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Home Eurosurveillance Weekly Release  2005: Volume 10/ Issue 30 Article 5
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Eurosurveillance, Volume 10, Issue 30, 28 July 2005
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Citation style for this article: Smith A, Petrovic M, Solomon T, Fooks AR. Death from rabies in a UK traveller returning from India. Euro Surveill. 2005;10(30):pii=2761. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2761

Death from rabies in a UK traveller returning from India

Alan Smith (alan.smith@hpa.org.uk)1, Marko Petrovic2, Tom Solomon3 and Antony Fooks4

1Communicable Disease Surveillance Centre, Health Protection Agency Centre for Infections, London, United Kingdom
2Greater Manchester Health Protection Unit, Manchester, United Kingdom
3Department of Neurological Science, University of Liverpool, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
4
Rabies Research & Diagnostic Group, Veterinary Laboratory Agency, Weybridge, United Kingdom

A fatal case of imported human rabies has been reported in England. The patient was bitten by a dog while on holiday in Goa, India. The diagnosis of rabies was confirmed by the United Kingdom National Reference Laboratory for Rabies in Weybridge, Surrey [1].

In February of this year, a German woman died of rabies after spending four weeks in India in late 2004 [2], and in May 2004, a man in Bavaria, Germany died from a rabies infection that he acquired during his five month stay in India [3]. India reports at least 30 000 human deaths from rabies per year [4].

There are risks associated with travel to rabies endemic countries [5]. Travellers should avoid all unnecessary contact with animals. If bitten or scratched by a warm blooded animal they should wash the wound with plenty of soap and water and seek medical attention immediately, even if previously vaccinated. If they do not seek medical treatment while abroad, they should seek it when they return to their home country, even if it is some time after the event. Promptly administered post-exposure prophylaxis is extremely effective in preventing rabies. For people who have not received any rabies vaccine prior to a potential exposure, post-exposure prophylaxis consists of a dose of vaccine as soon as possible after the bite followed by four further doses 3, 7,14 and 30 days later. If the person has been previously vaccinated, fewer doses of vaccine are required. Human rabies immunoglobulin may also be given if the exposure is considered to be high risk.

Travel agents need to stress the importance of obtaining travel health advice well before holidays or trips overseas to ensure that the risks of all travel associated illness, not just rabies, have been explained.
In the United Kingdom, while rabies vaccine is not routinely advised for all travellers, pre-exposure immunisation is recommended for those living in or travelling for more than one month to rabies enzootic areas, unless there is reliable access to prompt, safe medical services; those travelling for less than one month in rabies enzootic areas but who may be exposed to rabies because of their travel activities; and those who have limited access to post-exposure medical services.

References:
  1. HPA. Case of imported rabies in the UK. Commun Dis Rep CDR Weekly 2005; 15(30): news. (http://www.hpa.org.uk/cdr/index.html)
  2. Robert Koch-Institut. Informationen zu den Tollwutübertragungen durch Spenderorgane. Epidemiologisches Bulletin 2005; (8): 69 (http://www.rki.de/cln_006/nn_335538/DE/Content/Infekt/EpidBull/Archiv/2005/08__05,templateId=raw,property=publicationFile.pdf/08_05)
  3. Summer R, Ross S, Kiehl W. Imported case of rabies in Germany from India. Eurosurveillance Weekly 2004; 8(46): 11/11/2004 (http://www.eurosurveillance.org/ew/2004/041111.asp#4)
  4. World Health Organization. Immunization, Vaccines and Biologicals. Rabies vaccine. [Updated April 2003, cited 28 July 2005] (http://www.who.int/vaccines/en/rabies.shtml)
  5. Fooks AR, Johnson N, Brookes SM, Parsons G, McElhinney LM. Risk factors associated with travel to rabies endemic countries. J Appl Microbiol 2003; 94 Suppl 1; 31-6.

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