Rabies

Rabies virus is present on every continent except Antarctica, and is not uncommon in developing countries. For travelers, leading regions of exposure include : Asia (57-76%), Africa (10-28%), and South/Central America and the Caribbean (8-13%). Dog bites are thought responsible for up to 99% of rabies virus transmission to humans in endemic regions. Canine rabies as well as rabies in terrestrial mammal wildlife is endemic in parts of Afghanistan, Bangladesh, Bolivia, Brazil, Cambodia, China, Colombia, Ecuador, El Salvador, Guatemala, Haiti, India, Indonesia, Mexico, Morocco/Algeria, Myanmar, Nepal, Pakistan, Peru, Philippines, Sri Lanka, Thailand, Vietnam, and Yemen.

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The reservoirs of rabies virus are carnivores (dogs, cats, monkeys, other terrestrial mammals) and bats, which can transmit the disease before they show any signs of it. While traveling, therefore, contact with dogs and all other animals should be avoided even if they seem healthy. In 83 cases of imported rabies in travelers and migrants tabulated during 1990-2019, the involved animals (where information was available) were dogs (91%), cats, raccoons and foxes (5%) and bats (4%). Wolves, jackals, skunks, mongooses and non-human primates (e.g., monkeys) are additional wildlife of concern. Domesticated outdoors animal (e.g., dogs, cats, ferrets) can also be bitten and, if unvaccinated, then pose a possible risk to humans.

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In case of exposure (bite, scratch, licks to open skin breaks or mucosal surfaces or suspected contact), seek medical advice and wound care immediately.

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Travelers with extensive outdoor exposure in rural areas, particularly in the countries listed above as well as most of Africa, may also be at risk, depending on the region visited, and thus be candidates for pre-exposure prophylaxis. Cave explorers should never handle bats.

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Vaccination against Rabies

 

Pre exposure vaccination

Possible Indications

- Professional exposure: veterinarians, animal control and wildlife workers, hunters.
- Travel, including for extended periods in rural remote areas, to Asia of (South and Southeast Asia), Africa and Latin America and in particular to Thailand, Indonesia, Nepal, India, China, Vietnam, Cambodia, Philippines, Morocco/Algeria and Mexico. However, other countries also report rabies.
- Shorter trips with high-risk activities such as hiking, camping, biking, spelunking or visiting religious shrines in remote areas.

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Pre-exposure vaccination (revised by ACIP in February, 2021):

Rabies Vaccine:
Two intramuscular (IM) injections in deltoid muscle of 1.0 ml on days 0 and 7 for adults, including pregnant women and children.

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Booster:

For those who received PrEP (2-dose IM series) in the previous 3 years but remain at continued risk or have a subsequent risk of rabies exposure (revised by ACIP in February, 2021)
 

Additional information: CDC Health Information for International Travel 2020, Rabies, p. 316-325.