Don't get bit! Why rabies pre-exposure prophylaxis matters.
I was backpacking across South America with a touring group of fellow 20-somethings in 2012 when a fellow traveller had a potential rabies exposure. He got drunk in Cuzco, Peru; and, at 2 am in the morning, decided to pat a stray dog. The dog bit him, he staggered back to the motel, and went to sleep. Two days later, far removed from Cuzco and its hospital, he told our tour guide about the encounter with the dog. The local medical centre could not help him, so he had to return to Cuzco at his own time and expense. A full 7 days and $3,000 later, he rejoined our tour (with one very annoyed girlfriend in tow).
Many travellers balk upon hearing the price of rabies pre-exposure vaccinations, especially when they are already forking our hundreds of dollars on vaccines for more common diseases like hepatitis A, typhoid, tetanus or influenza. So it is only natural, upon learning that rabies is extremely rare and the pre-exposure vaccines cost $299-479, for most travellers to think 'well, I won't be getting those'.
But here's the thing - rabies is 100% fatal. It is universally the #1 most fatal disease in humans, responsible for anywhere from 30,000 to 150,000 deaths per year - with only a handful of recorded cases of survival (always in people who had at least had one pre-exposure vaccine, and who suffered serious neurological deficits after surviving the disease).
So how do you approach a disease that is extremely rare, but is guaranteed to kill you if you contract it? The only foolproof way to avoid rabies is to never get bitten or scratched by a mammal overseas; particularly dogs, bats and monkeys. But when you're visiting temples in Bali, safari parks in Thailand, game reserves in Africa or jungle resorts in the Amazon, there's no telling when a monkey will jump on you or try to steal your food. Likewise, in the rundown streets of rural villages across the developing world, a stray dog is never too far away. This leaves you with two options:
1. Get vaccinated before you travel. Pre-exposure prophylaxis may be expensive, but it is the best way to establish immunity against the rabies virus before you are ever exposed. The Waikato Travel Clinic offers the most competitive prices for this vaccine in New Zealand - see here - and our three dose technique in particular has a 98.2% seroconversion rate. The advantages of getting this done before you travel are significant:
a) You don't need to panic (always a bonus)
b) Two booster doses at day 0 + day 3 are enough to ensure your immune system is primed to deal with the rabies virus (saving time, money and hassle)
c) You don't require immediate hospital-level care, expensive life-saving blood products, or multiple vaccines spread across weeks (causing huge disruption to your travel).
or 2. Take a chance. If you get bitten, and have not had pre-exposure prophylaxis, this is a serious medical emergency. You must:
a) Clean the wound urgently
b) Get to a hospital urgently
c) Have the wound thoroughly scrubbed clean by a doctor
d) Have a series of rabies vaccines starting that day, usually 4-5 across 2-4 weeks
e) Get expensive, hard-to-get and potentially dangerous Human Rabies Immunoglobulin (a blood product), injected into the wound within 7 days of your first vaccine - the sooner, the better.
f) Hope that you don't die of rabies
So the decision, ultimately, rests with each traveller and how comfortable they are with risk. Of course, most of us never get bitten when travelling - but hundreds do, every year. This is why I strongly suggest that you at least consider getting rabies pre-exposure prophylaxis, especially if you are travelling for months on end, going to rural and remote areas, interacting with animals, or venturing far from reliable medical services.
Rabies is one souvenir you definitely don't want to bring home.