A rabies death in a UK traveller

The UK Health Security Agency has recently reported (June 18, 2025) the death of a British traveller who had a stray dog exposure while travelling in Morocco. The individual was diagnosed in northern England.

According to the report, there have been 6 previous notifications of rabies-related deaths in the UK from 2000 to 2024. All were from exposures abroad.

This is not an isolated report.

Global cases of rabies

In 2019 a Norwegian traveller died at home, more than 8 weeks after returning from a holiday in the Philippines. She had been bitten by a stray puppy and had not followed up on the bite while abroad or at home.

In 2018, a British traveller died after being bitten by a cat in Morocco. She was not followed up for the exposure.

In 2017 a 10-year-old boy died after returning to France from a holiday in Sri Lanka. He had been bitten by a stray dog on a beach.

The disturbing feature of all cases is the failure to seek medical advice after a “warm blooded furry animal” exposure. The need for urgent medical advice in the event of exposure should always be part of any pre-travel advice for travellers to rabies endemic countries.

Who’s most at risk?

Over half the deaths are in children under 15 years. Children are more likely to be savaged around the head and neck region. The proximity to the central nervous system can mean a shorter period before symptomatic disease.

The disease is almost invariably fatal once symptoms occur.

A preventable public health crisis

Rabies occurs in more than 150 countries worldwide with dogs responsible for more than 99% of human cases.

It is estimated that more than 50,000 people die of rabies annually and many deaths go unreported.

Three or four traveller deaths are reported each year.

Pre-travel protection vaccination can save lives

Rabies deaths are preventable.

The consideration of a course of a course of pre-travel rabies vaccinations should be based on individual circumstances.

Excellent vaccines are available for long term protection and post-exposure prophylaxis is very effective, in the event of an exposure.

According to the World Health Organisation (WHO) an estimated 29 million people receive post exposure prophylaxis for rabies every year.

Simple rules that reduce your risk

The risk of exposure can be dramatically reduced by just following some simple rules.

Avoid any engagement with animals.

DO NOT:

• Pat dogs
• Pick up pussy cats
• Feed monkeys

What to do if you’re exposed

If you are unfortunate to have an exposure, seek medical advice as soon as possible.

Prompt management of the wound is also vital. It should be gently cleaned with copious amounts of soapy water before applying a virucidal solution like povidone-iodine. This also helps to reduce the risk of bacterial secondary infection.

Resources for travellers and clinicians

The Australian Immunisation Handbook provides very useful advice on the management of a possible exposure to rabies or lyssavirus. There are 3 categories of exposure.

Category I: no exposure

• Touching or feeding animals
• Animal licks on intact skin
• Exposure to animal blood, urine or faeces

Category II: exposure

• Nibbling of uncovered skin
• Minor scratches or abrasions without bleeding

Category III: severe exposure

• Single or multiple transdermal bites or scratches
• Contamination of mucous membrane or broken skin with saliva from animal licks
• Exposures due to direct contact with bats