The countries where you're most at risk from rabies

Telegraph

6 hours ago

The UK Health Security Agency (UKHSA) has offered vaccinations to the 'close contacts' of a British tourist, who has died from rabies after being scratched by a puppy while on holiday in Morocco.
While the agency has said there is no risk to the wider public, it has warned that holidaymakers should exercise caution around animals in countries where the disease is present.
Egypt, Turkey and Albania are among the destinations that the Government has ascribed as 'high risk'. It advises that all visitors to rabies-affected countries 'should avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for rabies vaccine prior to travel'. Costa Rica, Bali, Mexico and South Africa are also rated 'high risk'.
Dr Katherine Russell, head of emerging infections and zoonoses at the UKHSA, said: 'If you are bitten, scratched or licked by an animal in a country where rabies is found then you should wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay in order to get post-exposure treatment to prevent rabies.'
'Human cases of rabies are extremely rare in the UK, and worldwide there are no documented instances of direct human-to-human transmission,' she added.
What is rabies?
Rabies is 'a rare but very serious infection of the brain and nerves', according to the NHS, that 'is almost always fatal once symptoms appear'.
How is rabies transmitted?
The disease is transferred from animals to humans through bites, licks and scratches, usually via saliva. Dogs are the primary cause of most rabies infections in people, but all animals can catch rabies and pass it on, including cats, monkeys and bats.
Symptoms of rabies usually take three to 12 weeks to appear, but they can appear after a few days or not for several months or even years. Initial symptoms include feeling anxious or energetic, and numbness where contact with the animal took place. Later, patients may experience hallucinations, respiratory failure and paralysis.
More than 59,000 people die from the disease every year, according to the World Health Organisation (WHO). Due to under-reporting, however, it notes that 'this number is likely a gross underestimate'.
It is thought that more than 15 million people a year receive a post-bite vaccination that prevents hundreds of thousands of deaths.
Where is rabies found?
Rabies is most common in Asia and Africa but there are a number of European nations said to be 'high risk', such as Poland and Lithuania. The WHO says that the disease is present on all continents except Antarctica, but that 95 per cent of human deaths take place in Asia or Africa.
The UK has been rabies-free since the beginning of the 20th century, though a rabies-like virus still resides in some wild bats. According to the Government, the last recorded case of rabies in the UK was in 2018, when a a 58-year-old man was bitten by a cat while visiting family in Mehdya, Morocco.
The UKHSA ascribes three different levels of risk to the world's territories – no risk, low risk and high risk. Some eastern European countries such as Slovenia, Croatia and Bulgaria are given a 'low risk' rating but the advice adds that 'foxes are high risk'.
The same is true of the US and Canada, where the warning is 'low risk but foxes, skunks and racoons are high risk'. The UK's entry reads: 'No risk in animals. Low risk in bats.'
What should I do if travelling to an area with rabies?
Dr Richard Dawood, Telegraph Travel's health expert, says it is not always possible to eliminate the chance of an unwanted encounter with a street dog.
'Having been attacked by a dog on my own travels, I have been a lifelong fan of pre-travel rabies vaccination: it is safe, effective, greatly simplifies treatment following a bite, and can be done cheaply,' he said.
'Vaccination requires three injections, ideally with a seven-day gap between the first two, and 14 to 21 days between the next. Protection is usually long-lasting. Most people have a full dose of vaccine, injected deep into a muscle. However, a reduced dose is also highly effective, given intradermally into the top layer of the skin, enabling more than one person to be vaccinated from a single vial.
'The Department of Health's official Green Book says that suitably qualified and experienced health care professionals may use this method, but does not recommend it, mainly because it requires skill to administer it correctly. However, it is approved by the World Health Organisation, used in other countries, supported by key British experts and should be used more widely.'
What should I do if bitten or exposed?
Scrub and rinse the wound thoroughly, and disinfect with alcohol or strong antiseptic. Get prompt local advice. Back this up with a call to your travel insurance company, your GP or a specialist travel clinic.
Without previous vaccination, you need a rapid vaccine course, plus an injection of rabies immune globulin (RIG) – a product containing antibodies that neutralises rabies virus and which is often unavailable in countries with the highest risk – to give protection until the vaccine takes effect. RIG is scarce and very expensive, and reliable treatment can be hard to find. If you have previously been vaccinated against rabies, simple booster doses after a bite give full protection.
How much is a rabies vaccine?
The price of the rabies vaccine varies dependent on the vendor and the type of vaccination. The NHS charges £82 for a rabies vaccine. The London Travel Clinic charges £72 per dose of the intradermal rabies vaccine, which is given under the skin, while the intramuscular vaccine is £79 per dose. In each case, three doses are required.
Superdrug's Travel Clinic charges £74 or £110 per dose, or £222 or £330 per course (which comprises three doses).
Without prior vaccination, treatment is more complicated and urgent: an injection of RIG into the area of the bite. This treatment is followed by an accelerated course of vaccine, which can throw your travel itinerary into chaos revolving around medical appointments. The price (and availability) of this varies wildly between countries.
For more information about travel vaccinations, read our guide here.