To ask about the rabies vaccine?

[Thelowquietsea]

We are off to Bali in July for 2 weeks, to quiet areas but not necessarily those considered rural.

The NHS travel nurse strongly suggested having the rabies vaccine - it's £180 per person! There's so much debate on www about whether it's necessary, with views leaning towards it isn't, I just wondered what others thought if they'd been recently.

Rabies is fatal, also the treatment IF given quickly enough is very unpleasant.
if it is common enough in the area you’re visiting to recommend the vaccine then you should consider having it.

I have been to Bali but it was part of a 6 month long trip around the world that included camping in East Africa so we did get the vaccine - but only because it was recommended for Africa, not Indonesia.
Honestly, the vaccine just buys you time if you do get bitten or scratched. If you’re not too far away from civilisation or a hospital (which you won’t be in Bali - it is a tourist destination after all) I wouldn’t bother. Obviously, don’t go near any wild animals. There are monkeys running about in some areas of Ubud. Good luck and have a great holiday!

If you're in a place where you can get to somewhere for treatment fairly quickly if necessary- I'm assuming this is the case in Bali - I wouldn't bother. We had it for rural Laos as there is no treatment available in the country - we would have had to go to Thailand and we might not have been able to do it within the 24 hour window.

The NHS nurse has no idea of the areas we're travelling to and so she just gave blanket advice.

We're not going to only resorts, but we're also not going anywhere considered rural

Dogs are a major rabies risk in quite a few countries, and you will find feral dogs everywhere in places like Bali. Having grown up in an area with endemic rabies, before the vaccine existed, I'm getting us all vaccinated before we go to a country where rabies is a known but low risk.

www.fitfortravel.nhs.uk/destinations/asia-east/indonesia

This says it's more of an issue in remote areas

Where rabies is endemic you need to be aware that there is the rabid form that we are all familiar with, the mad dog running and biting. There is also a prodromal form the lethargic, sluggish animal salivating a bit.
The treatment is one dose of immunoglobulin and four doses of the vaccine. Having the vaccine before you go provides you time to get the immunoglobulin.
Things to consider, 1. Rabies is almost always fatal if symptoms develop they just sedate you till you die. 2. Due to the fatal nature no study has been done to see if vaccine alone protects. However in other species challenge studies have shown that the vaccine protects against contracting the disease. 3. People forget that bats are carriers if you are consider visiting any caves it is important to get vaccinated.

@Lonecatwithkitten - thank you so much for such an informed reply

My question - if you get the pre vaccine (3 doses) and you get bitten, is it still fatal? Does it protect you in any way/stop the symptoms - or only if you then get immunoglobulin?

If you get the pre-vaccine you have longer to get the treatment and often get a shortened course of the treatment.
It would also be worth considering if you do not get vaccinated and then get bitten your travel insurance may not cover you as they could argue you were advised to get vaccinated. I deal with health insurance and am used to looking for their loop holes.
I am vaccinated due to my occupation, but my daughter and I are heading to Cambodia next year and I will be encouraging and paying for her rabies vaccines.

"if you get the pre vaccine (3 doses) and you get bitten, is it still fatal?"

Yes.

OK I haven't looked in to this recently (so i may have missed something) but rabies is the only disease where there is no documented case of a person with the symptomatic disease surviving. Ever. Anywhere.

The vaccine buys you the time to get to somewhere they can throw all the known treatments at you, in the hope you never become symptomatic. And that does seem to well well enough.

You'd be silly not to get it. All it takes is one dog. It's a country with a known rabies problem. It is always fatal if you become symptomatic and it's very unpleasant death.

I had it when I went to Africa, because I would be in places where I might have been more than 24 hours from a hospital, and it gives you more time to get treatment.

So it depends on what you'll be doing in Bali. If you were to be bitten by an animal, you would still need to get to hospital as soon as possible for it to be treated.

Apparently Superdrug charges £55 per dose. Not a huge saving but £165 is better than £180 I guess. I would think there might be even cheaper places to get it if you're willing to look.

@thelowquietsea

Are you saying each person's life is not worth £180?

Actually, there is a drive to promote rabies vaccination. I'm a health writer and had to research this topic.

The risk is that even if you are bitten, you may not be able to get to a hospital with the correct treatment, in time to prevent death.
Not all hospitals carry the treatment (immunoglobulin) and you could have to fly to a more sophisticated city or even country to be treated within hours of a bite.

You cannot tell if the animal that bites you is rabid. Dogs that appear friendly and bit you can be infected but not showing signs of illness.
Cats also carry it as do bats.

You can find info on the World Health site about where the risk if high and it includes most of Asia.

Why take the risk? The cost is a fraction of the cost of your holiday! If you can afford Bali, you can afford the vaccine.

After reading this thread I wouldn't think twice about getting it.

@JinglingHellsBells

Why the aggressive tone? I came on here to discuss, not be judged for discussing

I really don't think I would if you aren't doing high risk activities and aren't in remote areas

@ChesterDrawsDoesntExist

You have to have 3 doses - so Superdrug overall cost is £165 per person

What lonecat said.
Yes I would definitely be vaccinated (I am)
i.stuff.co.nz/travel/travel-troubles/96883283/doctors-warn-of-rabies-after-tourists-bitten-overseas

I’d also be careful about what you eat
www.news.com.au/travel/travel-advice/health-safety/tourists-warned-of-danger-in-indonesia/news-story/99b8ab8c2f08d02f94f33c423a54f40f

It's only recommended if you are in remote areas eg trekking in the jungle. Resorts and places you can reach a hospital within a few hours it's not normally necessary. We have never even had it suggested

Is it just a holiday or are you likely to be doing anything which will increase your liklihood of getting bitten like volunteering with animals etc? I went to bali and lombok for two weeks and it never even crossed my mind to get the rabies vaccination (and we went to the monkey forest in ubud, oops). I briefly considered getting it when I was in northern Thailand and Cambodia as I was slightly further from civilization but as a pp has said, all it really does is give you slightly longer to live rather than prevent you getting infected so in the end I didn't bother. Unless you are going to the really out there rural bits (Bali's road systems are terrible if you are off the beaten track and journeys take ages) then it probably won't help you much.

DS has had it. He’s off travelling later this year. The advice was he’s unlikely to encounter rabies. But if he does then the prognosis is pretty bleak without the jab. It’s a small price to pay to know i am safeguarding him as much as I can.

I had the jab before starting a job in a dog kennels here in the UK.

I can't think of many more unpleasant ways to die than through rabies.

But at least when someone IS dying they can console themselves by remembering they saved £180!

I'm going to Vietnam soon and getting the vaccination, I am quite scared which must be a sign of age as I travelled extensively in my youth and it never even crossed my mind... definitely worth the money. Do the big cities like Ho Chi Min have treatment centres or do you have to fly to Singapore? 24 hours doesn't seem very long does it..better than a fatal snake bite I suppose!

I was thinking about rabies last night because one of my cats caught a bat. I used gloves to handle it and take it to local wildlife rescue, but if it had bitten me I would have been desperately looking to find a hospital which could treat me!

I’ve never been to Bali, but I’m guessing it’s not a cheap holiday, so £180 can’t be much as a percentage of total cost. I’d simply consider the cost of the rabies jag as an essential part of the cost of the holiday. I wouldn’t risk my life for a £180.