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Rabies is an acute viral infection that causes inflammation of the spinal cord and the brain (encephalomyelitis) typically resulting in death. Rabies is found on all continents except Antarctica. Most cases of rabies occur in Asia, Africa and South and Latin America. It is usually spread through a bite from an infected animal, most commonly through saliva from a dog bite, although bats, monkeys and cats are also a potential source of infection and considered a rabies risk in some countries.

The incubation period for rabies is typically 1–3 months, but it can range from under a week to over one year [1].

The rabies virus transfers from the site of exposure to central nervous system resulting in headaches, fever, general weakness and numbness or tingling around the wound site. The disease progresses to muscle spasms, hydrophobia (fear of water), aggressive behaviour and convulsions. The time course of disease progression falls into two types. 'Furious' rabies, is the most common and more aggressive form of the disease, death typically occurring a few days thereafter, by cardio-respiratory arrest. Paralytic rabies, which accounts for the remaining 30% of cases, has a longer time course with gradual muscle paralysis eventually leading to coma and death [1].

Death is almost always the outcome of rabies infection once the disease progresses to the central nervous system.

There is no specific treatment available for rabies once symptoms develop.

If bitten by an animal, saliva must be washed off thoroughly with soap and water and the wound irrigated with iodine solution or alcohol to kill bacteria locally.

Even if you were vaccinated against rabies before travelling, it is imperative to seek medical attention as soon as possible if you sustain a bite or scratch in any rabies endemic area. The attending doctor should carry out a thorough risk assessment to determine the most appropriate post-exposure treatment which typically involves immediate vaccination and possibly the administration of rabies immunoglobulin. (Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.)

Recommendations for travellers
Rabies is present in most countries throughout the world. The best way to prevent rabies is to avoid direct contact with dogs and other animals that could be rabid when travelling in areas where rabies may be present. Anyone who intends to travel through areas affected by rabies should be vaccinated against the disease before travelling. Vaccination is particularly important if you plan to spend significant time outdoors including trekking, caving, cycling and hiking. It is also important to vaccinate children, who are an easy target for infected animals. Two rabies vaccines with good safety and efficacy profiles, for intramuscular use, are currently available in the UK. 

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Rabies vaccination. Here’s the point...

Rabies vaccination. Here’s the point...

Rabies deaths in the UK are a rare occurrence but it does happen. In 2012 a British woman died while being treated in isolation at the Hospital for Tropical Diseases at University College Hospital, London. She contracted the disease after being bitten by a free roaming dog while on holiday in India – where there are millions of dog bites every year and around 20,000 related rabies deaths[5].