Rabies when travelling: risk, prevention and what to do after a bite

Rabies spreads through the saliva of infected animals, usually through dog bites or scratches. Once symptoms appear, the disease is almost always fatal. Prompt treatment after exposure, however, prevents it with very high likelihood. So wash every bite or scratch immediately with soap and water for at least 15 minutes and seek medical help straight away, even if you have been vaccinated. Whether vaccination before the trip makes sense depends, according to the STIKO (Germany’s Standing Committee on Vaccination), on the country, local medical care, length of stay and travel style.

How rabies is transmitted

Rabies is a viral disease that passes from animals to humans and attacks the nervous system. According to the WHO, dogs are responsible for up to 99 per cent of human cases. The virus enters the body through bites, scratches or contact between saliva and mucous membranes or open wounds. Other mammals can transmit rabies too, and bats are a possible risk worldwide. The STIKO notes that visiting a monkey park is one of the situations in which travellers more often have risky animal contact.

The time until symptoms appear varies greatly and averages two to three months. It can be shorter after bites to the head. That is one reason why children are at particular risk: because of their height, they are bitten in the face more often, and they do not always mention an animal contact.

Where the risk is

According to the STIKO, most rabies deaths occur in Asia and Africa, with roughly a third of them in India alone. Large parts of Europe, Canada, the USA, Japan and Mexico have eliminated dog-transmitted rabies. Australia, New Zealand and many Pacific island nations have no rabies in land animals. Germany has been free of rabies in land animals since 2008. Bat rabies, on the other hand, exists worldwide.

The STIKO considers the actual risk of infection for travellers to be low. Animal bites and scratches are not unusual among travellers, though, and in some countries the vaccines needed after exposure are only available to a limited extent. The German Federal Foreign Office points this out for Thailand, for example. You will find the assessment for your destination on our country pages.

Who should be vaccinated before travelling

The STIKO recommends pre-exposure vaccination for trips to countries with a high or moderate risk of dog rabies if one of the following applies:

In high-risk countries, these criteria apply regardless of the length of stay according to the STIKO; in moderate-risk countries, mainly for stays of more than four weeks or repeated short trips. For children, the STIKO advises a generous approach to vaccination, and there is no age limit.

Pre-exposure vaccination needs more than one appointment, so plan it in good time, see when to get travel vaccinations. You can find a travel medicine practice near you in our directory of travel clinics.

How to protect yourself on the ground

Whatever your vaccination status, the most important protection is avoiding bites:

• Do not stroke or feed stray dogs, cats or monkeys, however tame they seem.
• Keep your distance from wild animals. According to the STIKO, rabid wild animals often lose their natural shyness, so unusually tame animals are a warning sign.
• Do not touch bats or flying foxes.
• Keep a close eye on children around animals and ask them whether there was any contact.

After a bite, scratch or lick: what to do straight away

Any animal contact abroad is a reason to act quickly. The STIKO and the WHO classify contacts into three categories:

What to do:

1. Wash the wound immediately: clean the wound and any affected skin thoroughly with soap and water for at least 15 minutes.
2. Disinfect: then treat the wound with an antiseptic. According to the RKI, the wound should not be stitched or cauterised.
3. Seek medical help straight away: go to a clinic or practice the same day. A doctor will decide whether post-exposure prophylaxis is needed. According to the STIKO, this is required after every relevant contact, even if you are fully vaccinated.
4. Have your tetanus protection checked: the RKI guide recommends considering tetanus protection for bite wounds as well.
5. Take your documents: show your vaccination record and note the place, date and the animal involved.

Even if the contact was some time ago, get it checked. Because of the long incubation period, the STIKO notes that treatment can still be useful weeks or months after exposure. Do not wait, though: get examined as early as possible, if necessary after you are back in Germany.

Why pre-travel vaccination still helps

Pre-exposure vaccination does not replace treatment after a bite, but it makes it much simpler. According to the STIKO, people who were vaccinated beforehand generally do not need rabies immunoglobulin, which is not available everywhere. On longer or remote trips in particular, this gives you valuable reassurance. Whether the vaccine makes sense for your trip is best discussed at a travel health consultation. Our travel vaccine check and our guide to travel vaccinations at a glance give you a first overview.