Rabies is a deadly viral infection that affects the brain. It is spread through the bite or scratch of an infected animal, most commonly dogs in Asia and Africa, or bats in the Americas. It can also spread if infected saliva gets into the eyes, mouth, nose, or an open wound. Rabies is not spread by touching or petting animals, or through their blood, urine, or faeces.

👩‍⚕️ Symptoms

Symptoms usually appear 1–3 months after exposure, but can occur sooner or much later. Early signs look like the flu: fever, headache, tiredness, and tingling or pain at the bite site.

As the disease spreads to the brain, it can cause two forms:

Furious rabies: agitation, confusion, hallucinations, seizures, fear of water, and difficulty breathing.

Paralytic rabies: gradual paralysis leading to coma and death. Once symptoms appear, rabies is almost always fatal within 1–2 weeks.

🐶 Behaviour of Rabid Dogs

Rabid dogs may become aggressive, confused, or restless. They might bite unexpectedly, avoid water, or show unusual behaviour. In endemic countries, stray dogs are the greatest risk.

Where Rabies is a Problem

Rabies causes around 59,000 deaths worldwide each year, mostly in Asia and Africa. For Australian travellers, destinations such as Indonesia (including Bali), Thailand, India, and Nepal carry a high risk of rabies exposure. In Bali, rabies has been endemic since 2008. Dogs are the main source, but monkeys, cats, and bats can also transmit the virus.

🌍 Rabies Risk (Asia)

Very High Risk: India, Pakistan, Bangladesh, Nepal, Sri Lanka.

High Risk: Thailand, Indonesia, Philippines, Cambodia, Laos, Vietnam, Myanmar.

Lower risk but cases occur: China - risk varies; rural areas higher, urban areas lower but not zero.

🌍 Rabies Risk (Africa)

High Risk: West Africa (Nigeria, Ghana), East Africa (Kenya, Tanzania, Uganda), Central Africa (DR Congo, Cameroon).

Lower risk but cases occur: Egypt, Morocco.

🌍 Rabies Risk (South America)

High Risk: Amazon basin regions of Brazil, Peru, Colombia, Ecuador, Bolivia — rabies occurs in bats and wild animals; dogs less common as a source.

Lower risk: Urban areas in Argentina, Chile, Uruguay, and southern Brazil.

👩‍⚕️ Travellers at Highest Risk

1. Long-Term Travellers & Expats

Living in Asia, Africa, South America for >1 month, especially in rural or semi-rural areas where dogs and other stray animals are common.

2. Children

More likely to play with animals, sustain bites/scratches, and may not report them.

3. Adventure / Outdoor Travellers

Backpackers, trekkers, cyclists, campers, and those exploring rural/remote areas.

Sleeping outdoors or in basic accommodation increases risk of exposure to animals, including bats.

4. Animal Contact Occupations / Activities

Veterinarians, wildlife workers, zookeepers, animal shelter volunteers, medical or research staff handling animals or samples.

5. Travellers to Remote Areas with Limited Medical Access

Areas where human rabies immune globulin (HRIG) and rabies vaccine may not be readily available. This is common in many rural regions of Asia.

✅ Key Point

Short-stay tourists in cities (staying in higher-end hotels, avoiding animals) = low risk.

Backpackers, children, animal workers, and long-stay/remote travellers = high risk → should strongly consider pre-travel rabies vaccination (PrEP).

Know where to access post-exposure prophylaxis (PEP) in the area you are visiting.

🚑 What To Do After a Bite or Scratch (Post-Exposure Prophylaxis – PEP)

First aid: wash the wound immediately with soap and running water for at least 15 minutes, then apply an iodine solution.

Seek urgent medical care at the nearest hospital or clinic.

If you haven’t had the rabies vaccine before travel: you will need 5 rabies vaccine doses over 2–4 weeks plus Human Rabies Immune Globulin (HRIG), which is injected into the wound. HRIG is often hard to find in many countries.

If you had the rabies vaccine before travel: you only need 2 booster doses of rabies vaccine (days 0 and 3) and do not need HRIG.

💉 Pre-Travel Rabies Vaccine (Pre-Exposure Prophylaxis – PrEP)

Recommended for backpackers, children, animal workers, and long-stay/remote travellers.

Two options:

3-dose schedule: days 0, 7, and 21–28 (gold standard, long-lasting).

2-dose schedule: days 0 and 7 (also effective, but booster recommended sooner).

After the first course, boosters are usually every 3 years or guided by blood tests.

The vaccine is safe at any age, including for infants and children.

✅ Key Take-Home Message

Rabies is almost always fatal once symptoms start, but it is 100% preventable with quick first aid and vaccination.

Travellers to Asia and Africa should avoid contact with animals, especially dogs and monkeys, (mainly bats in South America) and strongly consider vaccination before travel.

If bitten or scratched, wash thoroughly and get urgent medical help immediately.