Rabies

What is rabies?

Rabies is an infection of the brain or nervous system. This infection is caused by the rabies virus, which is transmitted through contact with infected animals. In general, rabies infections do not occur in the Netherlands; the disease is almost always contracted abroad. In the Netherlands, a mild version of the rabies virus occurs in bats, but this virus almost never causes infection in humans. It is recommended not to touch bats and to see a doctor if you have been scratched or bitten by a bat.

After infection, rabies progresses in several distinctive stages. Without treatment, it takes twenty to ninety days from the time of infection before symptoms develop. The length of this incubation period depends on the site of infection. The closer to the central nervous system the infection takes place, the faster the disease usually progresses.

In the first stage, the following symptoms occur:

·       a reduced appetite;
·       Nausea;
·       Chills;
·       Headache;
·       Vomiting.

In the next stage, neurological symptoms occur, such as:

·       Muscle spasms;
·       Paralysis;
·       Convulsions;
·       Difficulty swallowing and breathing.

Because swallowing water or mucus might become very painful, some people develop hydrophobia.

The disease is fatal, a person often ends up dying from swallowing and breathing problems. For this reason, it is important for anyone going to an high risk area to take preventive measures. It is also important to take immediate action when someone does get bitten or scratched.

How do you get rabies?

The rabies virus can be found all over the world, except in Japan, New Zealand and Antarctica. The risk of a rabies infection can vary greatly from country to country. The likelihood of contact with certain mammals is higher in some countries than in others. The activities undertaken during travel also affect the risk a person faces.

The virus that causes rabies can be present in many mammals. It is therefore recommended to stay away from (wild) animals when abroad. These include dogs, cats, bats and monkeys. Contact with many of these animals is risky. Although the chance of the animal being infected with rabies is very low, any contact can be a potential danger. In such cases, treatment is imperative.

What can you do to prevent rabies?

It is always best to prevent infection, this is especially important when it comes to rabies. When abroad, avoid contact with animals and pay extra attention to children since children are more likely to touch animals. If in your situation there is an increased risk of rabies during your trip, it is advisable to take preventive measures but also to have an emergency plan at hand. You are at increased risk of a rabies infection when:

• You are travelling to an area where rabies is common;
• You expect to come into frequent contact with (wild or stray) animals, for example because of your profession;
• You plan to cycle a lot (cyclists are at increased risk of dog bites);
• You spend more than three months in a high-risk country or make frequent short trips;
• You are travelling with small children;
• Medical care not readily available during (part of) your trip.

If one or more of these conditions apply to your trip, it may be wise to get a preventive rabies vaccination. If you are vaccinated against rabies, treatment after a bite or scratch is easier and more readily available.

What to do if you are bitten or scratched?

Regardless of your vaccination status, you should first clean the wound properly. You do this by rinsing the wound for at least ten minutes with lukewarm water and soap. Then disinfect the wound, which can be done with alcohol 70% or iodine. You may dress the wound, but do not stitch it; it is important that the wound remains open.

What to do after disinfecting depends on whether you have been vaccinated or not. In any case, make sure you monitor the wound closely and keep your vaccination passport at hand. That way, the doctor treating you will know which vaccinations you have had and which treatment is best for you.

Even if you are fully vaccinated, you should still see a doctor as soon as possible. You will then receive two vaccinations in three days. Always have these vaccinations recorded in your vaccination passport.

Are you bitten or scratched but not vaccinated against rabies? In that case, use the emergency number of your health insurance and/or travel insurance. Within 12 to 24 hours, MARIG, or human anti-rabies immunoglobulin, should be started. This drug is difficult to obtain or of poor quality in many countries. At the same time, a vaccination series is started, consisting of at least four vaccinations. This is usually done on day 0, 3, 7, 14-28. An embassy or consulate can tell you where the vaccine is in stock.

When is it advisable to do a rabies antibody determination?

If your profession involves a lot of contact with animals that may be infected with the rabies virus, a different procedure applies to you. Are you a veterinarian, biologist or do you research bats? Then you are at greatly increased risk and it is advisable to do a titre check four weeks after your vaccination. This is a blood test that determines your level of protection against rabies.

Based on the result, it can be decided to do a booster vaccination. Another titre check is then done four weeks after the booster vaccination. After that, checks should be done every six months. This ensures that you can continue to do your job safely.

In addition, a booster vaccination may be recommended if you are travelling to a very remote area and are unlikely to be able to start your treatment within 24 hours. A booster vaccination provides long-term protection for at least five years.

What protection does the rabies vaccination offer?

The vaccination provides lifelong protection against rabies after a full pre-exposure prophylaxis (PrEP) series. As a treatment, anti-serum (MARIG) is no longer required. However, additional vaccinations may be required as treatment. This depends on the wound and what kind of animal it has been. Always have this assessed by a doctor or expert. 

How much will a rabies vaccination cost?

If you meet a number of high-risk criteria, a rabies vaccination is usually covered by your health insurance. Check with your health insurance company whether the vaccination is (partially) covered. For more information on costs, please visit our prices page.

Questions or schedule an appointment?

Do you have questions or would you like to book an appointment for a personal (travel)consultation? Use the button below, email us at info@vaccinatiecentrum.nl or call 085-9020303.