That Cute Dog May Carry Rabies

While on the beach in the Bahamas, a vacationing couple noticed a dog struggling in the water, so the husband jumped in to rescue it. He was promptly bitten on the hand. His wife, a physician, insisted he check in with the federal Centers for Disease Control and Prevention to ask whether he needed to be vaccinated against rabies.

A viral disease spread by the bite of an infected animal--or even by a lick on broken skin, since the virus is carried in the saliva--rabies affects the nervous system of humans and is nearly always fatal if untreated.

Mary Reynolds, a CDC epidemiologist, fielded the call--one of many her office gets each year from overseas travelers panicked about the possibility of rabies after being bitten by a stray dog, cat, bat, monkey or other animal. After carefully examining the track record in the Bahamas and learning there had not been reports of rabies there, she told the man he did not need the shots. In fact, the dog was free of rabies, and the man remained healthy.

But not every case is as clear-cut. And because rabies has such a high mortality rate, travel medicine experts err on the side of caution, suggesting vaccination after a bite if there is any possibility the animal might be rabid. It’s a tough call, because an animal’s appearance and behavior can suggest it is well when it is not.

Travelers who are savvy about the need for vaccinations against such scourges as yellow fever and hepatitis often don’t even think to ask about the need to protect themselves against rabies, travel medicine experts say. Although rabies deaths are rare in the United States, the disease is prevalent in some countries, including parts of Brazil, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, India, Mexico, Nepal, Peru, the Philippines, Sri Lanka, Thailand and Vietnam, according to the CDC. And rabies is found in dogs in most other countries of Africa, Asia and Central and South America. Worldwide, more than 40,000 people die of rabies every year, according to the World Health Organization.

“Rabies is an underappreciated risk,” says Dr. Bradley Connor, medical director of the New York Center for Travel and Tropical Medicine and a travel medicine expert. He adds that children--who are more likely to pet a stray animal--and travelers who go off the beaten path are at greatest risk.

Few travelers think to ask about the disease, agrees Dr. Terri Rock, a Santa Monica family practice physician with a special interest in travel medicine. “We counsel everyone [going to areas where it is found] about rabies,” she says.

Depending on the traveler’s destination and activities planned while there, pre-exposure vaccination might be wise. The pre-exposure regimen includes three doses of vaccine given over three or four weeks.

A traveler who has received the pre-exposure vaccine and is bitten by a potentially rabid animal still needs two more doses of vaccine, the first given as soon as possible and the other on the third day after the bite, according to CDC guidelines. A traveler who was not vaccinated before the trip and who is bitten needs an immediate injection of anti-rabies immune globulin (which contains antibodies to the virus) plus five doses of vaccine (which stimulate the person’s own production of antibodies), given in an initial dose and then on Days 3, 7, 14 and 28.

When a traveler is bitten, there is often a strong sense of denial that the animal could be carrying rabies, Connor finds. “People don’t want to quit their trip,” he says. So they tend to rationalize that the dog didn’t look or act sick and couldn’t possibly be rabid.

In some countries, travel medicine experts say, it is difficult to find the needed vaccine. Says Rock: “Sometimes if you’re bitten you have to get to the airport and get to Europe or somewhere where there is vaccine available.” If rabies is suspected, post-exposure vaccinations should begin as soon as possible (preferably within two days, according to some travel medicine specialists). The CDC says travelers headed to remote areas, where prompt medical care may not be available, should consider pre-exposure vaccinations.

The disease’s typical incubation period is three to eight weeks, according to the CDC, but can be much shorter. Once symptoms develop, which may include fever, restlessness and malaise, only supportive care is possible.

Those who have been bitten should wash the bite with soap and water and apply Betadine solution (purchased over the counter) if available, advises the CDC’s Reynolds. She suggests next calling the U.S. Embassy for advice about getting medical attention and information about the local rabies situation. Travelers can also call the CDC at (404) 639-3311 and ask for the rabies section.

The vaccine is expensive, partly because it is in relatively low demand. The three-dose pre-exposure vaccine is about $450 to $750, plus some fees for the initial consultation, which can vary. Post-exposure vaccine, including the five doses plus immune globulin, costs $1,000 to $4,000 in the United States, Reynolds says.

The immunization has improved, Rock says, and rabies vaccine injections are less painful than they used to be; generally the only side effect is possible soreness at the injection site. The immune globulin is given at the site of the bite, so if that is, say, on the face, the injections hurt.

For more information, see the CDC Web site, www.cdc.gov.