Protecting yourself from rabies while traveling

Exposure to rabid dogs is responsible for 99% of rabies deaths around the world.¹

Rabies is known to exist on every continent except Antarctica, and overseas travel to high-risk areas can increase the risk of rabies exposure. In fact, rabies causes 59,000 deaths in 150 countries each year, with 95% of cases occurring in Africa and Asia, mostly among rural poor populations.¹

In the U.S., deaths from rabies are rare. However, about 55,000 persons are treated for potential rabies exposure annually.²

Mammals such as raccoons, skunks, foxes and bats are common carriers of the rabies virus. Bats have caused 62 out of 89 (70%) human rabies cases in the U.S. since 1960.²

When traveling, it’s best to avoid animals that are in the wild or roam free. Wild animals have a natural fear of humans, so if one approaches you or doesn’t run away, there may be something wrong with that animal. Look for signs of fearfulness, aggression, staggering, paralysis, seizures, or drooling more than normal. Others may act shy or timid, even uncharacteristically tame.³ If you spot an animal like this, stay away and immediately report it to local animal control.

Think you and your family won’t be at risk for rabies on your trip? Know the risk factors.

Consider the following when planning a trip^4-7:

Travel location

Especially to higher-risks areas such as Southeast Asia, India, and North Africa

Young age

Children are more likely to approach animals and not recognize possible danger

Types of activities planned

Risk increases when you venture to caves or remote areas where you may encounter wildlife or in parts of the world where dogs are more likely to roam

Likelihood of recurring travel

Odds for rabies exposure increase each time you travel to high-risk destinations

Unpredictability of exposures

Exposure can occur at any time; in fact, they are most often reported around 7-10 days after arrival

Access to quality healthcare

If exposed, understand the likelihood of readily obtaining medical care including vaccines and human rabies immune globulin (HRIG) treatment

What’s the risk of rabies where I’m traveling?

Take a look at the level of risk for rabies around the world. Risk shown here is based on the type of animal transmitting the rabies virus, data about the magnitude and distribution of rabies, access to proper medical care, and availability of rabies vaccines and HRIG treatment.^7,8

High risk

Pre-exposure prophylaxis (PrEP) recommended for travelers and people with occupational risks likely to have contact with rabid domestic animals, particularly dogs, bats, and wild carnivores.

Moderate risk

PrEP recommended for travelers to remote areas and people likely to have contact with bats and other wildlife.

Low risk

PrEP recommended for people likely to have regular direct contact with bats and wild carnivores.

No risk

No data

Not applicable

Graphic illustration of a family coming into contact with wildlife

With just one bite, rabies can end your trip. Don’t let it end your life.

Camping, certain kinds of outdoor exploration, and travel to higher-risk areas like Asia and Africa all increase the risk of rabies exposure,⁴ but you can take precautions that will help you minimize the risk for rabies infection.

Avoiding exposure to potentially rabid animals is your best bet, but if you think you may come in contact with bats and other wildlife—or dogs in countries without canine rabies vaccination programs—you may want to consider pre-exposure rabies vaccination for humans.⁹ Pre-exposure vaccination won’t eliminate the need for treatment after a bite, but does offer a level of protection, particularly against unrecognized exposures. Pre-exposure vaccination primes your immune response so treatment after exposure can be effective more quickly. It also reduces the number of vaccinations and simplifies treatment because no HRIG is needed.¹⁰

Seek a medical consultation at least 6 weeks before traveling to assess your risk so you and your doctor can decide if pre-exposure vaccination is right for you.¹¹

Learn more about pre-exposure vaccination

Finding medical help when you’re traveling

When traveling to a remote area, you may have less access to quality healthcare, including rabies treatment.

If you suspect you or someone in your family has been exposed to rabies while traveling, it’s important to immediately wash any wound for at least 15 minutes using soap and water.¹²

Seek help at the nearest medical facility and explain the circumstances around your possible rabies exposure. If you have been exposed, you may need to undergo a series of rabies doses and receive HRIG (if not previously vaccinated). Waiting for symptoms to appear will be too late. If you’re in any doubt, get medical attention right away.

References

World Health Organization. Epidemiology and burden of disease. Accessed April 15, 2021. https://www.who.int/teams/control-of-neglected-tropical-diseases/rabies/epidemiology-and-burden
Pieracci EG, et al. MMWR Morb Mortal Wkly Rep. 2019;68(23):524-528. doi:10.15585/mmwr.mm6823e1 https://www.cdc.gov/mmwr/volumes/68/wr/mm6823e1.htm
American Veterinary Medical Association. Rabies and your pet. Accessed April 14, 2021. https://www.avma.org/resources/public-health/rabies-and-your-pet
Di Quinzio M, McCarthy A. CMAJ. 2008;178(5):567. doi:10.1503/cmaj.071443 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2244672/
Piyaphanee W, et al. Am J Trop Med Hyg. 2010;82(6):1168-1171. doi:10.4269/ajtmh.2010.09-0699 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877430/
Wallace RM, et al. CDC Yellow Book 2020: Health Information for International Travel. Chapter 4: Rabies. Oxford University Press, 2019. Accessed May 21, 2021 https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/rabies
WHO Expert Consultation on Rabies: Third Report. WHO Technical Report Series; 2018. Accessed April 14, 2021. https://apps.who.int/iris/bitstream/handle/10665/272364/9789241210218-eng.pdf?ua=1
World Health Organization. Distribution of risk levels for humans contracting rabies, worldwide, 2018. Accessed May 21, 2021. https://www.who.int/ith/rabies2018.png?ua=1
Centers for Disease Control and Prevention. Rabies. Accessed April 14, 2021. https://wwwnc.cdc.gov/travel/diseases/rabies
Centers for Disease Control and Prevention. Preexposure vaccinations. Accessed June 28, 2021. https://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html
The Pretravel Consultation. Am Fam Physician. 2016 Oct 15;94(8):620-627. https://www.aafp.org/afp/2016/1015/p620.html
Centers for Disease Control and Prevention. When to seek care. Accessed April 14, 2021. https://www.cdc.gov/rabies/exposure/index.html

Important Safety Information

People with a history of severe allergic reaction (e.g., anaphylaxis) to RabAvert or any of its ingredients should not receive RabAvert…

Indication

RabAvert is a vaccine approved for all age groups to help prevent rabies infection both before and after a suspected exposure.

…for protection before a potential exposure (PrEP) to the rabies virus. They should receive a different rabies vaccine if a suitable product is available. However, because rabies is almost always fatal if left untreated, the protection provided with RabAvert after a potential exposure (PEP) to the rabies virus outweighs the risks associated with a severe allergic reaction.

The ingredients of RabAvert, which could in rare cases, cause allergic reactions in some people, include egg and chicken proteins, processed bovine (cow) gelatin and trace amounts of neomycin, chlortetracycline, and amphotericin B. Let your healthcare professional know if you have had any issues, including allergic reactions, with any of these ingredients or with vaccines in general.
Severe, potentially life-threatening allergic reaction, swelling of the brain and spinal cord; loss of movement or sensation due to nerve damage, such as inflammation of the brain or temporary loss of movement; Guillain-Barré Syndrome; inflammation of spinal cord; inflamed nerves of the eye; and multiple sclerosis have in very rare cases been reported.
RabAvert should be injected into muscle only. RabAvert injected into a vein may cause a reaction throughout the body, including shock.
Fainting can occur when injectable vaccines are used, including RabAvert. Your healthcare provider should put procedures in place to avoid falling injury and to restore blood flow to the brain after fainting.
Patients with a weakened immune system due to illness or the use of certain medications or treatments (such as radiation therapy, antimalarials, and corticosteroids) may have issues developing immunity. If such a patient is receiving RabAvert, then the healthcare professional may measure immune response through blood testing. Vaccination with RabAvert for protection before a potential exposure (PrEP) to the rabies virus should be delayed in anyone who is sick or recovering from an illness.
RabAvert contains albumin which is a protein found in human blood that carries an extremely remote risk for transmission of viral diseases, including Creutzfeldt-Jakob disease (CJD), a rare brain disorder. No cases of transmission of viral diseases or CJD have ever been identified for albumin.
Persons who have not been previously vaccinated against rabies will receive Human Rabies Immune Globulin (HRIG). HRIG should not be administered to persons who have been previously vaccinated as it may counteract the effect of the rabies vaccine. Let your healthcare provider know if you were previously vaccinated for rabies as you may not need HRIG.
Only use RabAvert while pregnant or breastfeeding if clearly needed. RabAvert was not studied in pregnant or lactating women so it is not known if RabAvert can cause any harm to the fetus, have any effect on ability to get pregnant, or whether it is passed through breast milk to infants (but many drugs are excreted in human milk).
There is no information on how RabAvert works when given at the same time as other vaccines.
The most common side effects in clinical trials were reactions at the injection site, such as reddening, hardening, and pain; flu-like symptoms, such as lack of energy, tiredness, fever, headache, muscle pain, and feeling of discomfort; joint pain; dizziness; swelling of lymph nodes; upset stomach; and rash.
Vaccination before a potential exposure (PrEP) to the rabies virus does not remove the need for additional therapy after a suspected or known rabies exposure.
Seek the advice of a healthcare professional to help assess your specific level of risk if you are traveling to areas of high risk of rabies exposure; in frequent contact with the rabies virus or rabid animals, such as on the job; and/or are active outdoors and could encounter animals with rabies in the wild.
If you are exposed to a potentially rabid animal, seek medical attention right away before you have symptoms. Once symptoms are present, the rabies infection has spread through the body and survival is unlikely.

Uses for RabAvert