Disease Description: Rabies is an acute, progressive, fatal encephalomyelitis caused by neurotropic viruses in the family Rhabdoviridae, genus Lyssaviru. The disease is almost always transmitted by an animal bite that inoculates the virus into wounds. All mammals are believed to be susceptible, but reservoirs are carnivores and bats. Although dogs are the main reservoir in developing countries, the epidemiology of the disease differs sufficiently from one region or country to another to warrant the medical evaluation of all mammal bites.
Risk to Travelers: Rabies is found on all continents except Antarctica. In certain areas of the world, canine rabies remains highly endemic, including (but not limited to) parts of Africa, Asia, and Central and South America. Street dogs represent the most frequent risk for bite exposure to travelers, followed by monkeys, especially those that live near temples in parts of Asia. Travelers with extensive unprotected outdoor exposure such as might be experienced while bicycling, camping, hiking, or engaging in certain occupational activities, might be at higher risk even if their trip is brief. Also, children are considered at higher risk because of their tendencies to play with animals and to not report bites. Casual exposure to cave air is not a concern, but cavers should be warned not to handle bats.
Some countries and regions are rabies free (see table).
Prevention - Vaccine: Pre-exposure vaccination with human diploid cell rabies vaccine (HDCV), or purified chick embryo cell (PCEC) vaccine, may be recommended for international travelers based on the local incidence of rabies in the country to be visited, the availability of appropriate antirabies biologicals, and the intended activity and duration of stay of the traveler. Pre-exposure vaccination does not eliminate the need for additional medical attention after a rabies exposure but simplifies postexposure prophylaxis in populations at risk by eliminating the need for rabies immune globulin (RIG) and by decreasing the number of doses of vaccine required.
Vaccine Adverse Effects: Vaccinees may experience local reactions after vaccination, such as pain, redness, swelling, or itching at the injection site, or mild systemic reactions, such as headache, nausea, abdominal pain, muscle aches, and dizziness.
Vaccine Contraindications: Pregnancy is not a contraindication to postexposure prophylaxis.
Vaccine Booster Recommendations: No serologic testing or boosters recommended for travelers.
Information adapted from CDC Health Information for International Travel (the Yellow Book), http://www.cdc.gov/travel/yellowbook/2010/table-of-contents.htm