Rabies: A 5 Point Primer for Expats and Travelers in SE Asia.

Rabies Immunization Clinic Photo

Creative Commons. Photo by C Newlin de Rojas

1. Fatal.

If you are exposed and don’t get treatment, it is 100% fatal. Receive treatment within first 24 hours of contact with a rabies carrier for best chances of survival.

2. Saliva.

That’s how it is transferred. It isn’t about the bite, though deeper bites are more dangerous. If you are licked by a stray animal in a country with a high rate of rabid animals, i.e. SE Asia and India, you should get yourself to an emergency room. You could take a chance but it’s a game of Russian Roulette. Once you develop symptoms, you can start planning your funeral.

3. Painful

On the up side, they no longer inject you in your abdomen. Yay! But if you haven’t been pre-vaccinated, you must have an injection of RIG or Rabies Immune Globuline in addition to the vaccine shots. RIG jump starts your immune system and this part of the treatment is *painful*. They need to inject as much of this stuff as possible under the surface of your skin where the bite/lick occurred. The balance goes in your bum.

To give you a sense of this part of the treatment, imagine slipping a deflated balloon under your skin and then inflating it as much as possible. My daughter’s hand looked like the hunchback…except on her hand. Many ‘brave’ candies and biscuits were doled out by the nurses. Oh and my daughter got some too!

If you haven’t had a Tetanus shot in the last 10 years you need one of these too. And if you have a deep puncture wound, you actually need shots every 5 years. (Without treatment or vaccinations 1/4 people infected will die of Tetanus. The rate is higher for infants)

4. Ka-Ching.$$$

It’s expensive. Well, the RIG is expensive. Prices will vary. At our local (Bangkok) Catholic non-profit hospital, for an adult, you are looking at THB20,000 or $200. Of course everything is relative. If you are an expat on a juicy contract, this is likely peanuts for you and you are probably already at the more expensive snazzy hospitals. If you are in the US, you’d shell out about $1500 for a RIG dose Which brings me to #5, and this will make you Mambo.

5. It’s un-necessary

Well the balloon injection pain and loss of cash is un-necessary. If you get the pre-exposure vaccination consisting of three shots over a month, you do not need the RIG treatment, saving you money, tears, and time.

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If you work for a government agency, chances are they will have obligated you to get this done. You should thank them. If you are negotiating an expat package as we speak, you could consider asking them to organize and cover the country’s recommended vaccines prior to moving.

If you are like the rest of us, moving or traveling by choice (or working for one of those shoddy companies who are increasingly cutting corners) I’d wait until you get to Asia to get it done. It costs a fraction of the price: In the US, the three shots will cost you about $600 total pp while in Bangkok, at the local travel clinic, we paid about $15 total pp. You also have the option to choose the intra-dermal instead of the intra-muscular jabs. They are cheaper, less painful, and just as effective.

Check in later this week for our amazing story: Horses, Humans, and Rabies Oh My!, where I recount how two of us were bitten in one week, by different animals, and ended up at a snake farm for our shots. For real folks. Welcome to Thailand.

 

Readers please note: This is a short and basic overview. There are many things to consider. For example: RIG shots must be given within the first 6 days. By day 7, it can impede your own body’s response. Depending on risk factors e.g. animal and exposure types, some doctors will recommend a ‘wait and see’ approach, given the cost and availability of RIG. But then all of this is avoided if you simply get pre-vaccinated.