World Rabies Day: Answering Your Questions About Rabies

Whether you're headed off to a place where wild animals run free and hospitals are few and far between, or whether you're going to a place with no dogs and easily accessible medical care, it's a good idea to inform yourself about rabies and how to avoid it. Beijing United Family Hospital (BJU) Director of Pharmacy, Helen Zhang, gives us the lowdown.

What is rabies? 

Rabies is a viral disease caused by a virus found in the saliva of infected animals. It is transmitted to humans by bites, or possibly by contamination of an open cut. Rabies is the most fatal disease known to man. Once symptoms develop, it is 100% fatal.

What is the rabies vaccine? 

Fortunately, there is a highly effective vaccine available, which can be used both for pre-exposure prevention and as part of post-exposure treatment of an animal bite. The vaccine used at BJU is Rabipur, imported by GSK. It is an FDA-approved, extremely safe, reasonably priced, and highly effective vaccine.

What animals can spread rabies?

Rabies is spread by warm-blooded animals, including raccoons, skunks, foxes, coyotes, woodchucks, and bats. Domestic animals like dogs, cats, ferrets, and farm animals can get rabies from wild animals. In China, dogs are the most significant spreaders of rabies. This is why it is important to vaccinate pets and livestock. Any mammal can get rabies. Birds, fish, snakes, and amphibians do not carry rabies.

What’s the rabies situation in Asia and China?

Asia has the heaviest burden of human rabies in the world, with tens of thousands of deaths every year. In China, rabies appeared to be coming under control for a while but, in the past few years, there has been a resurgence, with cases reported in southern, northern, and northwestern provinces. The estimated number of patients exposed annually has reached 40 million. Of these patients, 90% are infected from dog bites, with cats infecting a further 5%. Roughly half of these rabies cases involve domestic pets, many of which are not vaccinated. Since 2004, rabies has been in the top three causes of deaths by communicable diseases in China.

Why should I get the pre-exposure vaccine? 

Many experts recommend the pre-exposure vaccination for all people living or traveling in a rabies endemic area for more than 30 days. If you live in China, that includes you. Animal bites and other forms of exposure can be treated after the fact (this is called post-exposure treatment), but getting the pre-exposure vaccination is a good idea for two reasons. First, the post-exposure treatment is difficult to obtain, costly, and painful. Second, some people, especially children, may not recognize or report minor exposure. Post-exposure treatment requires not just repeated doses of the vaccine, but also infiltration of rabies immune globulin (RIG) around the wound. Not only is this medication not reliably available in China, it is also an extremely expensive and very painful treatment. People who have had the pre-exposure vaccine do not require RIG – only two doses of the rabies vaccine. 

Who has the highest risk of contracting rabies?

Children under the age of 15 are at the highest risk of rabies infection. They are more likely to approach an unknown animal, less likely to report exposure, and more at risk for rapid progression of the illness if exposure does occur. This is because the virus travels up the nerves to the brain; in children, the distance is shorter. Businessmen who often travel to India, Thailand, and southern China, or people who stay in rural areas for a long time are also at high risk. Pet owners and zoo workers need to take the vaccine regularly to keep a high immunology level. Anyone else living in China should at least consider the pre-exposure vaccine.

At what age can a child get the vaccine? 

The vaccine can be safely administered to even very young infants. In practice, it makes sense to start vaccination after the age of one, once a child becomes independently mobile.

Can the post-exposure vaccine protect you 100% against rabies? 

There has never been a rabies death in a person treated appropriately and promptly with the post-exposure regimen. However, there have been deaths when parts of the treatment were left out, or when treatment was delayed too long. In China, there have been deaths in people treated with vaccines and immunoglobulins that were obtained from improper sources.

What about the pre-exposure vaccine?

The pre-exposure vaccination consists of three doses given over a three- to four-week period. No booster doses are needed unless you work closely with animals. If you are vaccinated and are bitten or scratched by a potentially unvaccinated animal, you still need medical attention. This is very important. The wound needs to be thoroughly cleaned out and disinfected and two further doses of vaccine are needed. These extra doses cause a rapid immune response, allowing the body to quickly deal with any rabies virus that has been deposited in the wound. You do not need RIG in this situation.

Will my insurance cover the pre-exposure rabies vaccination?

To answer this question, BJU consulted with several insurance companies. Most of them cover the rabies vaccine for their members. If you want to be 100% certain, you need to check with your insurance company, as different policies have different coverage.

This article was written by Beijing United Family Hospital (BJU) Director of Pharmacy, Helen Zhang. She is a registered pharmacist in China and the USA. If you want to book an appointment to receive your pre-exposure rabies vaccine, please feel free to contact our service center at 4008-919191.

Additional research for this article comes from

1. China CDC: Technical Guidelines for Human Rabies Prevention and Control (2016)  中国疾病预防中心：狂犬病预防控制技术指南;

2. WHO and US CDC websites;

3. 2015年全国法定传染病疫情概况: http://www.nhfpc.gov.cn/jkj/s3578/201602/b9217ba14e17452aad9e45a5bcce6b65.shtml

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