The rabies vaccination is becoming more and more accepted by travelers and represents a considerable issue in travel medical advice. The fears of the traveler are in the foreground compared to the actual frequency of the illness.
As within all our medical activities a high-quality medical consultation, especially in this sensitive area of travel vaccinations should be based on factual arguments as well as on the individual feelings of the patient or traveler.
In order to reach an optimal result in terms of travel vaccination for the patient, the following considerations should be communicated:
Rabies occurs in almost all tropical regions, as so-called urban rabies. This means that the transmission to humans is mainly by dogs and rarely by bats.
The infection of German travelers with rabies is an extremely rare event. On average, we have an introduction every one to two years.
The rabies disease is absolutely fatal.
The contact with dogs during the journey is not so rare at all. Travel doctors speak of a probability up to 10%. Thelikelyhood is certainly dependent on the type, duration and destination of the trip.
If the traveler imagines to have contact with a possibly rabies-transmitting animal, he must decide the following alternatives for himself:
- A. He doesn’t do anything and says to himself: “there won’t be anything”.
- B. He immediately tries to get a post-exposure vaccination.
- C. He has been vaccinated prophylactically.
- Although point A is quite possible due to the rarity of the actual disease, in the case of absolutely fatal illness, the traveler will hardly bear this with the necessary serenitiy. It is also not particularly pleasant to watch each approaching dog like a hawk.
- Point B is possible, but often difficult to realize in practice. The effectiveness of the post-exposure vaccination is not 100% documented. The vaccine, especially the passive one, is not available everywhere. The application of a hyperimmunoglobulin is very painful and not without any side effects. Nobody knows exactly how fast such a post-exposure vaccination has to take place, ideally as quickly as possible within the first two days. After the first 3 vaccinations have to be given within one week, the consequence is usually to stay at the vaccination site.
- Point C: The preventive vaccination consists of three vaccinations, which are very well tolerated. There is only to consider the expenditure of time, 3 needlesticks and the costs. The costs for travel vaccinations are currently covered by many health insurance companies.
After having had contact with a probably infected animal, you should get 2 active vaccinations for safety’s sake. The passive vaccination can be omitted. If this re-vaccination is not possible or not desired, one nevertheless can feel very safe, since no rabies case of a vaccinated person became known yet.
With this information the doctor is able to accompany the traveler ethically clean in deciding for or against the prophylactic rabies vaccination in the travel medicine.