Q: I am taking a long delayed dream trip to Africa for safari and mountain climbing. I saw a recommendation at CDC.gov/travel that we get vaccinated for rabies. Is that necessary?
A: It depends. Many people are surprised to learn there is still no cure for rabies and once infected, there is a nearly 100% chance of death. Humans are infected from the bite, licks or scratches of mammals. In America, the most common sources are bats, raccoons, skunks and foxes. So avoid contact with unknown animals, even at home.
On international trips, the same risk applies. On safari, your greatest risk is not from a lion bite (you will have more immediate and pressing issues!) but that cute, neglected dog wandering around your camp at night. Worldwide, the most common source of potential rabies-infected bites in travelers comes from dogs.
Remember, when traveling internationally, you are no longer at home. Sometimes travelers think that a beautiful destination in a developing country is an extension of the U.S. — but these locales may have quite limited medical resources. That is important to keep in mind in general for safety and health issues. In developing countries, it is safe to assume that no domestic animals are vaccinated against rabies.
When thinking about rabies prevention, review your risk of bites from animals. If you’re a veterinarian going on a humanitarian trip or biologist doing cave research, you’re at a much higher risk. Another situation is the “monkey temples” in Asia offering close encounters with aggressive monkeys. If you are one of those people who cannot possibly resist the urge to pet and snuggle every stray dog and cat that wanders by, then you, too, should consider vaccination. However, if you are going on a typical guided trip with low risk of direct contact with animals, your risk and therefore need for rabies vaccination is likely quite low.
Getting a pre-exposure rabies vaccine means two shots, one week apart. In the event of a bite, you would still need to get two more shots of the same vaccine, quite often available even in remote locations. However, if you have not had any preventative shots prior to a significant bite or encounter, you will need an expensive and often difficult to obtain antibody injection (HRIG) at the infected site (usually hands, arms and face) in addition to four shots over a month’s time, which often means your trip is over.
Regardless of your vaccination status, all wounds need 15 minutes of constant flushing with clean water and soap followed by good wound care.
So, now you understand why the answer is complicated. Fortunately, the CDC recently simplified its advice. Contact your local travel medicine provider for personalized guidance in making vaccine decisions. And save your love and kisses for Fido or Fluffy back at home.
Dr. Richard Moody is a certified travel health physician with Chattanooga Family Practice and the president of the Chattanooga-Hamilton County Medical Society.
Dr. Richard Moody