Rabies Travel

Preventive vaccination is not indicated for the ordinary traveller. However it may be recommended for trekkers, peace corps workers and expatriates (especially children older than one year) in the high-risk areas of Africa, intertropical America, Middle East, Indian subcontinent and Southeast Asia.

In rabies-endemic countries, the risk to travellers is proportional to their contact with potentially infected animals (domestic, captive and wild). In tourist resorts the risk for most travellers is very low. However the risk may be higher for children who may contact animals and do not report incidents like bites or scratches. Following a suspect contact, first aid measures should start immediately and medical advice should be sought at once.

High risk countries (enzootic rabies): Colombia, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, India, Mexico (some regions), Nepal, Pakistan, Peru, Philippines, Sri Lanka, Thailand and Vietnam.

Low-moderate risk countries: Austria, Bulgaria, Canada, Czech Republic, Germany, USA (some regions) and Switzerland.

For up to date information on countries with rabies risk, visit the following sites:

The pre-exposure primary vaccination consist in three doses given at days 0-7-28 (inactivated vaccines). The vaccines are given intramuscularly (deltoide or quadricipes muscles) or deep subcutaneously (individuals with bleeding disorders). Pre-exposure vaccination does not eliminate the need for additional therapy after a rabies exposure, but eliminates the need for specific immune globulin and allows the reduction of the number of vaccine doses required.

The post-exposure prevention of rabies depends on the individual immunization status. For persons not previously vaccinated, post-exposure anti-rabies vaccination must include the administration of human immune globulin and vaccine; this is recommended for both bite and nonbite exposures, regardless of the interval between exposure and begining of treatment. Persons who have been previously vaccinated should receive only vaccine. The recommended post-exposures prophylaxis are as follows.

Treatment	Regimen
Wound cleansing	● All wounds must be cleaned with soap and water. If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds.
Human immune globulin	● The full dose should be infiltrated around any wounds and any remaining volume should be given intramuscularly at an anatomical site distant from the site of vaccine administration; ● Immune globulin should not be administered in the same seringe as the vaccine.
Vaccine	● Must be administered on days 0-3-7-14-28 (five doses).

Treatment	Regimen
Wound cleansing	● All wounds must be cleaned with soap and water. If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds.
Human immune globulin	● Should not be administered.
Vaccine	● Should be administered on days 0 and 3 (two doses).