Don't forget your rabies shots

There are 20 million dogs in India. Here are some of them. Most dogs I encountered were well-fed healthy specimens, generally disinterested in foreigners and evidently not infected with rabies. However, dogs - even puppies - with rabies tend to want to bite you.

Long-term travellers (over 3 months) to India and those travelling in remote areas are advised by authorities to get the rabies vaccinations. If bitten (or even licked on an open wound) by any dog or puppy, you can't afford not to take it seriously and there's a good chance getting the full treatment will bugger up your holiday quite a lot. But not so as much as not getting treatment could bugger up your life. Death is the certain outcome of a rabies bite if the disease gets to your central nervous system and symptoms begin to show. This can take anything from 10 days to two years. There has never been any suggestion that your body could fight the rabies virus on its own as we have no natural immunity to it. Vaccines are your only chance of survival.

Having rabies shots before an incident has the off-putting factor of high cost. It took me one month of research and consultation before I could be persuaded to go ahead and get them. In Australia it costs about AUD$300 but in the end I found a cheaper way - health insurance. The cheapest vaccines, if you have time, can be got in India. Only three are required - on day 1, 7, and 28 (I think). If you leave it until you've been bitten, you require 5 vaccine shots plus an immuno-globulin shot asap after the event to give you an immediate supply of antibodies. Otherwise the virus is working in your system for at least one week before your body can start to fight it off.

Accessing, this last shot is particularly problematic in India. All the shots must be kept in refrigerated conditions, meanwhile India has regular power failures. But hospitals have generators. The problem is, how far are you from a hospital that has this shot in stock and how rigorous are the people who manage the storage of the drug? Supply is an issue that may mean you have to fly across the country to get a dependable shot.

Locals regularly do not survive a rabies bite despite getting treatment. Many reasons have been given for this. In most cases 'fault' can be attributed to the victim's side (lack of money to get the whole course of treatment, getting to treatment too late), but some have been attributed to the fault with supply and administration of the treatment (stale supply, incomplete treatment). Can you afford to take such risks.

There have been rabies deaths of foreigners visiting India and dog bites are fairly common. The case I am most familiar with was of a woman who was on a two-week holiday in Goa. A puppy on a leash nipped her ankle. She did nothing about it. At home, she got sick and went to hospital. There they were able to get the story but were unable to save her.

It's not that the risk of getting rabies is especially high. The usual statistic is 20 000 deaths in India per year. In a country with a population of 1 billion this is not so high. That is only 2 cases per 100 000 people pa. And then you can consider that many of these cases are children who are more vulnerable.

The risk is that once symptoms appear, you die and getting good treatment promptly is difficult and upsetting for your trip, and you can't always tell if the dog that has bitten you is rabid or not.

Assuming you have your shots and then get bitten. The first thing to do is wash the wound thoroughly but gently with soap and water for about 10 minutes. This is very effective in washing most of the virus out and the alkalinity of the soapy water can help kill the virus. Then apply an iodine solution and get to a hospital, doctor or pharmacist ASAP for the vaccinations. But there is no guarantee that no virus is in the wound, so get the treatment. Even if you've had the vaccine before being bitten, you will still need three (or is it only two) afterwards but not the difficult immunoglobulin one.

Also, if its possible, notify people in the vicinity that the dog has bitten you and ask them to put it in quarantine or to get advice from health authorities - vet or medical doctor. Dogs kept in quarantine for a certain time will show whether or not they are rabid. If they are, then the local people can avoid further incidents.

To avoid getting bitten, give dogs a wide berth as much as possible. Don't pat them, don't tease them. Best to ignore them. If you must feed them - and really I don't advise it as they start to recognise foreigners as a food source and start pestering you which is unnerving - drop the food discretely and leave.