Recently, there has been a surge in reported rabies cases in Thailand. In fact, the Department of Livestock Development of Thailand has declared 24 provinces a “red zone” for the disease which has claimed 7 lives so far this year. These areas are: Chacherngsao, Prachinburi, Rayong, Samut Prakarn, Nakhon Ratchassima, Yasothon, Srisaket, Ubon Ratchathani, Kalasin, Khonkaen, Mukdahan, Udon Thani, Chiang Rai, Nan, Tak, Petchabun, Prachuab Kirikhan, Samut Songkram, Trang, Nakhon Si Thammarat, Surat Thani, Songkhla, Satun and Nonthaburi.

Already in 2018, there have been nearly 500 rabies cases reported, which is a significant increase over the 160 reported last year for the same period. The National Center for Biotechnology Information (NCBI) estimates that Thailand has 10 million stray dogs, with 1 in 10 dogs in Bangkok suspected to be infected with rabies.

What Is Rabies?

Rabies is a virus that attacks the central nervous system causing neurologic disease in the brain and, in many cases, death. The infection occurs when infected saliva gets into an open wound or the mouth or eyes. It is usually transmitted through animal bites. While all mammals are vulnerable to infection, only a few are commonly identified as carriers. Dogs, cats, bats, skunks and foxes are the usual suspects for animals infected with rabies.

How Can Rabies Be Prevented?

The good news about rabies is that, through seeking urgent medical care, the disease is 100% preventable. To effectively be protected against infection, it is recommended to receive the rabies pre-exposure vaccine which is given in several doses spread over the course of a few weeks. Bear in mind that children are especially high risk as they often play with animals, unaware of the possibility of being bitten, and do not often report animal scratches.

Despite being avoidable, the Centers for Disease Control and Prevention (CDC) states that, unfortunately, in excess of 55,000 people die every year from rabies, mostly in Asia and Africa. While the disease can be prevented medically, it’s a good idea to be educated on how to avoid infection from a physical threat. Here are a few ways to avoid being infected:

• Vaccinate your pets
• Monitor your pets and avoid exposing them to wildlife
• Receive a rabies pre-exposure vaccine if travelling to a risk zone
• Report stray animals to animal control
• Do not approach or antagonize stray animals

What to Do If Bitten?

If bitten by a stray animal, the wound should be cleaned immediately with soap and water in order to decrease the risk of infection. The next step should be to seek medical attention as quickly as possible.

An experienced doctor should determine whether there is need to administer rabies vaccination, known as postexposure prophylaxis (PEP):

1. If the animal involved is at risk to transmit Rabies
2. If the bite is severe enough to warrant treatment
3. If the treatment would require both Rabies Immunoglobulin (sometimes difficult to obtain) and Rabies Vaccine (Most cases require both treatments for more assured protection against the disease)

To be effective, the treatment would require 4 doses of Rabies Vaccine over a 2 week period.

What Are the Signs and Symptoms of Rabies?

Signs and symptoms of rabies at the onset of the disease are similar to those of the flu including fever, headache and general discomfort which may persist for several days. At the site of the bite, there may be discomfort and an itching sensation. This will progress and worsen to symptoms of cerebral dysfunction, anxiety, confusion and agitation. As the disease progresses further, the victim may experience delirium, abnormal behavior, hallucinations and insomnia. Upon exhibiting signs of rabies, survival is rare and treatment is usually supportive in nature. Historically, less than 10 documented cases have been reported of a human surviving clinical rabies.

This year’s rabies outbreak is cause for us to pay extra attention, not to panic. Thailand is aiming to be rabies-free by 2020 and, in the meantime, vigilance and cautiousness can go a long way in protecting you and your loved ones from the disease. However, extra precautions, such as the rabies vaccination, should be considered before visiting some of the surrounding countries in Southeast Asia. The risk of rabies in Myanmar, Cambodia and Indonesia (particularly the island province of Bali) can be quite significant.

If you have been bitten or would like to know more about rabies, please contact Bumrungrad International Hospital’s Travel Medicine Center . It is open every day from 08:00 to 16:00 and located at the Bumrungrad International Clinic (BIC) Building on the 15^th floor.