Rabies vaccination is not a requirement for entry into any country; however, travelers to rabies-endemic countries should be warned about the risk of acquiring rabies outside the United States. Rabies is almost always transmitted by bites, which introduce the virus into wounds. Dogs are the main reservoir of the disease in many developing countries, but other animals may carry the virus; therefore, all animal bites should be evaluated. Any animal bite or scratch should be thoroughly cleansed with soap and water as soon as possible. This treatment significantly reduces the risk of rabies. In addition, travelers bitten by an animal should notify local health authorities immediately to assess the need for rabies post-exposure prophylaxis. Upon returning to the United States, travelers who have been bitten should contact their physician or state health department as soon as possible.

Pre-exposure vaccination should be considered for international travelers likely to come in contact with animals in areas where rabies is present and where immediate access to appropriate medical care, including biologics, may be difficult. Thus, the need for pre-exposure rabies vaccinations depends both on the destination of the traveler and on their anticipated activities. Pre-exposure vaccination greatly simplifies, but does not eliminate the need for, post-exposure treatment.

For international travelers, three 0.1-mL intradermal OR three 1.0-mL intramuscular vaccinations are given over a 3- or 4-week period. The vaccination series should be initiated early enough to allow all three doses to be completed before departure. Travelers who will also be taking mefloquine or chloroquine for malaria prevention should complete their three-dose rabies vaccination series BEFORE beginning these medications, which may interfere with the antibody response to rabies vaccine. Thus, if the rabies series is given intradermally, it should be initiated at least 1 month before travel. If this timing is not possible, the rabies vaccine should be given intramuscularly, as this dose/route provides a sufficient margin of safety for persons who must also take anti-malarial drugs.

© Center for Disease Control

Credits: National Center for Infectious Diseases