Symptomatic rabies is invariably fatal and rabies vaccine is often discussed in a travel consultation.

Three vaccines are available in Australia. These include, Merieux, Rabipur and Verorab. They are all interchangeable and have a similar protective efficacy.

For long term protection, three doses of the vaccine are given over 3 to 4 weeks (0,7, 21 or 28 days). If a bite occurs a further 2 doses are always recommended but a delay is more tolerated.

A 2-dose +schedule (0,7 days) may be offered to travellers. A booster dose within 3 years can then be given for life-time cover. Two booster doses are still required in the event of an exposure.

All three vaccines are well tolerated. Side effects include local tenderness and swelling, headache, general tiredness, and nausea.

A discussion on how to avoid animal bites should be part of any pre-travel consultation.

This is particularly important in countries where dog rabies is reported.

Vaccination might be offered to expatriate workers and long-term travellers (backpackers in particular) in countries of risk. Both these groups have cumulative risk over time and animal bites are common. Those travelling “off the beaten path” may also consider vaccination. Access to post-exposure treatment (including rabies immune globulin (RIG) might very limited and there is a time concern from the time of the bite to when treatment is started. Families with children might also consider vaccination. Children are more likely to be bitten around the head and neck rather than hands and feet. This might influence the incubation period to serious disease. A vaccination in childhood is likely to provide protection for their young adult and adolescent adventures down the track.