Rabies is caused by the rabies virus. In humans and mammals, infection with the rabies virus causes an acute encephalitis (inflammation of the brain) that is almost always fatal.42 Initial symptoms include a sense of apprehension, headache, fever, tiredness, and sensory changes in the area of the wound. These are followed by excitability, disorientation, delirium and convulsions, and death a few days after onset.7,42
Transmission7,42 Infection in humans usually occurs through the bite of an infected animal. The virus is present in the saliva. Any contact involving penetration of the skin occurring in an area where rabies is present should be treated with caution. Cases of rabies after animal scratches or the licking of open wounds are extremely rare. In developing countries, transmission is usually from dogs. In some parts of the world other animals, such as jackals and bats, are important sources of exposure. In countries where rabies vaccination of domestic animals is widespread ( North America and Europe ), wild animals such as raccoons and foxes are important reservoirs. Person-to-person transmission has not been documented.
Geographical distribution7 Rabies is endemic throughout much of Africa, Asia, the Americas and Europe, where the virus is maintained in certain species of mammals. Australia , New Zealand and Papua New Guinea are free of endemic rabies.
Risk to travellers42
In rabies-endemic areas, travellers may be at risk if there is contact with wild or domestic animals, including dogs and cats. Children are of most concern, as they may not tell you they have been bitten.
Precautions and prevention
Avoid contact with wild animals and stray domestic animals, particularly dogs and cats, in rabies-endemic areas. If bitten by an animal that is potentially infected with rabies, or after other suspect contact, immediately clean the wound thoroughly with disinfectant or with soap or detergent and water. Seek medical assistance immediately.42Medical treatment is indicated.
Vaccination is recommended for expatriates and travellers who will be spending more than 4 weeks in countries where rabies is endemic, especially if travelling to rural and remote areas of the country/countries.7 (see your doctor)
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