Clinic visits for an animal bite were investigated in a number of international health clinics over a 12-year period (Jan 2007 to Dec 2018). More than six thousand animal exposures were recorded with most occurring in southeast Asia (71%). The majority (76%) involved dogs, cats and monkeys.
Animal bites are a common health issue in overseas travellers. The health implications are important, particularly regarding mammalian bites which carry the risk of rabies in many overseas countries.
Animal bites also run the risk of serious infection and early management is the key to prevention.
Advice regarding certain animals seems very straightforward: “Don’t pat dogs, pick up pussy cats or feed the monkeys. Bats should always be avoided”.
The advice is simple but not always followed. Even if you follow the rules there is still the possibility of an unprovoked attack. This is not unusual. A potential rabies exposure is a medical emergency.
- Clean the wound thoroughly with soap and water.
- Seek health advice as soon as possible. Further management will depend on where the injury took place. If you are in a country where human rabies is reported, then you will be offered post exposure prophylaxis. This is very effective but must be undertaken as soon as possible after the injury. In a person who is has not received rabies pre-exposure vaccination, it is important to commence post-exposure prophylaxis immediately. This is provided using RIG (Rabies Immune Globulin) and involves injecting the site of the wound. Vaccination is undertaken at the same time. The course of injections is usually 4 doses over 14 days (0,3.7 14). Sometimes a fifth dose is given. In the case of someone who has been vaccinated previously, there is no RIG and just 2 booster doses given on days 0,3.
Post-exposure prophylaxis for rabies has been shown to be very successful in the prevention of the disease, yet we still see reports of deaths in travellers. There are 2 main reasons.
- Many travellers do not follow up on exposures – they see the injury as trivial and believe the animal unlikely to be rabid. Expatriate workers, in particular, become very complacent about many health issues with time. These individuals are often targeted for pre-exposure vaccination.
- A lack of RIG in many overseas countries. The management of the potential rabies exposure is not consistent with best practice.
There are definite advantages in being vaccinated.
It gives you more time to receive advice and treatment and you will only require 2 booster doses. Frequent travellers to countries reporting endemic rabies should consider pre-exposure prophylaxis.
