The virus attacks the central nervous system causing, progressive damage to the brain and spinal cord. Once symptoms are present, rabies is almost always fatal.

Human rabies cases are often unreported so it is difficult to provide reliable figures on the incidence worldwide. The disease is estimated to cause 59,000 human deaths annually. Rabies is rare in travellers with only 25 human deaths in the UK from imported rabies since 1946.

Although rabies cases are rare in travellers, animal bites and scratches are common. It is important that travellers visiting areas where rabies occurs are aware of the risk and know what to do if they are bitten or scratched. The disease is preventable if the correct post-exposure treatment (PET) is provided quickly. PET can be expensive and difficult to obtain in some areas.

Prevention

Contact with wild or domestic animals during travel should be avoided. Travellers should also be advised:

• not to approach animals.
• not to attempt to pick up an unusually tame animal or one that appears to be unwell.
• not to attract stray animals by offering food or by being careless with litter.
• be aware that certain activities may attract dogs (e.g. running, cycling).

The following advice can be given regarding first aid following a possible rabies exposure:

• Urgent action is required; treatment should be commenced as soon as possible after the exposure.
• Immediately wash the wound with detergent or soap and running water for several minutes.
• Apply a disinfectant to the wound such as an iodine solution (tincture or aqueous solution of povidone-iodine) or 40-70 percent alcohol.
• Apply a simple dressing to the wound.
• Seek immediate medical advice about the need for PET and possible antibiotics to prevent a wound infection.
• Tetanus vaccine may be necessary if the traveller is not up-to-date.
• Suturing of the wound should be postponed until PET has started.