Rabies: What you need to know about the disease before going abroad

The recent death of a British woman from rabies after a holiday in Morocco is a sobering reminder of the risks posed by this almost universally fatal disease, once symptoms begin.
If you're considering travelling to a country where rabies is endemic, understanding how rabies works – and how to protect yourself – may go a long way in helping you stay safe.
Rabies is a zoonotic disease – meaning it is transmitted from animals to humans – and is caused by a viral infection. In 99% of cases the source of the infection is a member of the Canidae family (such as dogs, foxes and wolves). Bats are another animal group strongly associated with rabies, as the virus is endemic in many bat populations.
Even in countries that are officially rabies-free, including in their domestic animal populations – such as Australia, Sweden and New Zealand – the virus may still be found in native bat species. Other animals known to transmit rabies include raccoons, cats and skunks.
Rabies is caused by lyssaviruses (lit. rage or fury viruses), which are found in the saliva of infected animals. Transmission to humans can occur through bites, scratches or licks to broken skin or mucous membranes, such as those in the mouth.
Once inside the body, the virus spreads to eventually reach the nervous system.
Because it causes inflammation of the brain and spinal cord, symptoms are primarily neurological, often stemming from damage to the nerve pathways responsible for sensation and muscle control.
Patients who develop rabies symptoms often experience altered skin sensation and progressive paralysis. As the virus affects the brain, it can also cause hallucinations and unusual or erratic behaviours. One particularly distinctive symptom – hydrophobia, a serious aversion to water – is believed to result from severe pain and difficulty associated with swallowing.
Once rabies symptoms appear, the virus has already caused irreversible damage. At this stage, treatment is limited to supportive intensive care aimed at easing discomfort – such as providing fluids, sedation and relief from pain and seizures. Death typically results from progressive neurological deterioration, which ultimately leads to respiratory failure.
It's important to note that rabies symptoms can take several weeks, or even months, to appear. During this incubation period, there may be no signs that prompt people to seek medical help. However, this window is crucial as it offers the best chance to administer treatment and prevent the virus from progressing.
Another danger lies in how the virus is transmitted. Even animals that don't appear rabid – the classical frothing mouth and aggressive behaviour, for instance – can still transmit the virus.
Rabies can be transmitted through even superficial breaks in the skin, so minor wounds should not be dismissed or treated less seriously. It's also important to remember that bat wounds can often be felt but not seen. This makes them easy to overlook, should there be no bleeding or clear mark on the skin.
The vaccine
The good news is that there are proven and effective ways to protect yourself from rabies – either before travelling to a higher-risk area, or after possible exposure to an infected animal.
Modern rabies vaccines are far easier to administer than older versions, which some may recall – often with discomfort. In the past, treatment involved multiple frequent injections (over 20 in all) into the abdomen using a large needle. This was the case for a friend of mine who grew up in Africa and was one day bitten by a dog just hours after it had been attacked by a hyena.
The vaccine can now be given as an injection into a muscle, for instance in the shoulder, and a typical preventative course requires three doses. Since the protective effect can wane with time, booster shots may be needed for some individuals to maintain protection.
Sustaining a bite from any animal should always be taken seriously. Aside from rabies, animals carry many potentially harmful bacteria in their mouths, which can cause skin and soft tissue infections – or sepsis if they spread to the bloodstream.
First aid and wound treatment is the first port of call, and seeking urgent medical attention for any bites, scratches or licks to exposed skin or mucous membranes sustained abroad. In the UK, this also applies to any injuries sustained from bats.
A doctor will evaluate the risk based on the wound, the animal involved, whether the patient has had previous vaccines, and in which country they were bitten, among other things. This will help to guide treatment, which might include vaccines alone or combined with an infusion of immunoglobulin infusions – special antibodies that target the virus.
Timing is crucial. The sooner treatment is started, the better the outcome. This is why it is so important to seek medical help immediately.
In making the decision whether you should get a vaccine before going on holiday, there are recommendations, but ultimately the choice is individual. Think about what the healthcare is like where you are going and whether you'll be able to get treatment easily if you need it.
Vaccines can have side-effects, though these tend to be relatively minor, and the intended benefits vastly exceed the costs. And of course, avoid contact with stray animals while on holiday, despite how tempting it may be to pet them.
Several rules of thumb can counteract the dangers of rabies: plan your holiday carefully, seek travel advice from your GP, and always treat animal bites and scrapes seriously.

Try Our AI Features

Explore what Daily8 AI can do for you:

Learn with AIFact CheckingText to SpeechAI Summary

Related Articles

Times

an hour ago

• Times

Midwife took laughing gas while working on high-risk ward

A Scottish NHS midwife has been suspended after she was caught taking laughing gas while caring for vulnerable pregnant women. Mariedh King was discovered consuming nitrous oxide — also known as 'hippy crack' — in an empty labour room whilst working on a ward for high-risk patients, a disciplinary hearing was told. She admitted to an internal investigation that she had done so multiple times over a two-month period. The midwife claimed that the drug's effects were always out of her system by the time she saw patients but could have caused a problem if there was an emergency. Laughing gas is the colloquial term for nitrous oxide which causes euphoria, uncontrolled laughter, and dizziness. In medical settings it is used for sedation and pain relief. A fitness to practise committee has found that King had put patients at risk by 'knowingly and intentionally' taking the drug. It said the only 'appropriate and proportionate' sanction was a nine-month suspension from the Nursing and Midwifery Council register. The professional tribunal heard that the midwife, who was based in Fife, qualified in 2000 and was working on a ward for high-risk pregnancy patients. In September 2021, King was found by the senior charge midwife in an empty labour room inhaling laughing gas that was intended for patients. After being discovered King went home. The incident was the only time she was found using the drug, but during the course of an internal investigation she admitted to doing it more than once. King told the tribunal the effects of laughing gas are 'very short-lasting' and were always out of her system by the time she attended patients. However, she accepted this could have been different if she had been called to an emergency whilst under the influence. During the hearing it was suggested that the midwife, who had an unblemished career, was experiencing personal struggles at the time of her misconduct but the details have been withheld. A panel found that King had 'knowingly and intentionally' stolen the nitrous oxide from her employer and put vulnerable patients at risk, which amounted to misconduct as well as impairing her fitness to practise. It said: 'The panel determined that Mrs King knowingly and intentionally stole, and used, nitrous oxide at her place of work. 'Mrs King knew that it was wrong to take the nitrous oxide which was for the use of patients only … was responsible for vulnerable patients under her care and the panel was of the view that Mrs King's actions jeopardised patient safety and put patients at a risk of harm. 'This was a serious departure from the standards expected of a registered midwife and amounted to misconduct.' The panel ruled that a striking-off order would be 'unduly punitive' but her drug-taking did warrant further action. King was suspended for nine months with a review hearing required before she can be admitted back onto the register, to ensure she has developed enough insight into her misconduct to practise safely again. 'Mrs King's misconduct arose more than once, albeit it was a single episode, in an otherwise unblemished career,' the panel said. 'It has found attitudinal issues related to Mrs King's dishonesty but it did not deem these to be deep-seated or personality related. There is no evidence of Mrs King repeating her misconduct. 'Whilst the panel acknowledges that a suspension may have a punitive effect, it would be unduly punitive in Mrs King's case to impose a striking off order. 'Balancing all of these factors the panel has concluded that a suspension order is theappropriate and proportionate sanction.'

The Guardian

an hour ago

• The Guardian

Assisted dying bill: how will it work and when will it come into effect?

The right to an assisted death will become law in England and Wales within four years as MPs backed a historic societal shift in parliament on Friday by a tight majority. But what does it mean for the future? It may be some years away yet – although no later than 2029. There is no timetable but, under the terms of the legislation, it needs to start within four years after the law is passed. The bill is likely to be given royal assent by the end of the year, if it passes smoothly through the House of Lords. However, there are many details about the process that are yet to be ironed out, including how the system will work either within the NHS or outside it, that could delay its implementation. Many people with terminal illnesses campaigning for a change in the law will be relieved by the legislation but are not certain to benefit from it themselves. It could take years to implement, so those with a shorter life expectancy are unlikely to be eligible for an assisted dying service. The training and qualifications of doctors is one of the points yet to be resolved, although it has been decided that medical staff will not be compelled to take part in assisted dying services. Other subjects that need to be discussed include the type of lethal substance to be administered, the forms of identification patients would have to provide, the records that would have to be kept by doctors and the codes of practice around the assisted dying process – as well as the location and type of services. There are many logistics to thrash out, with health minister Stephen Kinnock and justice minister Sarah Sackman in charge of implementation. One possibility is integrating a service into the NHS, which would oversee the process of moving from palliative care to assisted dying for those with less than six months to live. An alternative would be to have a separate unit outside the NHS available through third parties, similar to the situation in Switzerland. A hybrid model could look like the way in which abortions are carried out by separate providers such as the not-for-profit British Pregnancy Advisory Service and others, but ultimately overseen by the NHS. The bill makes provision for the service to be carried out for free, but if it is publicly funded then it would get money that is currently not wholly provided to end-of-life services such as hospices, which tend to raise money as charities. The idea was not in the Labour government's manifesto, so convention dictates that it could be killed off in the second chamber. It could also be so mired in difficulty and delay in the Lords that it ran out of time. However, given it has been voted through in the House of Commons, it is highly likely to pass at some point, as most bills do – probably before the end of the year. If it were to run out of time in this parliamentary session, then it would not be carried over to the next because it is a private member's bill. Another MP would have to put it forward and start all over again, unless the government decided to take up the cause and propose its own legislation. Undoubtedly, some peers will attempt to change the legislation, and many MPs acknowledge there is still room for improvement. There are some outright opponents of the legislation as well, such as Tanni Grey-Thompson, a disabled peer and Paralympic medallist. But the most likely outcome is that peers will refine the legislation before it is sent back to the House of Commons and then ultimately passed. Kim Leadbeater, who introduced the bill as a backbencher, said recently that she thinks the House of Lords will end up voting in favour. The bill applies to England and Wales, with the Welsh parliament denied a veto over the legislation. Scotland is currently going through the process of examining its own legislation. There are no plans for assisted dying to be introduced in Northern Ireland at the moment.

The Independent

an hour ago

• The Independent

Assisted dying: All you need to know following the crunch Commons vote

The assisted dying Bill cleared the House of Commons in a historic vote on Friday, with MPs backing moves to legalise it by a slim majority. Here, the PA news agency takes a look at the Bill and what happens next after a significant moment in its journey to become law. – What is in the Terminally Ill Adults (End of Life) Bill? The proposed legislation would allow terminally ill adults in England and Wales, with fewer than six months to live, to apply for an assisted death. This would be subject to approval by two doctors and a panel featuring a social worker, senior legal figure and psychiatrist. The terminally ill person would take an approved substance, provided by a doctor but administered only by the person themselves. On Friday, MPs voted 314 to 291, majority 23, in favour of legalising assisted dying as they completed the mainstay of their work on the Bill. It will now face further debate in the House of Lords. – When would assisted dying be available if the Bill became law? The implementation period has been doubled to a maximum of four years from royal assent, the point it is rubber stamped into law, rather than the initially suggested two years. If the Bill was to pass later this year that would mean it might not be until 2029, potentially coinciding with the end of this Government's parliament, that assisted dying was being offered. Labour MP Kim Leadbeater, who is the parliamentarian behind the Bill and put forward the extended timeframe, has insisted it is 'a backstop' rather than a target, as she pledged to 'hold the Government's feet to the fire' on implementing legislation should the Bill pass. The extended implementation period was one of a number of changes made since the Bill was first introduced to the Commons back in October. – What other changes have there been? On Friday, MPs bolstered the Bill so people with eating disorders are ruled out of falling into its scope. Another amendment, requiring ministers to report within a year of the Bill passing on how assisted dying could affect palliative care, was also approved by MPs. Previously, a High Court safeguard was dropped, with the oversight of judges in the assisted dying process replaced with expert panels. The change was much criticised by opponents, who said it weakened the Bill, but Ms Leadbeater has argued it strengthens it. At the end of a weeks-long committee process earlier this year to amend the Bill, Ms Leadbeater said rather than removing judges from the process, 'we are adding the expertise and experience of psychiatrists and social workers to provide extra protections in the areas of assessing mental capacity and detecting coercion while retaining judicial oversight'. Changes were also made to ensure the establishment of independent advocates to support people with learning disabilities, autism or mental health conditions and to set up a disability advisory board to advise on legal implementation and impact on disabled people. Amendments added earlier this month during report stage in the Commons will also see assisted dying adverts banned if the Bill becomes law, and a prohibition on medics being able to speak to under-18s about assisted dying. – Do we know much more about the potential impact of such a service coming in? A Government impact assessment, published earlier this month, estimated that between 164 and 647 assisted deaths could potentially take place in the first year of the service, rising to between 1,042 and 4,559 in year 10. The establishment of a Voluntary Assisted Dying Commissioner and three-member expert panels would cost an estimated average of between £10.9 million and £13.6 million per year, the document said. It had 'not been possible' to estimate the overall implementation costs at this stage of the process, it added. While noting that cutting end-of-life care costs 'is not stated as an objective of the policy', the assessment estimated that such costs could be reduced by as much as an estimated £10 million in the first year and almost £60 million after 10 years. – Do healthcare staff have to take part in assisted dying? It was already the case that doctors would not have to take part, but MPs have since voted to insert a new clause into the Bill extending that to anyone. The wording means 'no person', including social care workers and pharmacists, is obliged to take part in assisted dying and can now opt out. Amendments to the Bill were debated on care homes and hospices also being able to opt out but these were not voted on. Ms Leadbeater has previously said there is nothing in the Bill to say they have to, nor is there anything to say they do not have to, adding on the Parliament Matters podcast that this is 'the best position to be in' and that nobody should be 'dictating to hospices what they do and don't do around assisted dying'. – What will happen next? Friday's vote in the Commons makes it more likely for the assisted dying Bill to become law, now that it has the backing of a majority of MPs. But this is not guaranteed, and first it must continue on a journey through Parliament. The Bill now heads to the House of Lords, as both Houses of Parliament must agree its final text before it can be signed into law. During the next stages, peers are expected to put forward amendments to the Bill. If the Commons disagrees with these amendments, this will spark a process known as 'ping pong' which will continue until both Houses agree over its text. – Will the Bill definitely become law? There is a risk that the Bill could be stuck in a deadlock between the House of Commons and House of Lords, as it goes back and forth in disagreement. If this continues until the current session of Parliament ends, then the Bill would fall. Ms Leadbeater told journalists on Friday she hoped there were no attempts to purposefully wreck it by peers. 'I really hope there are no funny games, because the process has been extremely fair,' she said. The Spen Valley MP said she did not know when the current parliamentary session would end, but suggested it could stretch into late 2025, giving her Bill the best part of six months to complete the full parliamentary process. Speaking about the end of the session to reporters, Ms Leadbeater said: 'I am not imagining that is going to be imminently, but it could be before the end of the year.' One member of the House of Lords, Bishop of London Dame Sarah Mullally, has already indicated she is against it. The Church of England bishop said peers 'must oppose' the assisted dying Bill when it reaches them because of the 'mounting evidence that it is unworkable and unsafe'. – What about assisted dying in the rest of the UK and Crown Dependencies? The Isle of Man looks likely to become the first part of the British Isles to legalise assisted dying, after its proposed legislation passed through a final vote of the parliament's upper chamber in March. In what was hailed a 'landmark moment', members of the Scottish Parliament (MSPs) in May voted in favour of the Assisted Dying for Terminally Ill Adults (Scotland) Bill, backing its general principles. It will now go forward for further scrutiny and amendments but will become law only if MSPs approve it in a final vote, which should take place later this year. Any move to legalise assisted dying in Northern Ireland would have to be passed by politicians in the devolved Assembly at Stormont. Jersey's parliament is expected to debate a draft law for an assisted dying service on the island for terminally ill people later this year. With a likely 18-month implementation period if a law is approved, the earliest it could come into effect would be summer 2027.