Is Rabies Still a Health Risk in Southeast Asia?

With its lush, rolling landscapes, thriving business hubs and vibrant wildlife, Asia remains a popular destination for expats. While you’re enjoying everything Asia has to offer, it’s worth bearing in mind some of the risks associated with this region – one of which is rabies – and what you should do if you come in to contact with infected animals.

What is rabies?

Foaming at the mouth and ferocious cartoon animals might be the general perception of rabies, but the reality for the victims of this animal-borne disease is sadly bleaker.

It is contracted from the bite of a rabies-infected animal, which are usually dogs in Asia. The virus is present in the nerves and saliva of a symptomatic rabid animal. In many cases, the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwise uncharacteristic behaviour.

Thankfully rabies is becoming less and less prevalent worldwide, but still caused about 17,500 deaths worldwide in 2015. There are also still high-risk zones, especially in Asia.

Before You Travel – Risk Zones

Hong Kong

Today, Hong Kong is a rabies-free zone. Pet smuggling from mainland China was the contributing factor to epidemics during the ‘50s and ‘80s – all prevalent outbreaks in the region coincided with spikes in the spread of the disease in China. During 2010, more than 2000 people died from rabies in China due to failure to vaccinate and rising abandonment of pets; the biggest outbreak there in recent history. By comparison, Hong Kong’s last death was in 2001 after a domestic worker was bitten in mainland China.

Thailand

Though still present in Thailand, rabies is a low risk for travellers, though may pose a higher risk to expats living and working near areas with stray dogs. Take care during your downtime, including adventure holidays where infected animals might be present ­– for example caving, hiking expeditions. Children should be monitored when playing with street dogs.

Indonesia

Rabies still remains a widespread problem in Indonesia. ‘Dog Elimination’ days have been held in an attempt to control the situation in areas such as Bali, which is very popular with expats. Around 15 people died from rabies after being bitten by dogs in 2015 while another two died in 2014. Up to 160 Balinese villages infected with the disease. Dogs and even cows have tested positive for it in West Sumatra and Sukabumi in West Java. Jakarta, one of the highest consumers of dog meat in Indonesia, is now rabies-free and Indonesia has a target to eliminate the disease by 2020.

World Health Organization (WHO) information on rabies risk

How do I prevent rabies?

Rabies still carries a 100% mortality rate in humans and there is currently no treatment or cure. Therefore, if you’re visiting areas such as Indonesia where risk of infection is higher, you may want to consider vaccination.

Inoculation (which includes three rounds of injections) can be expensive. No single treatment can provide lifelong immunity, which means if you’re exposed to the danger over a period of years you will need to get boosters, which can add up financially over time.

There is currently no treatment or cure for infected patients. If you’re travelling to an area where rabies is common, a vaccination could be vital to your survival. Vaccines do not cause infection – it is not possible to contract rabies from a rabies vaccination. Having a vaccine also pose no threat to children, or to pregnant women and their fetuses.

Avoiding wild animals or pets is the best form of prevention – this includes touching dead animals – reducing the need for vaccination altogether.

Rabies symptoms in humans

• A high temperature (fever) of 38C (100.4F) or above
• A headache
• Feeling anxious or generally unwell
• Discomfort at the site of a bite
• Confusion or aggressive behaviour
• Hallucinations
• Producing lots of saliva or frothing at the mouth
• Muscle spasms
• Difficulty swallowing and breathing
• Paralysis
• Fear of water

What should I do if suspected rabid animal bites or scratches me?

Wash any wounds with water and soap for at least 10 minutes, or if soap is not available, wash with water only. This method of treatment is currently the most effective against the infection of rabies directly after a patient is bitten. Attempt to capture the infected animal for inspection, but do not kill it, as the healthcare response may be determined by the behaviour of the suspected infected animal.

Symptoms in animals

If an animal is exhibiting any of the following symptoms, avoid approaching or touching said animal:

• Biting without any provocation
• Eating abnormal items such as sticks, nails, faeces, etc.
• Running for no apparent reason
• A change in sound e.g. hoarse barking and growling or inability to make a sound
• Excessive salivation or foaming at the angles of the mouth

What types of vaccines are available?

Two types of rabies vaccines are available. A pre-exposure vaccination consists of three doses of either cell-culture- or embryonated-egg-based vaccine, which is given on days 0, 7 and 21 or 28 in the arm. If a patient is bitten, a post-exposure prophylaxis will be administered to prevent the risk of infection.
Sources

• World Health Organization – www.who.int
• UK National Health Service – www.nhs.uk
• SPCA Hong Kong – www.spca.org.hk
• Sydney Morning Herald – https://www.smh.com.au

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