Rabies vaccination - is it worth it?

Bigzero

Some quotes from the wikipedia entry on rabies..

http://en.wikipedia.org/wiki/Rabies


On when the symptoms will start...

The period between infection and the first flu-like symptoms is normally three to twelve weeks, but can be as long as two years. Soon after, the symptoms expand to cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, hallucinations, progressing to delirium. The production of large quantities of saliva and tears coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in "hydrophobia". Death almost invariably results two to ten days after the first symptoms

On treatment...

Treatment after exposure, known as post-exposure prophylaxis or "P.E.P.", is highly successful in preventing the disease if administered promptly, within fourteen days after infection. The first step is immediately washing the wound with soap and water, which is very effective at reducing the number of viral particles. In the United States, patients receive one dose of immunoglobulin and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of immunoglobulin is injected in the region of the bite, if possible, with the remainder injected intramuscularly away from the bite. This is much less painful compared to administering immunoglobulin through the abdominal wall with a large needle, which is how it was done in the past. The first dose of rabies vaccine is given as soon as possible after exposure, with additional doses on days three, seven, fourteen, and twenty-eight after the first. Patients that have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations.

Hope this helps..

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Selkie

So, if travelling in, say, Rajastan for a month would it be worth getting vaccinated against rabies?

Do people generally not bother with getting vaccinated against this when coming to India?

When I came to Kerala it wasn't even mentioned in the thravel clinic for my jabs.

(Also, is the situation re rabies in Nepal likely to be the same as in India, i.e. quite common?)

Nick-H

If rabies was quite common in India it would be absolutely stupid to come here without having the vaccination.

I don't believe it is.

Questions to ask yourself...

Are you going to be working with any of the animals that carry Rabies and can pass it to a human?

Are you going to be travelling any place where you cannot get to a good hospital quickly?

If the answers to either of these questions is 'yes' then you probably should. Far more importantly, you should know about the disease and what to do in case of being bitten by, eg, a dog.

By and large, I think your questions have mostly been answered.

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Sarah55

I have just had my second pre-exposure jab.

I decided it was worth it, as, although I am only in India for a couple of weeks, I will be far from a city, and it would certainly be impossible to get post exposure treatment within 12 hours, (nd very unlikely to get it within 24, unless I was really lucky with timings and help from others) I'm travellin alone and just think the whole business would be very stressful.

Yes, it costs a lot, but that extra 24 hours could make all the difference, and it buys my family at home some peace of mind too. One booster within the next five years will take my cover up to ten years.

PeakXV

After all - Peace of mind is the best medicine.

It really is a bit surprising as to the different standards that exist throughout the world on these innoculations. I really think that one would have to almost 'pull a gun ' at any travel/tropical medicine clinic in Canada(USA?) to get these jabs - they just don't seem to be a priority, rarely in stock, & extremely expensive when available.

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Don't go to India ~ Pre-trip Warnings & Misconceptions?

edwardseco

Hope you cleaned to wound as that helps a lot with Rabies. Odds are that you don't get it. Its an odds game. An oddity is that someone actually survived getting it in the last couple of years. Her condition though..

Oyar

Are you going to working with animals? Are you in the habit of aggravating dogs / cats / monkeys?

If yes to the above ... then you might have some peace of mind in getting yourself vaccinated before hand.

The type of treatment all depends on the vaccination you are taking. For eg. rabipur will have its own dosage & recommended usage. What works for Rabipur ... might not work for another brand.

The treatment where you have to take multiple injections around the bite / in the stomach was used in government hospitals .. for poor patients who cant afford the more expensive injections. Nobody uses this. atleast not in the last 15 years in India !!

Just in case you are bitten by a dog which you suspect is rabid - the ideal course of injections (rabipur) would be -
Injection 1 - (Day Zero)As soon as possible. But NOT later than 24 hrs.
Injection 2 - Day 1 after bite
Injection 3 - Day 3 after bite
Injection 4 - Day 7 after bite
Injection 5 - Day 15 after bite
Injection 6 - 3 months after bite
Booster shot - 1 year (Optional)

Also rabies can be contracted from Dogs, Cats, Monkeys, Rats, Bats, etc. It is also a mis conception that only if you are bitten you can contract rabies. Even if any of the above scratch you & draw blood from your body ... it is adviceable to go through a minimum course of anti rabies.


On 2nd thoughts -

What is the rationale behind taking a vaccination if you are going to stay in India for more than 28 days????? Does the dog / cat / monkey ask you before biting- 'are you staying for 27 days or 29 days??' Or is it that a rabid dog has an ineffective bite if you return within 1 week? or is it that all animals in india pounce on you if you stay more than a month?

At this rate ... I think everyone coming to India should also take -
Anti maleria
Anti hepetitis
Anti aids
Anti dysentry
Anti tetanus
Anti polio
Anti leprosy
Anti TB
Anti conjuntivitis
Anti herpes
Anti chicken pox
Anti measels
Anti mumps
Anti piles
Anti Yellow fever
Anti birdflu
Anti plague
Anti sars
Anti hydrocele

BTW - your chances of slipping in your own bathroom are 48 times higher than getting rabies in India!

Nick-H

Our cat got an anti-rabies injection at the vet.

I asked her if, as we were now going to live with a houseful of cats, if she thought we ought to: she said no.

brownboy66

this is good advice. I guess its natural to assume you can only contract rabies from dogs - not so. Thinking of visiting any temples where there are monkeys, rats, etc? Here in Delhi - the monkeys are far more aggressive than the dogs (having the stray dogs around is actually quite nice - they keep the monkeys away).

In case anyone was wondering, last time we had this discussion I got hold of some stats which said there were 3-3.5 million dog bite cases in India. 70% of all rabies cases in the world - happen in India causing 30,000 deaths per year.

Dealing with Dogs?

so I guess when you consider the number of people in India the chances of dying from rabies is less than .1 percent. If you're one of the 30,000 however, doesn't matter as you're 100 percent screwed.

kristinm

I did get attacked by a monkey in Bundi - and I didn't antagonise it, merely walked up the stairs to the rooftop without noticing it hiding behind the wall! Its teeth missed thank heavens but it did scratch me quite badly through 3 layers of clothing...huge black bruise and red scratches but no blood though so I didn't rush off for rabies treatment, I guess I would have had it drawn blood.

So - although not actually working with any animals I still managed to get attacked!!!

kristinm

OK - this thread has a lot to answer for, I started worrying and of course checking the internet after that bloody Wikipedia entry!! I rang my partner and he said that there were in fact a few drops of blood - we did disinfect it immediately.

SO then I rang the NSW HEalth infectious diseases people and the upshot of the whole thing is that I am now going to have a course of post-exposure injections - just to be on the safe side....Apparently even though it was 30 days ago the injections will still be useful if there were any danger of infection.

Apparently as it is carried in saliva the animal would have to have been licking its paws immediately prior to scratching me... well it was eating a chapati!!!

machadinha

I wasn't gonna say a word Kristin, and I for one am not one who understands why one would want a preventative rabies shot going to a place like India unless one were a prospective vet or spelunker or something (although I quite appreciate and respect someone like Sarah's considerations above -- that would indeed sound like a situation where you might want to have it) -- but you had described the event before and I think this is a wise course of action.

As for licking its paws shortly before, have you ever observed wild animals? That's what they do.

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kristinm

I guess the only moral of the story is that - as with other wild animals in other touristy places, such as the dingos on Frazer Island in Australia - maybe our chances of being bitten or scratched are actually a lot higher than they used to be.

It seems the animals in some places - bears in parts of the US, dingos and kangaroos here, monkeys in India etc are getting way too used to human contact, and way too ready to be aggressive when they don't get the food they have been conditioned to expect. The dingo attacks are increasing on Frazer Island, and kangaroos in some camping areas have injured people and wrecked campsites looking for food. The monkeys in Bundi certainly seem to fit this pattern - apparently they are getting more aggressive each year...

So maybe rabies shots are moving up the list of necessary things???

I think the saliva would have to be basically still wet on the paws...well that was what I gathered anyway.

HEY EVERYONE - DON'T FEED THE WILD ANIMALS... OK????!!!!

terreneuve

i'm going in for my second shot tomorrow!

i'm in canada, and my doctor DID suggest i get the vaccine, although didn't pressure me into it, due to the cost. there was one thing that she mentioned that hasn't come up in this discussion as far as i can tell. from what i understand, if you get bitten and you haven't had the vaccines, the treatment shots contain blood matter (basically you're getting some kind of transfusion??). she said the blood in india wouldn't have been screened for various viruses, HIV for example, so you'd be taking an added risk there. Also, as mentioned previously, the treatment process is MUCH more intensive if you haven't been vaccinated. took me a while to decide if it was worth it, but in the end i opted to be on the safe side (it helps that all my shots are 80% covered by my boyfriend's insurance!).

machadinha

No, of course that's not the case, at a decent clinic it would be.

As for rabies, it could conversely be argued you'll need a full treatment anyway if you do get infected, the initial preventative shots will just buy you some time.

But, hey, and as always, I'm no doctor, we can argue about it till we're blue in the face. As for Kristin's arguments, yes, that's possible, or maybe we're just leaving those animals with too little space to live, and hence our mutual encroachments will increase. There's been quite a stink here of late about wild boars uprooting people's lawns (in those fancy areas where there's a remote possibility, and where people have anything that could be called a lawn to begin with, of course); I'd personally love one or a family in my yard, but whatever. I mean shouldn't we be happy to have them around still in some remote spots to uproot anything at all?