Rabies risk worldwide: practical advice for travellers during rabies vaccine shortages

An important reminder of practical aspects of rabies prevention for travellers

• This updates the news item of 01 December 2023

Rabies is a vaccine-preventable viral disease spread mostly by contact with saliva from any rabies-infected wild or domestic animal, including pets, via a bite, scratch, or a lick to an open wound. If animal saliva gets into your eyes, mouth or nose (mucous membranes) this is also a risk.

Bats can also carry rabies, including in the United Kingdom (UK) [1]. In humans, rabies is almost always fatal once symptoms develop [1, 2]. Rabies is found in more than 150 countries and territories on all continents, apart from Antarctica [2].

Rabies can be prevented by avoiding contact with animals and seeking prompt medical attention if in contact with saliva from a rabies- infected wild or domestic animal. Pre-exposure rabies vaccination may be recommended for some travellers [1].

Rabies vaccine for pre-exposure vaccination may sometimes be in short supply. In extreme circumstances (such as a worldwide rabies vaccine shortage, or discontinuation of a rabies vaccine product), pre-exposure rabies vaccines may be temporarily unavailable. In this situation, it is important to remember additional practical advice to ensure healthy travel to rabies risk areas.

Advice for travellers

Before you go

Check our Country Information pages to see if rabies is a risk at your destination.

• For advice on rabies vaccine, discuss your plans with a health professional. They can advise if you need rabies vaccine. If you are not able to access rabies vaccine or time is short before you travel, you may be advised to complete the course abroad, but should be aware that rabies vaccine supply may be limited at your destination. You can search for a clinic overseas on The International Society of Travel Medicine (ISTM) Global Travel Clinic Directory.
• Read about rabies and what you can do to reduce your risk before you visit rabies risk countries. An information leaflet is available from the UK Health Security Agency (UKHSA).

If you get pre-exposure vaccination, remember to take your vaccine records with you when you travel. This contains important information that will be needed if you get bitten, scratched, licked by an animal during your travels.

Make sure you have travel health insurance.

Are you at risk because of your occupation?

If you have certain jobs in the UK, you should be offered pre-exposure vaccination [1]. These jobs include:

• laboratory staff routinely working with rabies virus.
• workers at Department for Environment, Food and Rural Affairs (Defra)-authorised quarantine premises and carriers.
• those who regularly handle bats, including volunteers, in the UK.
• veterinary and technical staff who, because of the nature of their work, have an increased risk.

and if you work overseas in rabies risk areas:

• animal control and wildlife workers.
• veterinary staff.
• zoologists.

If you handle animals as part of your work, you should contact your Occupational Health (OH) team for advice.

While you are away

Even if you have had a rabies vaccine course, avoid contact with all wild and domestic animals, including pets. Remember, animals that appear to be behaving normally can still be infectious.

• Do not approach any animals (including bats).
• Do not pick up ill or unusually tame animals (including bats).
• Do not attract stray animals by being careless with litter or offering food.
• Children are at particular risk, as they are most likely to touch animals and may not report an animal bite, being scratched, or licked.
• Remember activities like cycling or running often attract dogs.

If you are bitten, scratched or licked by any animal or if you find a bat in your bedroom (you may have been bitten while you slept, bat bites do not always leave an obvious mark):

• immediately wash and thoroughly flush the area with soap and lots of water.
• get medical urgent medical help locally abroad– do not wait until you return to the UK. Even if you have had rabies vaccine before travelling, it is still important to seek medical advice promptly.
• if advised, start the rabies post-exposure treatment abroad and do not wait until you get back to the UK. You may need to travel to a nearby major city or possibly another country for appropriate treatment and vaccines. You can search for a clinic overseas on The International Society of Travel Medicine (ISTM) Global Travel Clinic Directory.

Ask for a written record of any post exposure treatment you receive overseas and contact your medical insurance company. If you do not feel comfortable with the medical advice you receive overseas, let your medical insurance company know this and ask for their advice.

When you return

Always contact your GP on return to the UK, even if you received treatment abroad or the exposure happened several weeks ago. You may need to continue a course of rabies vaccines. If you have a record of any treatment given, remember to bring this with you. Your GP will also be able to arrange for post-exposure treatment, if this was not started while you were abroad, but is considered necessary by UK experts.