Rabies is a vaccine preventable disease that occurs in more than 150 countries. WHO state that an average of 60,000 people die annually from rabies and report more than 15 million people receive post exposure prophylaxis every year.
RIGS, the Rabies and Immunoglobulin Service, is based at Public Health England Colindale in London. It is a specialist advisory service for healthcare professionals in England and provides a valuable resource for healthcare professionals dealing with post exposure rabies. The service receives large volumes of calls throughout the year and despatches rabies vaccine and rabies immunoglobulin daily direct to surgeries, clinics or hospital settings, to ensure patients receive appropriate treatment on time and according to the recommended post exposure schedule.
The service consists of consultant virologists, rabies immunisation nurses, immunoglobulin clerks and a service delivery manager. The service also receives epidemiological support from the Emerging Zoonotic Infections Unit at Colindale, and produces PHE guidelines on rabies post-exposure treatment.
From a review of the service April 2014 to March 2015, Thailand, Turkey, India and Indonesia topped the list for countries visited by travellers from England reporting exposure on return and predominantly from dogs, cats, and monkeys. Exposures in the UK all relate to bat bites.
In an ideal world all travellers would avoid animal contact by following pre-travel advice such as listed by NaTHNaC www.nathnac.org but we all know that with a nation of animal lovers there will be travellers who unfortunately forget these rules. We hear about those travellers who insist on rescuing an un-well looking puppy from the beach, try feeding cats under the table when eating outside or even walk around with bananas in a rucksack specifically to attract local monkeys. Of course there are also the unfortunate group who simply end up in the wrong place, the traveller who walks down an alley and steps over an unseen dog, the early morning jogger who runs into a pack of dogs with no escape, or children who love to play.
All exposures in high risk countries require post exposure rabies treatment as soon as possible and, following a risk assessment, will either require rabies vaccine + rabies immunoglobulin or rabies vaccine alone. Importantly, the recommended treatment will be reduced if the traveller received pre-exposure rabies vaccine before travel. Once the traveller has reviewed horror stories on the internet about rabies they generally become extremely anxious and often contact their GP surgery from overseas for advice.
The recommendation for travellers to countries with rabies should be to avoid contact with animals. If bitten / scratched then seek local medical advice, and report to own GP service on return to the UK. Pre-exposure rabies vaccine should be considered before travel and particularly for those planning higher risk activities. Guidance for countries at risk of rabies can be found at NaTHNaC or GOV.UK / rabies
Healthcare professionals can contact the RIGS service for risk assessment, advice and supply of treatment as outlined in DH Green Book on telephone 020 8327 6204 (or email for routine enquiries RIGS@phe.gov.uk)
Amanda Dennis, Rabies Immunisation Nurse Public Health England Colindale
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