Evans Travel Health

With the current shortage of supply of rabies vaccine and the recent death in the UK brings around the annual question why do so few travellers consider this as a risk when travelling outside of Europe.

A quick review of online advice provides a wide range of opinions. The true clinicians warn of the dangers and the national guidelines suggest a course of pre-travel exposure vaccinations.

Looking deeper at the sites that many of the younger travellers review produces comments from travel bloggers who suggest in some cases that rabies is not necessary or of a lower risk. They appear to base their claims on the fact that a) they never had it for travelling; b) they never saw any rabies c) the locals informed them there was no rabies or d) the treatment was available within 72hours. On the basis of this limited and biased information they suggest that rabies remains optional and if exposed then local treatment is available. 

The main point of their mis-understanding is that as untrained in clinical advice, they are unaware of the difference in post-exposure treatment (PET) pathways and also the level of risk.

Looking at the level of risk the ISTM produced a paper which looks at the level of risks of diseases. An animal bite with rabies risk is calculated around 1:100 incidence; comparing this to typhoid (1:2800) and hepA (1:9000) puts the level of risk into a different perspective.

Considering the cost of treatment for PET

Pre-travel vaccination course completed - 2 doses of rabies IM, 3 days apart, ave price $30/vial. Total cost $60.

No pre-travel vaccination course- 4 doses of rabies IM, over 21 days, total cost £120. If dog bite (WHO indicates that 90% of cases are from dogs) then RIG is required at an average cost $500 per vial, an average male may require 2 vials. Availability of RIG is commonly questioned and some areas e.g. Bali may require to import this from another country or send the patient to another destination.

To answer the points above, just because they have not seen rabies, did not receive it themselves is not a guide to the level of risk at a location. Neither is the advice from the local guides as they may have commercial reasons for tourism. Finally treatment is a global health concern and may not be readily available - causing increased travel costs and itinerary changes.

In conclusion, there needs to be a foil to some of the travel blog sites and bloggers that their interpretation of the risk towards rabies is flawed and a balanced understanding should be suggested.

Reference

Steffen R et al. Vaccine-preventable travel health risks: what is the evidence-what are the gaps? Journal of Travel Medicine 2015; volume 22 (issue 1) 1-12.