Rabies Vaccination

High Risk Countries and Pre-Travel Vaccination

Rabies remains a major public health problem in Asia, Africa, Central and South America. The highest risk countries for travelers include Colombia, Ecuador, El Salvador, Guatemala, India, Mexico, Nepal, Philippines, Sri Lanka, Thailand, and Viet Nam. In Thailand, between 200-300 human rabies deaths are reported annually with 95% due to dog bites. A survey of 1,882 foreign travelers in Thailand determined that 1.2% had a history of dog bite and 8.7% experienced a dog lick during their stay. Other animals that can spread rabies include bats, cats, skunks, racoons, foxes, jackals, mongooses, and wolves.

It is recommended that all unvaccinated individuals with animal bites receive immediate treatment with human rabies immune globulin (HRIG) injected into and around the wound followed by rabies vaccination. Two types of rabies vaccine are now available. The original human diploid cell vaccine (HDCV) and a new purified chick embryo culture vaccine (PCEC). After exposure, five doses of either rabies vaccine must be given into a muscle (intramuscularly) over a one month period.

While this treatment should be adequate to prevent the development of rabies, treatment can be simplified if rabies vaccine is given prior to exposure. Prior vaccination may also offer some degree of protection in cases when treatment after an animal bite may be unavoidably delayed.

Pre-travel vaccination would consist of three low dose injections into the skin (intradermal) of the HDCV vaccine or three intramuscular injections of the PCEC vaccine given over a one month time period. The first dose is followed by a second in one week and the third in 3-4 weeks. Once vaccinated, if you do experience an animal bite, treatment would then consist of only two booster doses of vaccine three days apart.

While traveling, special care should be taken to prevent dog bites, and any bite or scratch should be immediately cleansed with soap and water. You should then contact the local health authorities for advice on further treatment and also inform your own physician once you return home.

Gary P. Barnas, MD
Associate Professor
General Internal Medicine

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.