Rabies

How can you get rabies?

The rabies virus is spread through the saliva of infected animals. Most infections are caused by bites or scratches, although the virus can also be transmitted if an infected animal licks an open wound or your eyes, mouth, or another mucous membrane. The risk of getting rabies in the Netherlands is extremely low. In very rare cases, a form of the rabies virus has been found in bats. Most rabies infections are acquired outside of Europe and are caused by infected mammals, usually dogs. Other animals, such as cats, foxes, and monkeys, can also carry and transmit the virus.

In the Netherlands, you can reduce your risk of infection by avoiding contact with bats. When travelling abroad, it’s best to avoid contact with all animals, especially wild and stray animals. Rabies occurs throughout most of the world, except in most of Northwestern Europe, Japan, Australia, New Zealand, and Antarctica. The risk of infection varies from country to country. In North America, for example, the risk is very low. During your appointment with a travel health nurse, we will discuss the risks associated with your trip and the precautions you can take to protect yourself.

Symptoms of rabies

A rabies infection develops in stages. The incubation period is usually 20 to 90 days, depending on where the virus entered the body. The closer the site of infection is to the central nervous system (the brain), the more quickly the disease can progress.

The only way to contract rabies is through contact with an infected animal. If you are experiencing any of the symptoms listed below but have not been bitten, scratched, or licked by an animal, you do not need to worry about rabies.

First fase, early symptoms:

• Loss of appetite
• Nausea
• Vomiting
• Chills
• Headache

Second stage, neurological symptoms:

• Muscle spasms
• Paralysis
• Seizures
• Difficulty swallowing and breathing

At this stage, swallowing can be very painful. Some people therefore develop a fear of water, known as hydrophobia. Rabies is almost always fatal once symptoms have developed. Death is usually caused by problems with swallowing and breathing.

That is why it is important to take preventive measures when travelling to areas where rabies occurs and to seek medical attention immediately if you are bitten or scratched by an animal, especially a wild animal. If treated quickly, treatment is usually very effective at preventing rabies. Rabies cannot be treated if symptoms appear.

How to prevent rabies

All travelers are advised to avoid touching animals when abroad. This is especially important in areas where rabies is common. Keep a close eye on children and make sure they do not touch animals either.

For some travelers, getting vaccinated against rabies is recommended. This may be the case if:

• You are travelling to an area where rabies is present.
• You expect to have frequent contact with animals, especially wild animals, for example because of your work.
• You plan to do a lot of cycling.
• You plan on staying, in a country where rabies is present, for more than three months.
• You frequently take short trips to a country where rabies is present.
• You are travelling with young children.
• You are unable to get medical help quickly, for example because you are staying in a remote area.

If you have been vaccinated, the treatment you need after being bitten or scratched is much simpler. However, you still need to seek medical attention and receive treatment, even if you have been vaccinated against rabies.

The rabies vaccine can be given in two ways: into a muscle or into the skin (intradermally). With intradermal vaccination, less vaccine is needed while providing the same level of protection as vaccination into a muscle. This makes intradermal vaccination less expensive and causes fewer side effects than vaccination into a muscle. For these reasons, vaccinatiecentrum.nl usually gives the rabies vaccine intradermally.

The rabies vaccination schedule

The preventive rabies vaccine can be given according to different vaccination schedules. Your vaccination schedule depends on how the vaccine is given (into a muscle or intradermally), your age, and your health status. During your appointment at vaccinatiecentrum.nl, the travel health nurse will assess which schedule is most appropriate for you. In general, you can expect to need two or three vaccinations.

When is an antibody test for rabies recommended?

If you are in regular contact with animals that may be infected with the rabies virus, an antibody test may be recommended. For example, if you are a veterinarian, biologist, or work with bats, you have a significantly increased risk of exposure to rabies. In these cases, it is recommended to have an antibody test four weeks after your vaccinations. This is a blood test that measures the level of antibodies against rabies in your blood and shows how well you are protected.

Depending on the results, you may be advised to have a booster vaccination. Four weeks after the booster, you will have another antibody test to make sure that you have developed sufficient protection.

If you remain at risk of exposure to rabies, you should have this antibody test at least once a year. This helps ensure that you remain adequately protected while doing your work.

Both the booster vaccination and the antibody test can be done at vaccinatiecentrum.nl.

How long does the rabies vaccine protect you?

The rabies vaccine provides lifelong protection once you have received the primary vaccinations according to the recommended vaccination schedule. However, you still must seek medical attention if you are bitten or scratched by an animal.

Which countries may require rabies vaccination?

The risk of rabies varies from country to country and depends on your travel plans. The travel health nurse will discuss this with you during your appointment at vaccinatiecentrum.nl.

Examples of areas where rabies is present include:

• Thailand
• Indonesia (including Bali)
• India
• Vietnam
• Cambodia
• The Philippines
• Nepal
• Sri Lanka
• Morocco
• Kenya

What should you do after a bite, scratch, or lick?

Have you been bitten or scratched by an animal, especially a wild animal, while abroad? Or has an animal licked an open wound or mucous membrane? Clean the wound immediately. Rinse it thoroughly with plenty of water and soap for at least 15 minutes. Then disinfect the wound with 70% alcohol or iodine. You may cover the wound with a dressing, but it should not be stitched.

Next, contact the emergency assistance service of your travel insurance or health insurance provider immediately. They will advise you on the next steps. What you need to do depends on whether you have been vaccinated against rabies. In either case, you will need emergency treatment.

If you have been vaccinated: you will need two additional vaccine doses over a period of three days.

If you have not been vaccinated: you should start treatment with MARIG (human rabies immunoglobulin) within 12–24 hours. You will also need to follow a vaccination schedule consisting of at least four doses. These are usually given on day 0, 3, 7, and 14–28.

Side effects of the rabies vaccine

The rabies vaccine can cause side effects. The most common side effects after vaccination into a muscle are pain, redness or swelling at the injection site, headache, muscle aches, nausea, and swollen lymph nodes. Some people may experience flu-like symptoms or dizziness.

When the vaccine is given into the skin (intradermally), side effects are a bit less common. Some people may experience mild itching at the injection site or a headache. It is important to keep the vaccination site out of direct UV exposure for at least 48 hours after intradermal vaccination.

Cost of the rabies vaccine

Under certain conditions, the cost of the rabies vaccine may be covered by your health insurance. In some cases, you will have to pay for the vaccine yourself.

Please visit our pricing page for the most up-to-date information on costs.