Today I share a different article than usual. Because, of course, traveling is not all about fairy tail stories. I’m going to talk about why the rabies vaccine is so important and why you should always take this recommended vaccination. Actually because I often read and hear that travelers don’t take it. I’ll tell you why it is important to get the rabies vaccine and share my story with you.
Sometimes I get asked by friends, family and colleagues what is the most annoying or most intense thing I have experienced during my trip. Actually, I always tell them this story.
Before I started my travel in Southeast Asia for 3 months, I went to the clinic and got all the recommended vaccinations. I have to tell you honestly that I was a bit hesitant at first about getting the rabies vaccination. This was because I read more often and heard that many people do not take it and if you just be careful, you should be fine. But I’m glad I just took the rabies vaccine …
After about 2 months of traveling I found myself in Cambodia, in Kampot to be precise. Kampot is a sleepy town with a handful of sights. The accommodation where I stayed had basic huts next to the river. They had really tasty food and you had company of their cats. They regularly came to get a stroke and wanted to lie on your lap.
I was more careful with the cats than I would be in the Netherlands. But as I noticed that these cuties really didn’t mean any harm, I let them crawl on my lap and pat them regularly.
On my last day at the guesthouse, one of the cats stroked my legs and was eager to get petted. I lifted him up and he started purring and cuddling enthusiastically. Until he suddenly had enough and bit me in the chin. Well this is how cats can be. I laughed at the scene and walked back to my bungalow to pack my backpack.
Until I suddenly realized that I had just been bitten by a cat in a high rabies risk country. I looked in the mirror and saw that the wound had started to bleed. I started to panic a bit and discussed with my travel companion what I should do now.
We came to the conclusion that I should call the emergency number of my travel insurance and disinfect the wound. Calling turned out to be quite a challenge because it wasn’t possible to call the Netherlands. Fortunately, it worked with my travel companion’s phone.
I got an employee on the phone who asked me a number of questions. The bottom line was that I needed advice from the doctor. But it was 10:00 AM in Cambodia, which meant it was 5:00 AM in the Netherlands. And the doctors start at 8:00 AM which equates to 1:00 PM in Cambodia. At least the employee’s advice was to just go to the hospital and wait for the doctor’s advice, so that was what I did.
We took the tuk-tuk to the hospital with our backpacks. Fortunately, the Cambodian doctor spoke a little English and understood that I needed a rabies vaccination. What he did not understand was that I had already had two vaccinations in the Netherlands. I showed my vaccination booklet and he didn’t understand it. According to him, I still needed more than two vaccinations, four to be precise. Fortunately, I looked up some information on forehand and knew that this was not correct. He agreed to my decision to wait until the Dutch doctor called me back.
While waiting in the hospital I got a real culture shock. There were no toilets for patients and I hardly saw any employees. I watched as a patient with a major head wound was placed on a wooden bench and had to hold their own IV. I also saw how a pregnant woman had an ultrasound halfway through the waiting room. And I saw an unconscious child being brought in by screaming people. Moments later, I heard the loudest scream I’ve ever heard that made me know the boy was alive.
Rabies vaccine Day 0
Around 2 PM I was called back by the doctor. She told me that I indeed had to get a vaccination because we could not rule out that the animal did not have rabies. So I had to get the injection on day 0 within 24 hours of the bite. This time frame was very important because I was bitten in the chin and rabies spread in your brain. So it was extra important that I get the vaccine the same day. In addition, I also had to receive a last vaccination on day 3.
I asked the Cambodian doctor what vaccine he would give me later to make sure I got the right one. I called the Dutch doctor back to check this with her and she agreed that this was the right vaccine.
Meanwhile, a Norwegian girl had walked in. She also came for the rabies vaccination because she was bitten on Koh Rong by a dog that she tried to help. She had not received any vaccinations before her trip, so she needed four vaccinations. That day she had to have her third or fourth injection. The doctor told us that there were enough vaccines for both of us and that he was going to get them further down town. He got on his motorbike and came back after about an hour.
When he came back, he only had one vaccine, and we both needed one. We looked shocked at each other. The doctor said he would give me the vaccine because I was the first to arrive. I was incredibly relieved, but concerned about the girl at the same time. It was now 4:00 PM and she had nowhere to go. The doctor said it was not that big of a problem and she could get the vaccine tomorrow, the same for me. In the Netherlands they think very differently about this. The girl left and I never spoke to her again.
The rabies vaccine cost $ 35 and afterwards I asked for proof of payment for my insurance so I could get it reimbursed.
Rabies vaccine Day 3
So on day 0 I was in Kampot. The next day I traveled to the tropical island of Koh Rong Samloem. It was fantastic! But unfortunately I could only stay there for a few days because on day 3 I had to get my last vaccination.
So on day 3 I left early in the morning for Sihanoukville. Sihanoukville is an ugly and uninviting city transformed by Chinese investments. But in this city there was a hospital that had the rabies vaccine.
I had received the address by email from my travel insurance. When I looked up the hospital on Google and Facebook I got different addresses. I decided to keep the insurance address sent to me.
But when I got there I didn’t see a hospital at all. I walked a little further and then saw across the street what looked like a clinic. I went in and soon noticed that the employees didn’t speak English. With the help of my vaccination booklet and Google Translate (what a lifesaver!) I was able to make clear that I needed a rabies vaccinate and we seemed to understand each other. But they also didn’t fully understand that this would be my last vaccination.
Fortunately, they had a vaccine available. I was allowed to sit on one of the hospital beds. The nurse dressed in a traditional white dress with a matching white hat came up with an aluminum tray with a syringe on it. I didn’t see a jar and therefore didn’t know which vaccine I would receive. I asked her again using Google Translate to show me the jar. It had to be picked out of the trashcan again. I recognized the name of what the Dutch doctor had said and I agreed to the vaccination. This costed me $ 30. Afterwards, I asked for proof again for my health insurance.
A burden fell from my shoulders. But because everything didn’t go smoothly and I still wasn’t 100% sure I had the right vaccines, I still felt tense. It was a stressful experience, but luckily I can retell it. What would have happened if I had not taken any vaccinations?
What is rabies?
Rabies is a virus that is transmitted by infected mammals. It’s not always visible whether an animal has rabies. It’s therefore preferable not to touch animals while traveling (don’t take an example from me). The virus enters the body through wounds or through mucous membranes. The incubation period is usually about 20 – 90 days.
Then the virus enters the central nervous system. From here it spreads through the cranial nerves to the salivary glands. First, symptoms appear including fever, chills, fatigue, loss of appetite, nausea, vomiting, and headache. After that, hyperactivity cramps or flaccid paralysis occur. Eventually, the patient falls into a coma and paralyzes the respiratory muscles.
Rabies should always be treated immediately. Clinical rabies almost always leads to death if you don’t get the right vaccinations or the HRIG antiserum.
View the CDC website for a detailed description of rabies.
Epidemiologie in the Netherlands (source: RIVM)
Rabies hardly ever occurs in the Netherlands. But it is clear that it is very deadly if not treated properly.
- In 1996, a man in the Netherlands died after a dog bite in Morocco. The man received vaccinations but no HRIG (Human Rabies Immunoglobulin).
- In 2007 a Dutch woman died after a bat scratched her nose in Kenya. She hadn’t received any vaccinations.
- In 2013, a man died in Haiti after a dog bite. He received no vaccinations there.
- In 2014, rabies was diagnosed in a woman after a dog bite in India. She then received vaccinations, but no HRIG.
- In 2019, a Norwegian woman recently died after a bite from a playing puppy. She wasn’t vaccinated.
Do I have to take a rabies vaccine when I travel to a high risk country? YES! Isn’t your life worth more to you than the price for the vaccination? And you might think, “I don’t plan on touching animals.” But does that aggressive dog think the same? Or that hungry monkey? Or that bat? If you already have an animal scratch, then you’re srewed and you can get the vaccinations.
If you’re vaccinated for rabies, you will receive two vaccinations at one week intervals. People with immune disorders need three vaccinations with one week between the first two and two to three weeks between the last injections.
Once you have received this series of vaccines, you will never need the HRIG (Human Rabies Immunoglobulin) antiserum again. After a bite, scratch or lick on an animal’s wound, you should always get vaccinated immediately. But you only need two injections with a few days apart and no antiserum. If you haven’t been vaccinated in advance, after a bite you will need no less than 4 vaccinations + the antiserum according to a fixed schedule.
The HRIG antiserum is very scarce or of poor quality in some countries, especially in developing countries. So you do well to take the vaccinations in advance so that you don’t need the antiserum.
Make sure to make an appointment in time to receive the rabies vaccination. Stock can be scarce in high season.
Bitten, scratched or licked by an animal: What to do?
Always call your travel insurance and get advice from the doctor. Do not ask your question in Facebook groups, because the majority of people who answer are not doctors and do not answer in response to reliable sources. I still see this happen very often.
It’s always necessary to clean your wound for about 15 minutes with lukewarm water and soap and preferably disinfect with 70% alcohol.
- When you did get the vaccinations in advance: According to RIVM, you need post-exposure treatment on day 0 and on day 3 (WHO Essence Scheme).
- If you did NOT get the vaccinations in advance: According to the RIVM, you need post-exposure treatment on days 0, 3, 7, 14-28 (WHO-Essen Scheme) + HRIG.
My advice is to always take the rabies vaccination when traveling to a high rabies risk country. Try to avoid contact with animals. Always contact your travel insurance and always get advice from a doctor! Take your vaccination booklet + a copy with you on your trip and ask for proof of payment after the vaccination.
This article is not leading, but purely to warn you and to inform you about my experiences.
- RIVM/LCR Rabiës richtlijn: https://lci.rivm.nl/richtlijnen/rabies
- GGD Reisvaccinatie: https://www.ggdreisvaccinaties.nl/vaccinaties/rabies