Travel advice: Buy medevac insurance and don’t pet the dogs
In some countries, about 99 percent of the time, rabies exposure is through stray dog bites, said Anne Terry, UW Medicine Travel Clinic director at Hall Health.
That puppy wiggling at your feet in India might be cute, but travel medicine clinician Anne Terry has this advice: Don’t pet it.
Or the monkeys for that matter. In fact, add cats to that list too. Or really any animal with fur which can bite or scratch.
With peak travel season in full hum, many will arrive at their local travel medicine clinics to get their vaccines for anything from measles (recommended if you’re going anywhere) to more specific vaccines for various countries.
Yet, one topic which often doesn’t come up in the summer travel conversations is rabies. In short, if you’re traveling overseas to low- or medium- income countries, don’t pet the dogs.
“When you’re in these countries, about 99 percent of the time, exposure (for rabies) is through stray dog bites,” said Terry, a UW Medicine nurse practitioner. She directs the Travel Medicine Clinic at Hall Health on the University of Washington campus. “We always counsel people on avoiding interaction with dogs, and I think for many of us who are animal lovers, that can be challenging. But exposure to a stray animal, through a bite or scratch, in a developing country can be fatal.”
Terry explains: In poorer countries, such as India, most of the animals are not vaccinated for rabies, and the rabies immune globulin and rabies vaccine are generally not available at the remote clinics. A Washington Post writer recently recounted this reality after she was bitten by a dog at a bus station. After a bite, scratch or even a lick, the infection clock is ticking.
Without treatment, rabies is almost 100 percent fatal after symptoms appear, according to the Centers for Disease Control and Prevention. That fact was underlined this year when the CDC reported that a Virginia woman died after being bitten by a puppy at a yoga retreat in India. The woman did not seek help, but was checked into the ER weeks later with advanced symptoms that eventually claimed her life. This year, a Norwegian woman died after a puppy she was attempting to rescue bit her.
Treatment for rabies includes the initial shot of human rabies immune globulin or HRIG, given within 24 hours, and a series of four other shots over the next two weeks. One should assume that all dogs in a developing country have not been vaccinated and have likely been exposed to rabies, Terry said. Usually by the time a dog (or monkey) exhibits the classic signs of aggression, neurological problems, or foaming at the mouth, the animal is in the last stages of the disease.
“The incubation period for rabies lasts from several weeks to several months, and there are often no outward symptoms until the end,” Terry said.
Travelers visiting developing countries should invest in an emergency evacuation insurance, which usually costs around $100 to $200, or more, or consider getting a preventative rabies vaccine, which is, Terry warns, expensive. That vaccine, which buys more time to get the rest of the rabies vaccine shots, can cost between $1,500 to $1,800. Some insurances don’t cover it.
“I would encourage every traveler, no matter where they are going in the world, to have medical evacuation insurance,” she said. “That’s to insure that in the unlikely event of a car accident, dog bite, serious injury or something like a heart attack, you can be seen in a larger hospital or taken back to the U.S.”
Other tips include planning an evacuation route, in case of natural disaster, and carrying a small medical bag with you, which can be purchased at most pharmacies. Those needing the yellow fever vaccine for trips to Brazil and certain regions of Africa should check early to see where it is available. Currently, there is a nationwide shortage of the vaccine due to production problems, and Hall Health is one of the only local clinics in the Seattle area to have a supply of the vaccine.
In her 17 years at Hall Health, Terry estimates she’s seen about a dozen cases of rabies exposure through the clinic. The most recent event was when a student was bitten by a dog in Peru and had to be evacuated since the correct treatment was not available where she was. She did not have medevac insurance.
“It was an expensive trip for her,” Terry said.
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