Rabies advice for travellers from Australia

19 Feb 13

 

Caroline Nash and Lisa Wisely are Registered Nurses who work at Ballarat Medical Centre a busy medical practice in Ballarat, Victoria, Australia. With 8 General Practitioners (GPs), the practice along with others, serves a community of 95,000 people. It is the only practice in the area that specialises in travel medicine and is a member of the Travel Clinics Australia (TCA) group. Travellers that attend the clinic are offered comprehensive pre-travel consultations. Of all travellers that attend the clinic, 66% travel to rabies endemic regions such as South East Asia. Staff at the clinic therefore ensure that the traveller is well informed about the rabies virus, prevention strategies, pre-exposure vaccination and post-exposure treatment and provide resources.

The cost of intramuscular rabies vaccine is commonly an issue, so the practice offers intradermal vaccination as a cheaper option. In Australia intradermal administration of rabies vaccine is approved by the National Health & Medical Research Council (NHMRC). It can only be given intradermally at licensed travel clinics by specially trained staff that have expertise and regularly use this technique.

In 2011, due to their keen interest in travel medicine, the nurses commenced post-graduate studies at James Cook University (JCU), in Queensland, Australia. They first enrolled in a Graduate Certificate of Travel Medicine and in 2012 received individual $30,000 scholarships from the Australian Government to upgrade to a Masters of Public Health. Next month they will travel to Bangkok to attend Mahidol University to undertake an elective in tropical medicine.

In recent years Caroline and Lisa have noted an increase in the number of travellers returning from high-risk areas that have required rabies post-exposure prophylaxis following an animal bite. Most of these travellers had not sought specialised pre-travel advice. Many were unaware of the risks associated with rabies or that it was endemic in areas such as Bali that have previously been rabies free. The increasing number of returning travellers requiring rabies post-exposure prophylaxis is also reflected in Victorian Department of Health statistics (227 in 2011 and 206 to the end of August 2012). Countries where travellers had most commonly returned from were Bali and Thailand and the most common animals responsible were monkeys and dogs. Each rabies post-exposure prophylaxis series (4 rabies vaccines & RIG) costs the Australian government approximately AUD 1100 ($US 1140).

In response to these statistics, the nurses have produced a rabies brochure, designed to educate travellers (pictured). The brochure outlines facts about the disease, who is at risk and the countries where rabies is present. Intramuscular and intradermal pre-exposure vaccination options are also discussed. Most importantly, the action to take in the event of a potential rabies exposure is outlined for both the vaccinated and unvaccinated traveller. Caroline and Lisa have since embarked on a campaign to increase awareness of the risks of rabies while travelling. They have presented to GPs, nurses and other allied health professionals, local community groups, travel agents and the Department of Health in the state of Victoria. Their brochure has been promoted in an article in the Department of Health Victoria newsletter. To date Caroline and Lisa have been very successful in increasing awareness of rabies and have seen an increase in the uptake of vaccination in their clinic.

Contributed by Caroline Nash and Lisa Wisely of Ballarat Medical Centre, Victoria, Australia. Their brochure is also available on the GARC website, here.