Rabies prevalence (inc bats) & vaccines in asia
Replies: 14 - Last Post: Oct 24, 2012 5:18 AM Last Post By: urchin79
Sep 17, 2012 10:09 AM
Rabies prevalence (inc bats) & vaccines in asiaHi,
I'm thinking of going to Sri Lanka either very soon, in about 10 days time and probably just for 10 days - 2 weeks as I have other possible travel plans for later in October. I may possibly delay until next April due to being a bit rushed getting myself organised to go. I may also visit Malaysia and Indonesia at some point this year... this is less likely than Sri Lanka and a separate trip.
Basically, for Sri Lanka, I will, if this month, be visiting just the south... Along the coast on beaches, then Yala, Kandy then back to Colombo airport. The places I would stay at mention monkeys frequenting the accomodation A LOT (as if this a good thing :/ ). I would probably be in Yala roaming around but may go on tour there.
If I go in April I will visit all of Sri Lanka. Malaysia & Indonesia would be Borneo, Sulawesi & Bali.
My query is whether rabies is enough of an issue to warrant a vaccine. All the info I have read seems to suggest that over a month (some say 3 months) it might be wise. I don't get this, I could get bitten within the first day! I have been chased by monkeys aggressively in NP and cloudforest) in the only 2 countries (Mauritius & Belize) I have been that have them, within the first day of being there. I am not sure if I atrract them. Dogs obviously major carriers but appear to be good at avoiding them!
I would not have time to get course of pre exposure vaccinations in time for Sri Lanka this month of course but might consider it for April (and if it's really recommended them might be a reason to wait.) My worry is that if I don't have them then I might not immunoglobin if they are in short supply. I heard this is esp a problem in Bali.
So my question is, based on these locations are there possible issues with availability of immunoglobin? & how much of a problem is rabies in the first place? It's not something I want to mess with really.
P.S I love bats and may visit caves (proper caving) in any part of the world with rabies so would that be even more of a risk than monkeys?
Sep 18, 2012 7:37 AM
Sep 18, 2012 11:57 AM
2I've been thinking about it and wondering about the chance of being bitten...I guess it depends on numbers but on the UK trips where there are admittedly just a couple/few bats, i've made sure not to cause any disturbance.
In terms on other diseases... I suspect i've come across a fair amount of bat poo before! :/
Sep 19, 2012 7:28 AM
3The _Public Health Veterinary Services _ of Sri Lanka reports that
Rabies has been identified in bats in Sri Lanka, but I found no recent reports of human cases from exposure to bats--although the most recent reports had 6% of cases as "source unknown."
The US CDC recommends immunization for " travelers involved in any activities that might bring them into direct contact with bats."
Sep 19, 2012 9:36 AM
4There are vast numbers of street dogs in Sri Lanka, so they are hard to avoid. I've spent two months there and never knowingly came across a rabid one, but that's only anecdotal of course.
I didn't have my rabies jab, and nor did anyone ele in the family but we were mostly heading to areas where decent medical treatment was available at short notice or in any case within a few hours drive of Kandy or Colombo.
I would, however, suggest you consider monsoon seasons and any effect they may have on your trip.
Sep 19, 2012 12:25 PM
I'm going to look into caving more and make a decision beforehand whether I will do it based on the fact that I have decided to get rabies jabs if it's present in bats.
I fancied going in the 'shoulder seasons' to avoid crowds and potentially turning up and finding accomodation booked out. But, if I cave then I need to find out which area would be driest and how easily flooded they are!
Sep 21, 2012 11:40 AM
Sep 21, 2012 10:37 PM
7As you have said - it isn't just the chance of being bitten, but availability of immune globulin. I suspect it is hard to get reliable information on this, particularly somewhere like TT. Most people seem to assume that if reasonable medical care is available then so will immune globulin. I've been through the post-bite series in India. It is extremely hard to find human immune globulin here. Since the main reason is that it is hideously expensive (an average European male could cost $1000 - it is based on weight), then chances are it is also hard to find in Sri Lanka (i.e., local people can't afford it). Horse immune globulin is usually available in rabies clinics - you could look at the side effects and see whether you would be happy to have that in an emergency. I am not sure how you check actual availability.
While many street dogs can be avoided a rabid dog can bite lots of people before it is brought under control! Bats. I've been flown into before, and I can imagine some caves having good populations.
Sep 23, 2012 3:17 PM
8Update on Rabies in Sri Lanka. An article from a Sri Lankan newspaper. Rabies rises as dog population drops
It mentions where to go if you need treatment, the Rabies Treatment Center at the National Hospital in Colombo. They get an average of 50 to 60 people a day who have been bitten by dogs, mostly children.
Sep 24, 2012 11:55 AM
9What you could do is start a vaccination treatment before leaving home and if you are worried about the cost, offset it by having later shots in the asian country you are going to. Or have them all done there.
The reason why the adisories say one month or three months, is because the risks are greater the longer you stay somewhere according to statistics. But you are right you could easily be bitten by a rabid dog on the day you arrive. Not very likely of course but possible.
The thing is you don't have a vaccine before hand, and you get bitten and can't find the immunoglobulin shot, you just fly home or to the nearest country that has the shot. But it seems to me that if they are treating 50-60 people a day with dog bites, they won't be giving that IG shot to everyone of those people. So it looks like they do some sort of observation practice instead. This would possibly be good enough in most cases if i understand the thing correctly.
I even start to wonder if the IG shot is actually necessary now that i come to think about it. The idea is that gives you immediate protection. But you have to badly bitten for the rabies to get into your central nervous system really quickly anyway. So if you got a mild bite, then the ordinary vaccine would have time to work and fight off the rabies before it could enter the CNS. I don't know if this speculation is valid but it seems reasonable to me. However, i myself would not mess with the idea in practice if i had an option of getting it. Of course all those kids/locals don't have that option.
Sep 24, 2012 5:42 PM
10Thanks guys for the information and discussion. 50-60 people a day wow, too many dog bites for my liking!
I did wonder that myself about whether IG would be necessary in minor cases and just the regular vaccines would work in time. However I do feel myself that given the situation, if i was unvaccinated i'd not take anyones view of how long they think i've got before CNS involvement as fact, (doctors are only human and can get it wrong) and just go and find somewhere that could administer IG, providing it's available (not sure I like the sound of horse IG). Hell if it was a bad bite near the head and I had already been vaccinated i'd probably ask for the IG anyway! Vaccines don't always work. I don't know how effective the rabies ones are but certainly my antibody test for Hep B was negative after the first course.
I've also been looking into Romania ( there are some good caves there which may or may not be of interest as it's a short trip again). I then came across information about rabies there too... to be considered for outdoor activities (tracking wildlife) and recommended for bat exposure (bats are not getting good PR here!). Varying views on the stray dog situation there...some people saying they are massive packs lurking and growling but mostly people say they aren't too much bother. I think part of my uneasyness with reading about these situations is probably largely down to thinking about being bitten in the first place. A vaccine won't stop that!
Sep 25, 2012 12:19 AM
Sep 26, 2012 1:41 AM
12Our local rabies clinic where we live in India treats something like 200 bites a week and they state they never give immune globulin. They argue that "there is no evidence" that it is necessary. However, they do have people die of rabies in which case they believe that treatment was delayed or the shots weren't stored properly. I've also read of rabies deaths where immune globulin was recommended by local doctors (for a bad bite) but wasn't affordable (so probably it is just the mild bites they don't use it for).
Having gone through the whole procedure, I can say that it really doesn't matter whether people believe it is or isn't necessary. When you're faced with a non-treatable disease then you want to take absolutely everything to prevent it. It is very stressful, and you will probably have no idea whether the dog was rabid or not, or even whether the dog died. In most cases, a dog that bites you will be behaving strangely and aggressively. Also, immune globulin seems to be hard to find in most places. There was a post by someone who went home to Australia to have the shot and also found it difficult to locate there. I know people who have had post-bite treatment in Thailand and were never offered immune globulin.
Oct 3, 2012 8:21 AM
13I can easily believe it would be difficult to find Rabies immune globulin in Australia - they are one of the few countries in the world where there is no rabies, although it sounds like that might change soon with increased chance of it spreading from Asia.
I base my response to rabies on what the locals do - in the area i work in the Philippines if someone local gets bitten they jump straight on the bus and head to the city to get the shots... pretty good indicator that rabies is around and a real risk (and i would be asking for the immune globulin even through i have had the preventative jabs). I have worked in other countries where the risk is there (but obviously lower) as the locals just wash the wound thoroughly and carry on with life. If local people rush to get treatment - then you should do the same thing, if they are relaxed then you can be conservative and get treated anyway but the risk is probably minimal.
Oct 24, 2012 5:18 AM
14I've booked flights for Thailand now (with short 2 night stopover in Vietnam.) I'll mostly be in National Parks and beaches but couple of nights in Bangkok. I havnt even looked into the jabs for there yet (i'm covered for basics until 2013). I go in just under 5 weeks. I've felt a bit fluey for a while so not even sure if it's best idea to get vaccinations anyway, I think the body might make less antibodies if it's busy fighting other bugs.
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