Thought Archive

Infectious Diseases

Rabies — Travel Risks & What To Do After a Bite

30 Aug 2025

Rabies — Travel Risks & What To Do After a Bite

Intro

Rabies is almost always fatal once symptoms begin — but it is 100% preventable with prompt post-exposure prophylaxis (PEP). If you’re bitten or scratched by a potentially rabid animal (including bats), treat it as urgent.

Key Points

  • High-risk regions include parts of Asia, Africa, and Latin America; dogs are the main source globally.
  • Any bite or scratch that breaks skin (or saliva in eyes/mouth) needs immediate wound washing and urgent medical care for PEP.
  • Bats: even tiny, unseen bites can transmit rabies — if you wake to a bat in your room, seek PEP.
  • Pre-exposure vaccine simplifies PEP for frequent travelers or high-risk work, but does not replace PEP after an exposure.

Before You Travel

  • Check destination risk and consider pre-exposure vaccination if you’ll be in rural areas, around animals, or far from medical care.
  • Learn where to access rabies vaccine and rabies immune globulin (RIG) at your destination.

If You’re Bitten or Scratched (Any Country)

  1. Wash the wound immediately with soap and running water for 15 minutes; irrigate thoroughly.
  2. Apply povidone-iodine or another antiseptic if available.
  3. Seek medical care ASAP for assessment and PEP (vaccine ± RIG).
  4. If safe to do so, get details about the animal (species, behavior, vaccination status) and inform local health authorities.

Post-Exposure Prophylaxis (PEP)

  • Unvaccinated people:
    • RIG: infiltrate around the wound as much as possible on Day 0.
    • Vaccine: doses on Days 0, 3, 7, 14 (some regions add Day 28 for immunocompromised).
  • Previously vaccinated (pre-exposure or prior full PEP):
    • No RIG.
    • Vaccine: Days 0 and 3.

Start PEP as soon as possible; do not delay waiting for animal testing unless advised it’s safe.

Which Exposures Need PEP?

  • Bites/scratches that break skin.
  • Saliva in eyes, mouth, or on broken skin.
  • Bat exposures where a bite cannot be ruled out (asleep in a room with a bat, child/mentally impaired person with bat contact).
  • Do not generally need PEP for touching/feeding animals without bites/scratches or contact with blood/urine/feces/fur alone.

Monitoring the Animal (When Feasible)

  • Healthy dogs/cats/ferrets can sometimes be observed for 10 days; if they remain healthy, transmission is unlikely.
  • Wildlife (bats, raccoons, foxes, stray dogs in high-risk areas) should be treated as rabid until proven otherwise — don’t delay PEP.

Side Effects & Safety

  • Rabies vaccines are well-tolerated (sore arm, mild fever).
  • RIG can cause local soreness; correct dosing and infiltration around the wound are important.
  • PEP is safe during pregnancy and in children — do not withhold.

Prevention Tips While Traveling

  • Avoid contact with dogs, cats, monkeys, and wildlife; don’t feed or pet animals.
  • Keep doors/windows screened; avoid sleeping where bats could enter.
  • Carry a small first-aid kit (soap/antiseptic) for immediate wound care.

When to Seek Emergency Care

  • Any bite/scratch from a mammal in a rabies-endemic area.
  • Any bat exposure where a bite can’t be ruled out.
  • Delayed access to vaccine/RIG — seek guidance on where to obtain them urgently.

FAQ

If I started PEP abroad, should I finish it at home?
Yes. Bring documentation; continue the schedule without restarting.

What if RIG isn’t available on Day 0?
Start vaccine immediately; RIG can be given up to Day 7 after the first vaccine.

Do small scratches need PEP?
If they break skin, yes — especially in high-risk regions or with bats.

Further Reading