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.

I don't know how true this is, but when she was young my late mother worked at a quarantine kennels. If any staff reported a bite from a quarantined dog, the treatment was (according to ma) a course of 6 injections into the stomach muscle, and incredibly painful!

Needless to say, no-one ever reported a bite. Or got rabies.

I rathe hope things have improved since 1950 though.

I'm a nurse and always recommend rabies vaccine if there's rabies in that country. Always. If you are bitten and get to a treatment facility immediately and you haven't shown symptoms then you stand a chance of recovery. Once symptoms show it is game over I'm afraid.

Check out the fit for travel site above as that's what we use in practice.

It always amazes me that people pay thousands to go to places and then quibble over the price of life saving vaccines.

My advice as a HCP is to get the vaccine.

I was in zimbabwe once and realised i hadnt had it. Was so nervous the rest of the trip

I would get it if you are more than 24hrs from a good hospital. (Unlikely in Bali!)
It just gives you an extra 2-3 days to get treatment.
For Bali I wouldn't. For other PP for Vietnam I wouldn't as you don't sound like you're going far off the beaten track (the hospitals are resonably good). I've had it when I was travelling to really remote areas- like 2 days travel to a town. I'm pretty sure it's run out now- lasts about 10 years.
Stay away from animals. Don't be all "aww what a cute stray" (which is what I see all the time from UK travellers!)
If you do decide to have it it's a 4 week course so if you're leaving soon factor that in.
NHS advice is to have it if you are going to a country with rabies for a month or more, or where there's no quick access to good medical care; or if you plan on doing activities that could make more more likely to get bitten.
If youre very nervous then get it for peace of mind- but it won't stop you getting rabies, just give you more time for treatment.
If you get bitten by anything, go see a doctor straight away.

To those posters suggesting that it will be easy to access rabies immunoglobulin for post exposure prophylaxis in a medical centre, it’s worth noting that there’s a global shortage of it and it isn’t available in many countries where rabies is endemic.
www.who.int/ith/vaccines/rabies/en/

Yes, I was told there was a shortage

Oh bloody great re shortage. Is it true that even a lick can be potentially lethal?

Only if there is an open wound

It’s absolutely not worth taking the risk. What if you were bitten and couldn’t get to a hospital because there was a tsunami/earthquake/ash cloud/terrorist attack?

So do people get rabies vaccines before coming to the US? Domestic animals are supposed to be vaccinated but rabies does exist here.

My daughter was bitten by a dog last year. We took her to the emergency room (A&E) and they reported the bite to the county health department. The county then contacted the dog owner and veterinarian for proof of vaccines. (We knew the dog had had the vaccine. If you are bitten by a stray or a dog with symptoms they start immunoglobulin immediately.) Regardless, they wait 10 days and then the dog has to be examined for symptoms of rabies. They do this in case the vaccine fails in a particular case. I was told there is ample time to start immunoglobulin even after the ten days so I'm surprised people are being told 24 hours. I've also never heard the vaccine doesn't work, but it makes sense that they use immunoglobulin as aprecaution. There are no second chances with rabies!.

It only buys you time, like others have mentioned.

More of a problem if you're visiting caves (bats) or in remote areas (where unlikely to receive treatment in time), or in cities where there are problems with stray dogs. Do NOT go near any monkeys, they carry rabies.

I have had post exposure treatment and it is horrible but it is essential, rabies is fatal. It's also extremely difficult to get in the UK, particularly on the NHS - barely anyone has any training or experience administering the drug and it can be very difficult to source and take on the specified dates required, so do be careful if you go near areas with known rabies. It was an absolute nightmare!

Do bear in mind that if you do get bitten it is best to extend the trip and finish the course at the hospital you get treated at. I don't want to get outed ( because some may recognise the story...) but it is VERY VERY difficult to get post exposure treatment in the UK. They are more equipped in countries where rabies is rife - it's standard procedure there.

The drug they gave me was over 6 weeks. So make sure you have travel insurance!

GET THE VACCINE!

We went to Bali in February. The place is teeming with dogs and cats who are broadly domestic but roam free.

I didn't get the vaccine before we went.

On the penultimate day of the holiday I got scratched by a kitten in a market. Couple of tiny scratches but broke the skin. I then started to worry and google. Whilst the risk was tiny (99% of rabies is from dog bites), with rabies you're either fine or dead.

So I went to the clinic in Kuta the same day. And the post-exposure immunoglobulin vaccines cost me £2700, alongside the rabies vaccines. So it was an expensive kitten scratch.

I then had to have another three injections when I got back to the UK, over the next two weeks.

I'm now considered fully vaccinated. If I get exposed to rabies again then it would just be a case of getting the booster rabies injections, not the immunoglobulin.

Thankfully my travel insurance covered the cost but it was stressful. Get the vaccines - it's a drop in the ocean in cost compared to having to get treatment after the event!!

(Bali was great by the way, have a lovely time!)

So do people get rabies vaccines before coming to the US? Domestic animals are supposed to be vaccinated but rabies does exist here.

Generally not because

1. Interactions of tourists with free roaming dogs and cats in the USA is limited
2. Sylvatic rabies is more common in the uk but domestic dog rabies is still pretty rare

Compared to countries like Indonesia the risks are vastly different both in terms of prevalence and access

Uk should be US

@FreckledLeopard - wow! I'm so sorry that happened to you. Please you got the costs back

So....we went and started the vaccine yesterday. We had appointments anyway, and we kept them, despite my waver in the morning.

Thank you all for your input. It was really appreciated.

I can't remember if I had for Bali. As a pp said it's teeming with dogs. I felt nervous so perhaps I didn't!

I had it before for Madagascar. Got bitten by a bat (ecology work) and many injections followed.

MIL just came back from Bali and had hers done. They stayed in luxury resorts throughout. They quite often found monkeys in their villas so she felt better for having the vaccination.

She is a complete worry wart though.

Crossed post. Enjoy bali

Stressful travelling isn't it!!

Glad you decided to get the immunisations in the end OP.
After reading this thread I know I wouldn't take the risk. I actually didn't realise rabies is always fatal if symptomatic, how awful.

Yes, rabies can be transmitted via licks either if there is a wound or if there is contact with mucous membranes, the classic being puppies licking childrens’ faces.

Yikes. DS is going to China and Zambia in September. Should I check that he's getting rabies vaccination too?

The rabies vaccination does NOT protect you from rabies. It simply gives you longer to get to the hospital. If you are in a very rural area, it is suggested you get it if you won't be able to get to a hospital quickly if bitten by an animal. Rabies must be treated very quickly - you have to get treated with 15 hours to have the best chance if you haven't had the vaccination, and if you HAVE had the vaccination, you have to get treated within 24 hours. The treatment is still the same whether you have the vaccination or not, and is very unpleasant. (A friend of mine had it recently, in Sri Lanka). If you will not be more than 15 hours from a hospital, there's no point getting the vaccination. (I worked in Uganda in 2010 and we had a talk from our company about whether it was worth getting he vaccine or not. None of us did).