What is Rabies?
Rabies is a viral disease that causes progressive and fatal inflammation of the brain and spinal cord. The virus is transmitted through close contact with saliva or blood from infected animals; if you get bitten, scratched, licked on broken skin the virus can be transmitted.
The virus occurs in more than 150 countries. In the Netherlands rabies infections are rare, the disease is almost always sustained abroad.
All mammals can carry the virus, so it’s best to avoid contact with (wild) animals in foreign countries. Amongst others, the following animals can transmit rabies:
The chance is very low that an animal has rabies, but once symptoms develop, rabies is fatal. Because the virus is fatal, it is important to be treated after an incident with a mammal abroad.
Where does rabies occur?
The rabies virus is found worldwide, excepted are Japan, New-Zealand and Antarctica. The risk of a rabies infection however varies from country to country. The chance of being in contact with certain mammals is more likely in some countries than others. Also the reason of visiting and your activities have influence on the risk.
Known risk areas:
- Africa (except Mauritius and the Seychelles)
- Asia (starting in Turkey, excepted are Bahrein, Kuwait, the Maldives, Taiwan, Hongkong, Singapore, Japan and Papua New Guinea)
- South and Central America (except Uruguay)
- Haïti, Cuba and the Dominican Republic
Rabies in the Netherlands
In the Netherlands the rabies virus only occurs amongst bats. This is a mild type of the virus that rarely infects humans. However, having contact with bats is not recommended. If you got bitten or scratched by a bat in the Netherlands it is important to seek medical help.
Stages of the infection with rabies
The infection with rabies goes in stages. Without treatment it takes about 20 to 90 days for someone to get ill. The incubation period may vary between one week to one year, this is also depending on the place on the body where the transmission has taken place. The closer to the central nervous system, the quicker the symptoms will develop.
In the first stage of infection someone may have the following complains: feeling nauseous, vomiting, having a decreased appetite, headache and chills.
In the next stage neurological symptoms will occur: having muscle cramps, paralysis, convulsions, having difficulties with swallowing and breathing. Some people develop a fear for water. Eventually the infection is fatal, most of the time caused by swallow- and breathing problems.
It is very important to take preventative measurements when you travel to a risk area and to take immediate action if an incident takes place.
Prevention is better than cure, definitely for rabies. Avoid contact with animals abroad and pay extra attention to your kids. Children are more likely to pet animals which increases the chance of an incident. In the following cases you have an increased risk of getting the rabies virus, in theses cases you should definitely consider getting vaccinations against rabies:
- Traveling to a high risk country or area
- If avoiding contact with animals abroad is not possible, for your profession or internship for example
- Cycling trips
- Traveling for 3 months or more, or a lot of short trips to an endemic country
- If medical help is difficult to reach
In these cases it’s advisable to get vaccinations before your trip. To be vaccinated against rabies you have complete the rabies vaccination series; the series consists of four vaccinations in total. At the first appointment you’ll receive the first two vaccinations, at least one week later you will receive the last two vaccinations.
After these four vaccinations you’re body will make antibodies that will stay in your immunological memory for the rest of your life. The procedure after an incident with an animal is a lot easier than when you’re unvaccinated against rabies.
What to do after an incident
Vaccinated or not, you always have to clean the wound or scratch thoroughly; clean it at least 15 minutes with lukewarm running water and soap. Then disinfect the wound with alcohol 70% or iodine. After these measurements you can cover up the wound but it is important that it is not stitched; you wound has to remain open.
The next step is depending on if you already have had vaccinations against rabies or not. Always make sure you have your vaccination booklet with you. Based on your booklet a doctor knows when and which vaccinations you had and knows what kind of treatment is needed.
When you have been fully vaccinated against rabies, you need to get two additional rabies vaccinations as soon as possible but at least within one week. You will have to get a vaccination at day 0 and day 3. These vaccinations are usually easy to get.
If you haven’t been vaccinated before and you get bitten, scratched or licked on broken skin, you need to contact the emergency telephone number of your health insurance. In 12 to 24 hours start your treatment with MARIG (human anti rabies immunoglobulin). MARIG is in a lot of countries hard to obtain or is of poor quality. Besides the immunoglobulin, a rabies vaccination program is started; a series of at least four vaccinations, usually given at day 0, 3, 7, 14 or 28. The embassy or consulate can inform you where the vaccinations are in stock.
When you have an increased risk of getting in contact with rabies, for your profession for example, you will have to follow a slightly different procedure. If you’re a veterinarian, biologist or if you’re working with bats you have an increased risk. After the preventable rabies vaccinations it is advisable to do a blood test to check how many antibodies your body has made based on the vaccinations. This is important to know because you might get a scratch without your awareness. Based on the blood result you might need an additional vaccination and possibly you need another blood test four weeks after the revaccination. Every 6 months the blood test is needed so you know you’re able to remain performing your profession safely.
A revaccination can also be advised if you’re traveling to a remote area where it’s unlikely for you to obtain a rabies vaccination within 24 hours. A revaccination offers you extra time to get the two vaccinations you need after an incident for at least five years.
Vaccinations against rabies protects you against a fatal infection disease. The vaccinations are available at every location of Vaccinatiecentrum.