Rabies

Rabies is an important Occupational Health topic as the disease is 99% fatal and there is an effective vaccine. Expatriates and long-term travellers to areas with a high rabies exposure risk should be immunised if local access to rabies vaccine or immunoglobulin (HRIG) is limited, unpredictable or absent. Accompanying children of expats and long term travellers should be considered for vaccination as they are more likely to play with dogs or monkeys and may not report bites. Pre-exposure immunisation is recommended for travellers who plan to a lot of outdoors activities in endemic areas. Human rabies vaccines are recommended for people in certain high-risk occupations such as laboratory workers handling rabies infected animals and workers in direct contact with bats or monkeys that might have rabies. Although traditionally only rural areas have been considered endemic, in some South-East Asian cities (most notably Bangkok) street dogs are ubiquitous and can carry rabies. Therefore rabies prophylaxis measures may need to be considered for long term stays in this kind of environment. It is also the case that some areas do not have easy access to HRIG and in the circumstances also pre-exposure vaccination should be considered. Control measures include seeking prior contemporaneous information about prevalence, avoiding risk situations such as being in the vicinity of dogs and monkeys where bites or scratches are more likely,  washing bite lick or scratch sites with soap and water promptly, seeking post exposure medical assistance in a timely fashion Health Considerations

The incubation period for rabies is 1 week to 1 year, typically 2-3 months. Rabies initial symptoms are typically fever and pain and altered sensation around the wound site Rabies fatality rates are 99% Cavers can be at risk of inhalation rabies whereby the organism is aerosolised in bats' urine and inhaled: 'inhalation rabies.' WHO guidelines suggest neither post exposure vaccine nor immunoglobulin are warranted in the case of a lick to unbroken skin. Extensive washing of the area with soap/detergent is recommended. A lick on broken skin or a transdermal wound warrants both vaccine and immunoglobulin administration:- Category I - touching or feeding animals, animal licks on intact skin (no exposure) Rx: Washing of exposed skin surfaces, no PEP Category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure) Rx: Wound washing and immediate vaccination Category III - single or multiple transdermal bites or scratches, with saliva from animal licks, contamination of mucous membrane or broken skin exposures due to direct contact with bats (severe exposure) Rx: Wound washing, immediate vaccination and administration of rabies immunoglobulin/monoclonal antibodies (HRIG) In short no blood no mucosa exposure: no HRIG