RABIES VACCINE

RABIES VACCINE
W H A T Y O U N E E D T O K N O W
Many Vaccine Information Statements are available in Spanish and other languages. See http://www.immunize.org/vis.
1 What is rabies?
Rabies is a serious disease. It is caused by a virus.
Rabies is mainly a disease of animals. Humans get rabies when they are bitten by infected animals.
At first there might not be any symptoms. But weeks, or even months after a bite, rabies can cause pain, fatigue, headaches, fever, and irritability. These are followed by seizures, hallucinations, and paralysis.
Human rabies is almost always fatal.
clip art image of bat and a raccoon.
clip art image of bat and a raccoon. clip art image of bat and a raccoon.
most common source of human rabies infection in the United States.
Skunks, raccoons, dogs, cats, coyotes, foxes and other mammals can also transmit the disease.
Human rabies is rare in the United States. There have been only 55 cases diagnosed since 1990. However, between 16,000 and 39,000 people are vaccinated each year as a precaution after animal bites. Also, rabies is far more common in other parts of the world, with about 40,000 - 70,000 rabies-related deaths worldwide each year. Bites from unvaccinated dogs cause most of these cases.
Rabies vaccine can prevent rabies
2 Rabies vaccine
Rabies vaccine is given to people at high risk of rabies to protect them if they are exposed. It can also prevent the disease if it is given to a person after they have been exposed.
Rabies vaccine is made from killed rabies virus. It cannot cause rabies.
3 Who should get rabiesvaccine and when?
Preventive Vaccination (No Exposure)
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People at high risk of exposure to rabies, such as veterinarians, animal handlers, rabies laboratory workers, spelunkers, and rabies biologics production workers should be offered rabies vaccine.
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The vaccine should also be considered for:
-People whose activities bring them into frequent contact with rabies virus or with possibly rabid animals.
-International travelers who are likely to come in contact with animals in parts of the world where rabies is common.
The pre-exposure schedule for rabies vaccination is 3
doses, given at the following times:
Dose 1: As appropriate
Dose 2: 7 days after Dose 1
Dose 3: 21 days or 28 days after Dose 1
For laboratory workers and others who may be repeatedly exposed to rabies virus, periodic testing for immunity is recommended, and booster doses should be given as needed. (Testing or booster doses are not recommended for travelers.) Ask your doctor for details.
Vaccination After an Exposure
Anyone who has been bitten by an animal, or who otherwise may have been exposed to rabies, should clean the wound and see a doctor immediately. The doctor will determine if they need to be vaccinated.
A person who is exposed and has never been vaccinated against rabies should get 4 doses of rabies vaccine - one dose right away, and additional doses on the 3rd, 7th, and 14th days. They should also get another shot called Rabies Immune Globulin at the same time as the fi rst dose.
A person who has been previously vaccinated should get 2 doses of rabies vaccine - one right away and another on the 3rd day. Rabies Immune Globulin is not needed.
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4 Tell your doctor if . . .
Talk with a doctor before getting rabies vaccine if you:
1) ever had a serious (life-threatening) allergic reaction to a previous dose of rabies vaccine, or to any component of the vaccine; tell your doctor if you have any severe allergies,
2) have a weakened immune system because of:
- HIV/AIDS or another disease that affects the immune system,
- treatment with drugs that affect the immune system, such as steroids,
- cancer, or cancer treatment with radiation or drugs.
If you have a minor illnesses, such as a cold, you can be vaccinated. If you are moderately or severely ill, you should probably wait until you recover before getting a routine (non-exposure) dose of rabies vaccine. If you have been exposed to rabies virus, you should get the vaccine regardless of any other illnesses you may have.
5 What are the risks from rabies vaccine?
A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small. Serious problems from rabies vaccine are very rare.
Mild Problems
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soreness, redness, swelling, or itching wherethe shot was given (30% - 74%)
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headache, nausea, abdominal pain, muscleaches, dizziness (5% - 40%)
Moderate Problems
• hives, pain in the joints, fever (about 6% of booster doses)
Other nervous system disorders, such asGuillain Barré syndrome (GBS), have beenreported after rabies vaccine, but this happensso rarely that it is not known whether they arerelated to the vaccine.
NOTE: Several brands of rabies vaccine are available in the United States, and reactions may vary between brands. Your provider can give you more information about a particular brand.
6 What if there is a moderate or severe reaction?
What should I look for?
Any unusual condition, such as a severe allergic reaction or a high fever. If a severe allergic reaction occurred, it would be within a few minutes to an hour after the shot. Signs of a serious allergic reaction can include difficulty breathing, weakness, hoarseness or wheezing, a fast heart beat, hives, dizziness, paleness, or swelling of the throat.
hat should I do?
Call a doctor, or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your provider to report the reaction by fi ling a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.
7 How can I learn more?
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Ask your doctor or other health care provider. They can give you the vaccine package insert or suggest other sources of information.
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Outbreak Notice Rabies in Bali, Indonesia

In December 2008, the Indonesian Ministry of Agriculture reported a rabies outbreak in dogs on the island of Bali, Indonesia, to the World Organization for Animal Health. As of October 2009, the Indonesia Ministry of Health has reported 15 deaths caused by rabies on Bali. Most human and animal rabies cases have been confirmed near popular tourist destinations on the southern tip of Bali. However, because the situation is evolving, CDC advises travelers to take precaution on the entire island.

The following activities may put travelers to Bali at higher risk for rabies:

• Working closely with animals of unknown rabies exposure or vaccination history.
• Spending a lot of time in a rural area or doing outdoor activities such as bicycling, camping, or hiking. These activities increase the risk for coming in contact with animals.
• Touching or playing with animals.
• Adopting animals with the intention of bringing them home to the United States.

Information About Rabies

A threat to both human and animal health, rabies is a rapidly progressing, deadly disease. It is almost always spread by an animal bite but can also be spread when a rabid animal’s saliva gets directly into the eyes, nose, mouth, or broken skin. The primary sources of human infection worldwide are dogs and certain wildlife species, such as foxes, raccoons, mongooses, and bats.

Each year throughout the world, rabies kills approximately 50,000 people, mostly children. The risk of rabies from domestic animals is low for people in the United States. For people who travel to other parts of the world, the risk of rabies may be higher. Therefore, all travelers should know how to protect themselves from this disease.

Advice for Travelers

Follow these recommendations to protect you and your family from rabies:

Avoid animal bites.

• Avoid touching all animals, including wild animals and pets. Pets in other countries may not have been vaccinated against rabies.
• Resist the urge to rescue animals with the intent to bring them home to the United States. Dogs and cats may be infected with rabies but not show signs until several days or weeks after you first encounter them.
• Supervise children closely, especially around dogs, cats, and wildlife such as monkeys. This is important since children are more likely to be bitten by animals, may not report the bite, and may have more severe injuries from animal bites.
• If you are traveling with your pet, supervise your pet closely and do not allow it to play with local animals, especially strays.

Act quickly if an animal bites or scratches you.

• Wash the wound well with soap and water.
• See a doctor right away, even if you don’t feel sick or your wound is not serious. To prevent rabies, you may need to start a series of vaccinations immediately.
• To get vaccinated, be prepared to travel back to the United States or to another area. (Adequate vaccination for exposure to rabies is not available in all parts of the world.)
• After you return home, tell your doctor or state health department that you were bitten or scratched during travel.

Before your trip, find out if your health insurance covers health care overseas and medical evacuation. If it does not, consider buying supplemental health insurance for your trip.

Information for Health-Care Providers

GeoSentinel data indicate that the number of requests for rabies postexposure prophylaxis has increased among travelers returning from Bali since May 2008. GeoSentinel is a worldwide communication and data collection network for the surveillance of travel-related illness. It is operated in partnership between the International Society of Travel Medicine and CDC.

During pre-travel consultations, health-care providers should stress the importance of avoiding animal bites and recommend that travelers to Indonesia supplement their health insurance to cover emergency evacuation or health care abroad.

In December 2008 and January 2009, cases of rabies in dogs were reported in Badung and Denpasar districts in southern Bali [1, 2]. Dog rabies continues to be reported from Bali, with infected dogs most recently identified in the district of Tabanan [3]. As of 29 September 2009, more than 70,000 animals have been vaccinated across the three districts [3]. Nearly 20,000 dogs out of a population of more than 400,000 have been destroyed across nine districts of Bali [3].

In May 2009, the World Health Organization South East Asia Regional Office (SEARO) reported seven suspected cases and one laboratory confirmed case of rabies in humans [4].

The US Embassy in Indonesia reports that post-exposure rabies vaccine and immunoglobulin are in short supply [5].

Advice for travellers

The occurrence of rabies in Bali is a reminder of the importance of rabies prevention for travellers in many regions of the world. Rabies is transmitted following contact with the saliva from an infected wild or domestic animal (including bats in some countries) often via a bite, or a lick to an open wound. Human rabies is nearly always fatal.

The risk of exposure is increased by type of activity (e.g. running, cycling), occupation (e.g. veterinarians) and long duration of stay. Children are at increased risk, as they are more likely to have animal contact and may not report a bite, scratch or lick.

All travellers should avoid contact with any wild and domestic animals, including pets. Pre-exposure vaccination should be given to adults and children at increased risk of rabies (see above) or who are travelling to remote areas where medical care and post-exposure rabies vaccine and immunoglobulin are not readily available.

Following an animal bite, wounds must be thoroughly cleaned and an urgent medical assessment sought, even if the wound appears trivial. Prompt post-exposure treatment is required, even if pre-exposure vaccine has been received. Suitable vaccines and immunoglobulin are in short supply or unavailable in many areas of the world, including Bali. In some locations a flight back to the UK or to a medical centre in a nearby country may be necessary in order to obtain vaccine.

Travellers should ensure that they have comprehensive travel insurance and that it will cover them should they require medical evacuation.

Rabies

About Rabies

Rabies infections in people are rare in the United States. However, worldwide about 50,000 people die from rabies each year, mostly in developing countries where programs for vaccinating dogs against rabies don't exist. But the good news is that problems can be prevented if the exposed person receives treatment before symptoms of the infection develop.

Rabies is a virus that in the U.S. is usually transmitted by a bite from a wild infected animal, such as a bat, raccoon, skunk, or fox. If a bite from a rabid animal goes untreated and an infection develops, it is almost always fatal.

If you suspect that your child has been bitten by a rabid animal, go to the emergency department immediately. Any animal bites — even those that don't involve rabies — can lead to infections and other medical problems. As a precaution, call your doctor any time your child has been bitten.

Transmission

About 7,000 cases of rabies in animals are reported each year to the Centers for Disease Control and Prevention (CDC). Raccoons are the most common carriers of rabies in the United States, but bats are most likely to infect people. Almost three quarters of rabies cases between 1990 and 2001 came from contact with bats.

Skunks and foxes also can be infected with rabies, and a few cases have been reported in wolves, coyotes, bobcats, and ferrets. Small rodents such as hamsters, squirrels, chipmunks, mice, and rabbits are very rarely infected with the virus.

Because of widespread vaccination programs in the United States, transmission from dogs to people is very rare. Outside the United States, exposure to rabid dogs is the most common cause of transmission to humans.

An infected animal has the rabies virus in its saliva and can transmit it to a person through biting. In rarer cases, an animal can spread the virus when its saliva comes in contact with a person's mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or broken skin such as a cut, scratch, bruise, or open wound.

After a bite, the rabies virus can spread into surrounding muscle, then travel up nearby nerves to the brain. Once the virus reaches the brain, the infection is fatal in almost all cases.

Signs and Symptoms

The first symptoms can appear from a few days to more than a year after the bite occurs.

One of the most distinctive signs of a rabies infection is a tingling or twitching sensation around the area of the animal bite. It is often accompanied by a fever, headache, muscle aches, loss of appetite, nausea, and fatigue.

As the infection progresses, someone infected with rabies may develop any of these symptoms:

• irritability
• excessive movements or agitation
• confusion
• hallucinations
• aggressiveness
• bizarre or abnormal thoughts
• muscle spasms
• abnormal postures
• seizures (convulsions)
• weakness or paralysis (when a person cannot move some part of the body)
• extreme sensitivity to bright lights, sounds, or touch
• increased production of saliva or tears
• difficulty speaking

In the advanced stage of the infection, as it spreads to other parts of the nervous system, these symptoms may develop:

• double vision
• problems moving facial muscles
• abnormal movements of the diaphragm and muscles that control breathing
• difficulty swallowing and increased production of saliva, causing the "foaming at the mouth" usually associated with a rabies infection

If Your Child Is Bitten by an Animal

If your child has been bitten by an animal, take the following steps right away:

• Wash the bite area with soap and water for 10 minutes and cover the bite with a clean bandage.
• Immediately call your doctor and go to a nearby emergency department. Anyone with a possible rabies infection must be treated in a hospital.
• Call local animal-control authorities to help find the animal that caused the bite. The animal may need to be detained and observed for signs of rabies.
• If you know the owner of the animal that has bitten your child, get all the information about the animal, including vaccination status and the owner's name and address. Notify your local health department, particularly if the animal hasn't been vaccinated.
• If you suspect that your child has been bitten by an unknown dog, bat, rat, or other animal, contact your doctor immediately or take your child to the emergency department.

Treatment

At the hospital, it is likely that the doctor will first clean the wound thoroughly and make sure that your child's tetanus immunizations are current.

To keep any potential infection from spreading, the doctor may decide to start treating your child right away with shots of human rabies immune globulin to the wound site and vaccine shots in the arm. This decision is usually based on the circumstances of the bite (provoked or unprovoked), the type of animal (species, wild or domestic), the animal's health history (vaccinated or not), and the recommendations of local health authorities.

Prevention

You can reduce the chances that your family is exposed to rabies. Vaccinate your pets — dogs, cats, and ferrets can be infected by rabies. Report any stray animals to your local health authorities or animal-control officer. Remind kids that animals can be "strangers," too. They should never touch or feed stray cats or dogs wandering in the neighborhood or elsewhere.

As a precaution against rabies or any other infections, call your doctor if:

• your child has been exposed to an animal that might have rabies, but is too young to describe the contact with the animal
• your child has been exposed to bats, even if there is no bite
• you plan to travel abroad and may come into contact with rabid animals, particularly if you're traveling to an area where you might not have access to health care