4 August 2005

Imported Case of Rabies in the UK

The Health Protection Agency (HPA), Centre for Infections confirmed that an imported case of human rabies has occurred this month (July 2005) in England following clinical and epidemiological investigations by the NHS, HPA, Department of Health and Department for Environment Food and Rural Affairs [1].

The diagnosis of rabies was confirmed by tests on samples sent to the UK National Reference Laboratory for Rabies at VLA-Weybridge, Surrey. This followed a dog bite in Goa, India; India is considered to be at high risk of rabies. Medical attention was not sought after the bite occurred.

In the last 10 years there have been three other imported cases of human rabies in England and Wales. The first case occurred in 1996 following a bite from a stray dog in Nigeria where post exposure prophylaxis had not been given (CDR Weekly 18 October 1996 available at http://www.hpa.org.uk/cdr/archives/CDR96/cdr4296.pdf.

The second case occurred in 2001 and followed a bite from a dog in the Philippines (CDR Weekly 11 May 2001 http://www.hpa.org.uk/cdr/archives/2001/cdr1901.pdf. Medical treatment was not sought following the biting incident. The third case also occurred in 2001 and again followed a dog bite in Nigeria (CDR Weekly 14 June http://www.hpa.org.uk/cdr/archives/2001/cdr2401.pdf. While medical attention was sought in this case and a course of injections was given it was unclear whether this was rabies vaccine.

Travellers should always be advised to seek travel health advice well in advance of their holiday or trip overseas to ensure that the risks of all travel associated illness, not just rabies, have been explained.

While rabies vaccine is not routinely advised for travellers there are situations where it should be considered: such as those who intend to travel for a prolonged period or live in rabies endemic countries, or those who may be unable to get immediate medical attention (and safe and effective rabies vaccine and immunoglobulin) if bitten e.g. those on trekking holidays in resource poor countries. Detailed information is available in the Department of Health Green Book chapter on rabies http://www.dh.gov.uk/assetRoot/04/11/09/70/04110970.pdf.

Travellers should be advised to avoid all unnecessary contact with animals. If bitten or scratched by a warm blooded animal they should wash the wound with plenty of soap and water and seek medical attention immediately, even if previously vaccinated. If they do not seek medical treatment whilst abroad, they should still seek it when they come home, even if it is some time after the event. Promptly administered post-exposure prophylaxis is extremely effective in preventing rabies. For persons who have not received any rabies vaccine prior to a potential exposure, post-exposure prophylaxis consists of a dose of vaccine as soon as possible after the bite followed by four further doses 3,7,14 and 30 days later. Human rabies immunoglobulin may also be needed. If the person has been previously vaccinated fewer doses of vaccine are required.

Further information about rabies can be found on the NaTHNaC information sheet:

http://www.NaTHNaC.org/travel/factsheets/rabies1.htm

Currently, Rabipur® rabies vaccine may be obtained from Chiron Vaccines (0151 705 5000) or MASTA (0113 2387500). Rabies vaccine may also be obtained from Sanofi Pasteur MSD. (01628 785291).

Reference

1. HPA. Case of imported rabies in the UK. Commun Dis Rep CDR Wkly [online] 2005; [cited 29 July 2005];15 (30)

Available at http://www.hpa.org.uk/cdr/archives/2005/cdr3005.pdf