The Travel Clinic Ltd

Date: 13/11/09

Rabies outbreak in Bali and China: news from the Travel Clinic

Since July 2008 there have been 17 known deaths in humans from rabies disease in Bali. Initially the disease was only being reported from one district but over the last few months it has spread and cases of the disease are now being reported from the densely populated areas of south east and eastern Bali.

Travellers to Bali should be aware of the current outbreaks and how to avoid the disease, correct post-exposure treatment and the need to consider having a course of vaccines before travelling to Bali.

In China the Ministry of Health reports that more than 40 million individuals on the mainland are bitten by animals annually; the report also states that China is one of the countries most threatened by rabies. In recent years, an average of 2400 individuals in China died from rabies infection annually. In the past five years, most rabies deaths occurred in the Guangxi Zhuang Autonomous Region and the southern provinces of Guizhou, Guangdong, Hunan and Sichuan; accounting for 60.85% of the total. The number of rabies cases in the central and northern parts of the country have also increased in recent years.

The incubation period varies with different strains of the virus, but the average time between bite and onset is four to eight weeks. Approximately 50% of infected bites lead to the disease. Children may be at a greater risk from infection, as they are shorter in height and their upper body is closer to the ground. They should be discouraged from petting unknown animals whilst abroad.

If an animal that is possibly infected with rabies bites you, you must be treated promptly. Rabies is fatal once symptoms develop. Medical advice should be sought for any animal bite, and a tetanus injection given.

Symptoms can usually be prevented from developing if proper treatment is started immediately after being bitten. Early treatment is especially important following bites on the face. Immediately after being bitten, you should:

wash the wound thoroughly with soap and water under a running tap,
use antiseptic or alcohol to clean the wound, if available,
apply alcohol or iodine, if available,
leave the wound open. Do not attempt to stitch it, and
go to the nearest doctor or hospital and explain you have been bitten.

If you have not been vaccinated before you were bitten, human rabies immunoglobulin (HRIG), also known as passive immunisation, will be injected around the bite to neutralise the virus before it gets into the body. This substance binds to the virus so that the immune system can destroy it. In addition, a longer-lasting rabies vaccine (active immunisation) should be given in 5-6 doses over 30 days. The vaccine is given into the arm and is relatively painless, with minimal side effects that may include headaches, fever, nausea, muscle aches, and dizziness.

If you have already been vaccinated before being bitten (the pre-exposure vaccine), two doses of the rabies vaccine will be given: one at the time of the bite, and one 3-7 days later. When you can, access good medical help. The body should respond to treatment quickly. The immunoglobulin is not needed in this instance.

The Bali Animal Welfare Association has provided updated information .Travellers to Bali should be made aware of the rabies risk and lack of rabies immunoglobulin and shortage of rabies vaccine on the island. Pre-travel vaccination should be considered. Animal contact should be discouraged and medical attention should be sought following any animal or bat bite.

Although there is a worldwide shortage of rabies vaccine, The Travel Clinic has managed to source sufficient stocks at the present time.

Pre-exposure vaccination consists of 3 doses of rabies vaccine, a single dose each given on day 0, day 7 & day 21-28. Please call 01223 367362 (Cambridge) or 01473 225176 (Ipswich) for more information or to make an appointment.

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Organisation: The Travel Clinic Ltd

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