Rabies vaccine in Southeast Asia. Is it necessary ? (2)

Let’s go back to the question. Is it necessary to get rabies vaccine before travel in Southeast Asia? As in any vaccine; we have to consider the risk of getting the diseases and the cost/side-effect of vaccine. Benefit of vaccines should clearly outweight the cost and side-effect of vaccine. In that case we’ll recommend the vaccine.

So we’ll come to the most important question. We, all, know that we might get rabies only when we are bitten/licked by animal. So what it the chance for someone to get bitten/licked during travel. Difficult to say? Yes, that’s right. Risk for any individual is not equal. But according to previous researches we have some information;

  • In 1994; a survey in general traveler in Thailand found that the risk of being bitten and being licked were 1.3% and 8.9% respectively, in an average stay of 17 days.
  • Our recent survey (2009) in Khao San Road, we found that 0.7% of backpackers were bitten and 3.6% of backpackers were licked during their trip (average duration of travel = 30 days).

So, are the risk of being bitten high or low in your point of view? Some may say it is high so I would like to get vaccine; while some may say it is low risk for me to be bitten so I will not get the vaccine. By the way, many factors should also be considered such as duration of travel, exact destination, availability of medical care in the destination, traveler’s preference, activity during travel, budget, etc. So it is recommended to have a formal consultation/discussion with your travel doctor in this issue.

For us, we usually consider pre-exposure rabies vaccine in travelers who 
       – will travel in a rural or remote area where standard medical care is not available
       – have high risk activities including cycling, backpacking etc
       – have longer duration of stay (more than 2 wks)

Reference:

  1. Phanuphak P, Ubolyam S, Sirivichayakul S. Should travelers in rabies endemic areas receive pre-exposure rabies immunization? Ann Med Interne (Paris) 1994; 145(6):409-11.
  2. Piyaphanee W, Shantavasinkul P, Phumratanaprapin W, et al. Rabies exposure risk among foreign backpackers in Southeast Asia. Am J Trop Med Hyg. 2010 Jun;82(6):1168-71.

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