jenniferstone

Rabies Vaccination

48 posts in this topic

To all - this just goes to show the level of ignorance about rabies versus the current recommendations. There is NO reason for anyone to receive a prophylactic rabies (pre-exposure) rabies vaccination. This is a complete waste of money. If you should be bitten by any animal you can receive a very highly effective post-exposure series of vaccinations.....

 

 

This and the subsequent links summarise my understanding of pre-exposure rabies vaccination.

 

If you are unfortunate enough to get bitten by something you suspect to be rabid, you need to get medical attention pdq either way, and as the post exposure treatments are so effective, why bother with the pre-exposure vaccine?

Share this post


Link to post
Share on other sites

...very interesting. I am not an expert in this field myself, but I have had a lengthy discussion with friends of mine who are leading veterinary virologists and conservation biologists.

 

Rabies, from what I understand is a very frequent cause of human deaths in many developing nations. Apparently, there are hundreds of thousands of fatalities in Southeast Asia and India every year. The incubation period is weeks to months, however there are now strands in Northern Thailand that will incubate within a fortnight or less. After a bite and before incubation, treatment is usually successful, but can be cumbersome and intensive. After incubation, chances of survival are close to 0%.

 

When I think of where I could be at risk during safari travels, it would be in very few situations. Say at a small town airport where I just walk across the road to look at some curio stall, or near some village during a road transfer where I would step out for a loo break or to stretch my legs. As we usually find ourselves in such situations during our travels, both my wife and I have taken rabies shots some time ago. They weren't painful, by the way. The cost was less than USD 150 per person. Vaccin Rabique Merieux® is what we were given.

 

Brgds,

 

Patrick

Share this post


Link to post
Share on other sites

So glad I stumbled upon this topic! I loathe shots, and I've heard the rabies vaccine is painful (and, as mentioned, expensive), so I was worried about that. Very glad to hear it's not necessary.

Not more painful than any other vaccine I recall. The antidote, administered through the stomach in a series of shots, is supposed to hurt a lot. But better than the alternative.

Share this post


Link to post
Share on other sites

I would politely disagree with a couple of the posts above. But there is some very good information. Not trying to offend anyone, but some facts.

 

First, as mentioned, the vaccine does not in any way prevent the transmission of the disease. It only delays the imminent threat by about 48-72 hours. It basically gives you a larger window of opportunity to get post-exposure treatment. Once symptoms start- too late, you are dead regardless.

 

Second, as mentioned, the post-exposure treatment is nearly 100% effective. But that doesn't mean there is NEVER a time to get the vaccine. If you will be in an at risks location with a reasonable chance of exposure AND more than 48 hours from a hospital that has the treatment, then the vaccine helps fill the gap in time. That is the ONLY indication for its use.

 

Third, I would disagree that exposure to animals, handling them, even bats or dogs is an indication. If you have to receive the post-exposure treatment no matter whether you got the vaccine, and you have it available within 48 hours, then why is there a need to get the vaccine? It has absolutely no advantage at all. What good did it do to take the vaccine?

 

Fourth, the vaccine is not without risks and costs. Since it does not offer any protection, those risks and costs quickly outweigh the benefit in many situations.

 

I cannot ever think of a reason to take the vaccine when going to a country like south africa with good infrastructure and good medical care. Absolutely never a reason to take it there (unless you will be more than 48 hours from medical care- hard to do in that country).

 

If anyone can come up with any advantage of the vaccine outside of the more than 48 hour delay, I would love to hear it. I want to learn as well.

 

Lots of misunderstanding about the Rabies vaccine, but this post does help. Some good facts above.

4 people like this

Share this post


Link to post
Share on other sites

I was always told that I'd need post bite treatment regardless of whether I had the vaccine or not, so never bothered with it... and I could get it for free when I was in the Army.

 

I agree with @@urologysteve that there's no point unless you need the additional delay in the onset of symptoms.

1 person likes this

Share this post


Link to post
Share on other sites

I think this thread has become somewhat misleading.

 

The indication for pre-exposure (prophylactic) vaccination is complex and is really dependent on assessing the chances of receiving an infected bite coupled with lack of access to prompt post-exposure treatment.

The vast majority of us DO NOT require prophylactic vaccination. Indeed we are perhaps more likely to get post-vaccine encephalitis than we are to get a rabid bite.

 

If you were doing bat research in Indonesian caves or working on village dog immunisation as part of volunteer work in protecting Wild Dogs then prophylactic immunisation is most definitely worthwhile.

 

 

An effective prophylactic immunisation schedule does protect against Rabies -assuming the immunised individual has achieved a satisfactory specific antibody level in response to immunisation. Rabies antibody levels are generally only checked in those immunised individuals at very high risk (those working in reference labs, etc). Post-vaccination antibody titres are not routinely checked and so those achieving sub-optimal immune status following vaccination are not identified.

Immunisation of village dogs prevents the spread of rabies amongst the dogs and prevents spread to humans. An adequately immunised human does have protection from a rabid bite. However, the stakes are so high with rabies that immunised individuals are still given post-bite treatment -in large part because it is not possible to know just how immune they are.

 

 

 

So what is the post-exposure treatment of a rabies bite?

 

If you are manifesting signs and symptoms of rabies then you are likely to die and treatment is effectively palliative (ease your symptoms). A very few unvaccinated individuals have survived clinical rabies through the adoption of the Milwaukee protocol which basically involved inducing a medical coma using drugs such as ketamine. But by and large if you have clinical rabies then your number's up!

 

Assuming you don't have clinical rabies then the mainstay of post-bite treatment is ***VACCINATION***!

If you are bitten by a rabid dog the treatment is immediate effective and thorough wound cleansing (with delay in wound-suturing) followed by vaccine administration of the very same vaccine used for pre-exposure immunisation (the usual regime is a dose as soon after exposure as possible followed by doses on days 3, 7, 14 and 30). You may also be given passive immunisation using gamma globulin (antibodies) that is derived form the blood of rabies-immune individuals. This treatment regime is almost 100% effective if administered in the rabies incubation period (which can vary from as short as short as 4 days to as long as 6 years -dependent upon the position and severity of the bite, the location of the wound and the virus load received from the bite).

 

Pre-exposure (prophylactic) vaccination is effective at preventing rabies transmission and those individuals who achieve a good antibody response are likely to be immune. HOWEVER even in previously immunised individuals it is still recommended that rabies vaccine should be given in a two dose regime as soon as possible after the high risk bite as this regime has always carried an almost 100% success rate. The issue is that nobody dares to stray from this tried and tested protocol by not giving these two vaccine doses following exposure so the effectiveness of pre-exposure vaccination can never truly be put to the test.

 

I would have to say that IF I were bitten by a rabid dog I would most definitely have wished that I had been vaccinated before exposure! That said I have not been immunised against rabies despite the fact I have ready access to the vaccine.

 

Pre-exposure rabies vaccination most definitely can save lives in very rare and specific situations; however, most of us don't have a high enough index of risk to justify the risk of vaccination-induced side effects, the hassle or the cost of prophylactic vaccination.

 

 

4 people like this

Share this post


Link to post
Share on other sites

Thank you! Prior to Africa travel when visiting the travel medicine doctor, rabies has never ever been mentioned to us.

Share this post


Link to post
Share on other sites

I think this thread has become somewhat misleading.

 

The indication for pre-exposure (prophylactic) vaccination is complex and is really dependent on assessing the chances of receiving an infected bite coupled with lack of access to prompt post-exposure treatment.

The vast majority of us DO NOT require prophylactic vaccination. Indeed we are perhaps more likely to get post-vaccine encephalitis than we are to get a rabid bite.

 

Great info rainbirder. Sounds like we are on the same page. The risks of the bite AND the lack of access to treatment is really about the only reason. The risk of encephalitis from the vaccine is higher than any significant risks for most of us getting a rabid dog bite.

 

I would question any travel clinic or doctor that recommends the rabies vaccine to any "routine" tourists in Africa. Poor understanding on their part.

Share this post


Link to post
Share on other sites

I don't bother with it. If you are just doing an ordinary safari in a national park and an animal there bites you... Rabies I think would be the least of your problems!

Share this post


Link to post
Share on other sites

just out of interest.. noone has said anything about the problematic international shortage of the post-exposure immoglobulin which seems to be the issue here?

Share this post


Link to post
Share on other sites

Posted (edited)

So i just had a consult with travel doctor before our safari trip to Kenya in August and we discussed rabies.....

 

I have a pretty good understanding of the pros/cons I believe and someone can correct me if I am wrong...

 

We decided to get the vaccination for several reasons.

 

1. our insurance covers the vaccine for my wife and I, its very expensive (i dont know why) but insurance covers 100%. Our insurance ends July 1st so best time is now to do it.

2. we are young and enjoy travelling therefore this will cover us for many many trips to come when we may be at greater risk of rabies than on a safari, the vaccination is effective and lasts a long time so will cover us for the next many many years when we will do most of our travelling.

3. if you are NOT vaccinated its is very urgent for you to get to a medical center and receive the immunoglobulin. Depending where you are bitten this could be very difficult and not all places carry the immunoglobulin so u may be a plane ride away from somewhere that can give it or perhaps in a third world country where standards of obtaining the immunoglobulin, storing it etc are not well done. Also i believe getting the immunoglobulin can be painful as it needs to go right into the wound or around the wound.

4. with the vaccine you have a bit more time (1-2 days) after the bite to get the vaccine and DO NOT NEED the immunoglobulin. i like this in that i am not subjected to take the immunoglubulin as well as that with the vaccine being more readily available it may be easier to get access to that then the immunoglobulin.

5. if you get bitten and have the vaccine already you only need to have booster via another rabies vaccine at day 0 and day 3 roughly so this can be managed in the middle of the trip and would not require me to make big changes to our trip or travel plans. wheres as WITHOUT being vaccinated i would need to have access to the immunoglubulin (which may be more difficult) and need the vaccine at 0,3,7,14 days which would be a much larger interruption of our travel plans.

6. i understand risk is low and rare but with rabies if you get it, your dead. Its not like being sick for a few days etc. so i like to be a bit more cautious with a more serious disease like rabies.

Edited by gregv

Share this post


Link to post
Share on other sites

I think if you carry the post immonuglobulin with you it has to be cooled all the time(never heard about anyone doing it though) despite it being very expensive, and if not, it is very unlikely to get rabies as long as not backpacking through local villages or working with animals. But I`m not sure how big are our chances to catch rabies during a normal 2-3 weeks stay.. very little, I guess. Our lodges in South Luangwa said they never heard about guests catching rabies.

I`m thinking about it too. I`d say for a normal visitor`s stay it`s unnessesary and vaccinations carry risks too, but I don`t know and haven`t got an answer to wheather there is a (rare) post-immonuglobulin available anywhere near or not. In South Arfrica? Hope someone with experience on this topic finally has an answer. If I could get it within 48 hours I wouldn`t think about the vaccination..

Share this post


Link to post
Share on other sites

Well, that person with(out) experience is eventually myself. Here`s a start to which clinics supply the post-immonuglobulin in SA.. :

 

Mediclinic Pietermaritzburg

Mediclinic Nelspruit

Mediclinic Newcastle

Mediclinic Welkom

Mediclinic Kimberley

Mediclinic Howick

Mediclinic Morningside

1 person likes this

Share this post


Link to post
Share on other sites

First, as mentioned, the vaccine does not in any way prevent the transmission of the disease. It only delays the imminent threat by about 48-72 hours. It basically gives you a larger window of opportunity to get post-exposure treatment. Once symptoms start- too late, you are dead regardless.

If anyone can come up with any advantage of the vaccine outside of the more than 48 hour delay, I would love to hear it. I want to learn as well.

Preparing for a trip to Gambia, my friend and I are taking the rabies vaccination. The nurse told me that the three shots give a life-long resistance and that an after-exposure shot is not needed. However, she said, a shot after a bite could be good if the bite is severe.

 

In Sweden, I pay USD 360 for three shots.

Share this post


Link to post
Share on other sites

My hubby and I had the shots before our self-drive trip in Namibia, mainly for the extra time it buys you. We were told that without the vaccinations beforehand then you needed to get both the immunoglobulin and vaccine ideally within 24 hours. We didn't know how easy that was to do in Namibia, and given that rabies is 100% fatal and the cost only a fraction of the cost of our trip, we went for it ($130Australian each). Here's a link to our local travel expert's blog on this.

 

http://www.thetraveldoctor.com.au/blog/rabies_vaccine/

Share this post


Link to post
Share on other sites

In the UK the recommendations are only to have it if you have a prolonged stay or are likely to be in close contact with animals (i.e. you are a vet) and so we have never even considered it

Share this post


Link to post
Share on other sites

I too do not have the rabies jab but get advice from Local GP practice and everything is kept up to date that is legitimately required and rabies has never been one of these in 15 years of Africa travel.

 

I have an acquaintance who is planning to return to Africa (he worked there some 35 years ago). He went to the GP practice, submitted his request for nurse advice, got no response so he took himself off to a private clinic who advised everything including rabies and one of the hepatitis (cannot remember which ). Then returning to his GP for something else he complained about lack of response (quiet rightly) BUT it transpires that he had already had 2 hep jabs with the GP and the rabies would not have been recommended.

 

Money talks. :(

Share this post


Link to post
Share on other sites

There is NO reason for anyone to receive a prophylactic rabies (pre-exposure) rabies vaccination. This is a complete waste of money. If you should be bitten by any animal you can receive a very highly effective post-exposure series of vaccinations.

 

See here:

 

http://www.cdc.gov/rabies/resources/acip_recommendations.html

 

 

 

 

Having just opted to have the vaccine I wanted to point out why there IS a reason.

 

Post incident treatment for those without the 3 shot vaccination series includes the RIG (Rabies Immune Globulin) shot at the same time as the first PEP (post exposure prophylaxis) followed by 3 or 4 additional PEP shots. Without the RIG, the PEP is ineffective unless you've had the pre incident vaccine. While RIG may be readily available in the US, it is in short supply world wide. The shortage issue is compounded by the storage requirements of 35 - 43*f. When in remote parts of the bush it's realistic to plan on 24 hours from incident to medical facility; perhaps longer to get to a facility that has RIG available. Then still, there is the question as to how old the RIG is and was it properly stored. The advance vaccine buys you a little more time (still time critical) but more so eliminates the need to get to a facility with RIG.

 

While not reckless, I believe an ounce of prevention gives me latitude to explore with one less concern on my mind.

 

I'm not a health care professional and only provide this additional/alternate view as a starting point for you to discuss your specific concerns and needs with your GP.

3 people like this

Share this post


Link to post
Share on other sites

Posted (edited)

@@GBE

 

I agree. No reason not to get it other than the cost. Rabies occur in epidemics. Just because there has been no incidents in an area does not necessarily mean there won't be.

 

I should mention the price tag of $800 or whatever seems insane. I got my 3 shots many years ago, and I don't recall it being anywhere near that price.

Edited by Safaridude

Share this post


Link to post
Share on other sites

@@Safaridude

 

$1,113 for each of us... Hard pill to swallow. Good thing it's an injection!

Share this post


Link to post
Share on other sites

@@GBE

 

Good thing I got my 3 shots 26 years ago!

1 person likes this

Share this post


Link to post
Share on other sites

I need one injection in a series, so I plan on doing that during a brief layover at Joburg. There is a couple Travel Clinics near the airport. I think there is one at the airport too. Cost is just a fraction of what is charged in the USA. Because I will be in Malarial areas camping most the time, I plan on picking up my meds(like Coartem and doxy) after I arrive too.

Share this post


Link to post
Share on other sites

I think, if bitten/injured you get 5 shots? A friend of mine was accidentally bitten when he got in between two of his dogs that were in a fight -

 

Don't remember details, but I think the shots are spread out over several weeks.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now

  • Recently Browsing   0 members

    No registered users viewing this page.


© 2006 - 2017 www.safaritalk.net - Talking Safaris and African Wildlife Conservation since 2006. Passionate about Africa.