yes —> Go to the emergency services.
  • I'm vaccinated against rabies? Whether you are or not, if the previous 2 questions were positive, go to the emergency services ipso facto because it is necessary to finish the vaccination schedule ASAP. Ideally, the first dose should be received within the first 24 hours, which is not always possible.

• Act quickly. Preventing the virus (if it is present) from spreading to the central nervous system is the most important thing. Washing and disinfecting the wound can make a difference.
• If this would be possible, the responsible animal has to remain under observation for at least 10 days, to assess whether he develops symptoms of rabies.

If I received previous vaccinations, do I need to be vaccinated against rabies again after an exposure?

Having received previous doses of the rabies vaccine gives a certain advantage because antibodies have already been generated and it allows more reaction time, but... it does NOT exempt you from re-vaccinating after a bite. It is essential that you go to the emergency services or a health center after being bitten by a suspicious animal.

Generally, if you were previously vaccinated with pre-exposure doses, you should only receive 2 extra doses after exposure (although it may vary depending on the country). If you were not previously vaccinated, you should receive the 5 consecutive ones, on days 0, 3, 7, 14 and 28 and very possibly the anti-rabies immunoglobulin, especially when the suspicion of infection is high and always in immunosuppressed people. Ideally, it should be provided within the first 24 hours. The bad news is that it is not so easy to find rabies immunoglobulin in some areas of the world nor in all the emergency services so you can see yourself in a truly harrowing time trial. So, it never hurts to get vaccinated before traveling if the possibility of contagion exists, no matter how small it may seem...

Other curiosities about rabies

After an animal bite, and always under medical evaluation, it is likely that you will also receive tetanus toxoid (the tetanus vaccine) and antibiotics, in order to avoid possible infections.

It is important to note that the rabies vaccine is safe for both children and pregnant women.

Also underline the fact that vaccination in human beings is a recommendation, never an obligation, therefore, it will be YOUR decision to pre-vaccinate or not against rabies before traveling to certain areas, weighing the pros and cons.

Lastly, it is essential not to panic in the event of an animal bite. Being bitten is not synonymous with getting sick. If the biting animal belongs to an acquaintance, friend or family member, if it does not behave strangely, if it is correctly vaccinated and if it is in a place where rabies is practically eliminated, it would NOT be necessary to go to the emergency services , unless the wound requires more attention to avoid other infections.

And you, would you vaccinate or not against rabies? Have you had any story to remember related to rabies on a trip? Share it with us!

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If you wish to cite this article in your academic works:

Martín-Rubio L. Do I have to get rabies vaccination to travel to another country? 10 points that should be known [Internet]. Madrid: Nutrition and Zero Hunger; 2022 [consulted day/month/year]. Available on: https://nutricionyhambrecero.com/personas-vacuna-rabia-viajar

Laura Martin Rubio

Teacher, Specialist in International Health, Cooperation and Communication in Health, Dietician-Nutritionist and Consultant/Auditor of Food Quality.