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Are Rabies shots essential before going to Thailand?


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There appears to be some confusing information about rabies offered on this post. (This excludes Sheryl's advice of course)


May I offer this :

 

Serious reactions to rabies vaccine are rare.

Rabies vaccination is generally recommended for stays in Thailand of greater than 6 weeks and consists of 3 shots of rabies vaccine.

I have only ever seen warnings on Thai areas with rabies problems on Thaivisa. Actually I would assume rabies is endemic all over Thailand.

The same rabies vaccine is used for pre and post exposure. In post exposure it is used as a vaccine too.

An exposure or dog bite should be treated as a matter of urgency.

Exposure for an unvaccinated person requires a shot of human or equine rabies immunoglobulin which is expensive and can be difficult to find. It is also a blood product with its inherent risks.

In addition to this generally 5 shots of rabies vaccine are given over a 30 day period.

Exposure for an immunised person requires only 2 rabies vaccine shots 

Once a person has the post exposure regime he generally only requires 2 rabies vaccine shots for all subsequent exposures.

 

Edited by sanuk21
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2 hours ago, sanuk21 said:

Exposure for an unvaccinated person requires a shot of human or equine rabies immunoglobulin which is expensive and can be difficult to find. It is also a blood product with its inherent risks.

 

 

Thanks but are you a doctor or medically qualified to say this?

 

A quick Google says immunoglobulin is no longer used in modern day Rabies treatment

 

 

 

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9 hours ago, LandOfSmiles99 said:

 

Thanks but are you a doctor or medically qualified to say this?

 

A quick Google says immunoglobulin is no longer used in modern day Rabies treatment

 

 

 

He is correct in what he says.

 

Immunoglobulin IS used if the person bitten has not had prior vaccination.  It is nto necessary for people who had pre-exposure vaccination, and this is one of the main advantages to getting the pre-exposure vaccine.

 

Quick google searches are not the best way to identify medical protocols and guidelines. See instead the WHO and CDC treatment guidelines.

 

www.who.int/rabies/PEP_Prophylaxis_guideline_15_12_2014.pdf

https://www.cdc.gov/rabies/medical_care/index.html

 

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12 hours ago, sanuk21 said:

Exposure for an unvaccinated person requires a shot of human or equine rabies immunoglobulin which is expensive and can be difficult to find. It is also a blood product with its inherent risks.

 

 

9 hours ago, LandOfSmiles99 said:

 

Thanks but are you a doctor or medically qualified to say this?

 

A quick Google says immunoglobulin is no longer used in modern day Rabies treatment

 

 

 

I am not a doctor and I am not qualified to say this but the WHO is.

 

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I had the three pre-exposure rabies shots.  

      I see "Kwasaki" says that  by "all" accounts, they can have some rather nasty after effects.  ALL ? ?

 

   Well, here's one account that disagrees with Kwasaki's unknown sources.  

   I had no after affects at all.  They were no worse than an average needle.  Worse after affects I've ever had was a sore upper arm for three days from a Tetanus vaccination, and thats to be expected, and normal for that shot. 

 

    If not previously vaccinated against rabies, they will not only need at least four rabies vaccine shots, but they will also need Human Rabies Immune Globulin injected into the bites. Human Rabies Immune Globulin (HRIG), can be both hard to find in some areas and also expensive. I got the three pre-exposure rabies vaccine shots. If I got bit, I would only need a further two rabies vaccine shots, and I would not need the very pricey and sometimes hard to find Human Rabies Immune Globulin.

        If you have not had the pre-exposure vaccinations.. you need the Human Rabies Immune Globulin, along with at least four shots of the vaccine. 

 

Type of vaccine: Modern cell-culture or embryonated-egg vaccine

Number of doses: Three, one on each of days 0, 7 and 21 or 28, given i.m. (1 or 0.5 ml/dose depending on the vaccine) or i.d. (0.1 ml/inoculation site)a

Booster: Not routinely needed for general travellersb

Adverse reactions: Minor local or systemic reactions

Before departure: Pre-exposure prophylaxis for those planning a visit to a country or area at risk, especially if the area to be visited is far from major urban centres and appropriate care, including the availability of post-exposure rabies prophylaxis, cannot be assured.

 

For those who have NOT recieved Pre-Exposure vaccination.... the Centers for Disease Control and Prevention recommends people receive one dose of human rabies immunoglobulin (HRIG) and four doses of rabies vaccine over a 14-day period. The immunoglobulin dose should not exceed 20 units per kilogram body weight. HRIG is expensive and constitutes most of the cost of post exposure treatment, ranging as high as several thousand dollars.

    Rabies pre-exposure vaccine shots are given .... day zero: first shot,       day 7: second shot,        21 or 28 days after second shot; third shot.

   Pre-exposure vaccination also gives you more time to get to medical help.   

    When bitten, you will still need a further two shots of the vaccine..  (YES... these are vaccine)    But no need of Human Rabies Immune Globulin...(which can be very pricey and also hard to find in some areas.) 

 

   Do the math.    Remember, Rabies ....one the symptoms appear.. is almost 100% FATAL.  And a very horrible suffering way to die.. 

 

  I would also suggest Hep B with your other shots... and Japanese Encephalitis if you can easily afford it. An Australian guy died from JE after returning to Australia from a Thailand vacation..   

 

  Perhaps think about getting your shots in Bangkok if you are going to be there for a while..  The Thai Travel Clinic is a special clinic of the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand. You can get all your travel vaccinations there for a cost much less than in the west. 

Edited by Catoni
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The potential  vaccine side effects are mild and similiar to those of other vaccines (soreness at the injection site, muscle aches etc) and in any case it is the same vaccine used for pre and post exposure.

 

The immunoglbulin however can have more serious side effects in some people including (rarely)  anaphylactic shock. By getting the pre-exposure vaccine you avoid the need for the immune globulin.

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12 hours ago, LandOfSmiles99 said:

 

Thanks but are you a doctor or medically qualified to say this?

 

A quick Google says immunoglobulin is no longer used in modern day Rabies treatment

 

 

 

                Human Rabies Immune Globulin (HRIG) is not needed...IF... the patient has been pre-vaccinated against Rabies in the past.   Just a follow up two shots of vaccine needed.  Studied the subject for years... CDC and WHO sources.   Rabies pre-exposure shots received in 2013.  

                   I'd be very interested in your sources saying HRIG is no longer used.  Can you provide the links please?  

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7 hours ago, mindovermatter said:

Up to you but personally, a rabies shot isn't necessary. Some go for a pre-exposure but anti-rabies shots and hrig/erig are administered once bitten anyway.
 

               But you need at least four shots of vaccine instead of three... and you need the Human Rabies Immune Globulin (HRIG) also...  which is hard to find in some places... and can be very very expensive. 

           For myself... I got the pre-exposure three shots...      so I will only need a further two shots of vaccine if exposed to Rabies......and I wouldn't need the HRIG......

             I would NOT have to worry about them having HRIG on hand, and not worry about paying a hefty price for it. 

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21 hours ago, ukrules said:

If you were bit by an animal with rabies they advise that you get shots but it can take many weeks or even much, much longer to develop rabies.

 

What I'm saying is, it's not an emergency to get the shots, you don't need to call an ambulance or taxi minutes after the bite and go straight to the hospital.

 

It's something you can do when you have the time and opportunity.

 

"What do you do after a bite?
There is no treatment for rabies once the symptoms have been shown. Therefore, it is important to act immediately after you have been bitten. After a bite, consult a doctor, wash the wound thoroughly with water and soap, start vaccination programs immediately and, if possible, get antibodies to rabies. Also remember vaccination against tetanus. If you are bitten, you must have rabies vaccinations, whether or not you have already received vaccinations. However, fewer vaccinations can be made and you are better off if you have already been vaccinated. You should be aware of whether you travel to areas where vaccination and antibodies are not immediately available; In that case, it is particularly important to be vaccinated before departure."


 

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22 hours ago, ukrules said:

If you were bit by an animal with rabies they advise that you get shots but it can take many weeks or even much, much longer to develop rabies.

 

What I'm saying is, it's not an emergency to get the shots, you don't need to call an ambulance or taxi minutes after the bite and go straight to the hospital.

 

It's something you can do when you have the time and opportunity.

 

Rabies treatment should be started within hours of the bite, not days or weeks. By the the rabies develops, if you have not had the shots, death is close to 100 % certain.

I would not have the shots unless bitten.  My wife had 4  sets of two injections which some people find painful. I think the last one was 4 weeks or more later.

 

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Think most people in thailand not even have what you want to get for shots

the government program for children in the area we live in does not provide this for the children only Hep B

 

this what the internet tells

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus (HAV). It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Hepatitis A is a self-limited disease that does not result in chronic infection.

There is no specific medicine to treat or cure hepatitis A. If you have the virus, your body will eventually get rid of the infection on its own. You probably will feel sick for a few months before you begin to feel better.

 

 

 

if you do the vaccination you also have to do the testing to see if the vaccination program did work.. without having done the test it is never sure.

and you have to take the full program 3 or 4 shots. a/b can be done at the same time.

 

the other things I no know why you need to have that

 

the essential one is missing

Japanese B encephalitis. and this was also 3 shot in my case and did let test on it as well.

 

you have to plan because not all vaccines can be set at the same time and do have a waiting period if you have had other vaccine that is not compatible,

 

Rabies, just avoid the animal incubation time is 2 weeks before hey show the symptoms and are already contaminating the area with rabies. 

 

but there are other things they also not told you and that is that is it better to wear closed shoes, avoid water, grass and other green ara because many nasty small creatures live there walking sitting and flying around. 

 

 

 

 

 

Edited by Autonuaq
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1 hour ago, The Deerhunter said:

Rabies treatment should be started within hours of the bite, not days or weeks. By the the rabies develops, if you have not had the shots, death is close to 100 % certain.

I would not have the shots unless bitten.  My wife had 4  sets of two injections which some people find painful. I think the last one was 4 weeks or more later.

 

 

It's not an emergency situation, it normally takes at least weeks before symptoms appear.

 

Of course you should go as soon as possible but if you're in the middle of the jungle you don't need to call in an expensive medevac to fly you to the nearest big city for treatment. Waiting a few days will make no difference.

 

Edited by ukrules
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23 hours ago, impulse said:

 

Just out of curiosity, who recommended that list?  Because I just hopped on a plane in Beijing 7 years ago, bound for Bangkok.  And 10 years before that, I hopped on a plane in Houston, bound for Beijing.  Nobody told me to get any shots.  And my old fart doctor in Houston suggested I'd be better off swimming in sewage than get the vaccines available at that time.  (He didn't really mention sewage, but I didn't want to get into skanky hookers on a family friendly forum.  He was a colorful character.)

I wonder where this information comes from only today had an email from a friend in Aus who  is  visiting in a couple of months and his Doc advised some of those on the list plus Japanese encephalitis malaria and Zika 

Asked if the Doc wasn’t thinking of Bangladesh or perhaps you were going to work on the Burma railway ! ! !

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Gosh

 

I really hope you go down to your local S&M shop and buy one of those complete rubber suits. 

I presume you had the usual shots when you were a kid

 

Honestly do not worry. We all live here, shop at local markets, face the worse from 5* hotel breakfast buffets, face off the local soi dogs ( never met a nasty one yet) eat seafood from polluted seas .

 

dont worry.

 

If you are really concerned - bring epipen , king cobra anti venom , Yellow fever vaccination and don’t forget the malaria tablets. Read up on dengue. There is a danger from liver flukes and also being killed by wild elephants 

 

Also make sure you fully understand that there are now totally antibiotic resistant strains of sexually transmitted diseases in SE Asia - also that pesky flesh eating bacteria - it’s present on most beaches here.

Damn forgot the sand flies - they are really bad - you can end up on an antibiotic drip for a week in hospital- bad news. ( actually this is  true) 

 

Just remembered - Fruit Bats - totally wonderful creatures - amazing , there is a famous temple I have visited with thousands of them - don’t go- apparently they carry some fiendish virus.

 

What else Jelly Fish - can be painful  - avoid the really big lizards - they give a deadly toxic bite 

 

Anything more do not swim in the sea - there is no effective water treatment- it’s full of feceal matter - stay away from hotel pools - if there many children- some nationalities encourage the kids to pee in the pool. 

 

The local beer is full of formaldehyde- don’t drink - NO ICE EVER . 

Have fun and stay safe 

 

I hope you realise I’m being humorous! It is the tropics and yes there are dangers here compared to back home - some points are serious ( hotel buffets ) 

 

 

Edited by peterb17
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1 hour ago, ukrules said:

 

It's not an emergency situation, it normally takes at least weeks before symptoms appear.

 

Of course you should go as soon as possible but if you're in the middle of the jungle you don't need to call in an expensive medevac to fly you to the nearest big city for treatment. Waiting a few days will make no difference.

 

Of course, but your two posts could  unfortunately be construed to mean that one could wait until you see symptoms appear.    A few days at the most is all that I understand it is prudent to wait.  And that would not be waiting for waiting's sake.  More that you WERE in the jungle and could not get it started earlier.  Sure, a few days you should get away with but the recommendation is to start treatment ASAP after the bite from a suspect animal.  Who on earth would want to wait and why would anyone want to wait?  Whose life are they playing with?  Rabies is recognised as being nearly 100% irreversibly fatal if it gets to the stage of symptoms appearing.

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OP

 

After my last post - I would not worry about pumping yourself with vaccinations.

 

However my advice would be NEVER EVER- rent a scooter - the chance of rabies - minute .

The chances of ending up in A&E from a motorbike accident - a million times greater.

 

And do not forget the ultimate travel insurance- repatriation, zillions of cover - enjoy your trip. 

 

Dont forget - most on this forum are Americans- they just love Big Pharma . 

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3 hours ago, Autonuaq said:

Think most people in thailand not even have what you want to get for shots

the government program for children in the area we live in does not provide this for the children only Hep B...

 

 

 

 

 

 

The government program most definitely does provide children with both diptheria and tetanus vaccine (as well as Hep B, Japanese B and some others). Pretty much all countries do this and the OP will have been vaccinated for diptheria and tetanus several times as a child, this will just be a routine booster . And no more essential for Thailand than for anywhere else, it is just a standard recommendation to have all of one's basic immunizations up to date before traveling. Not necessary if already had a booster anytime in past 10 years.

 

Cholera and typhoid are not given and as I advised, not indicated. These diseases are uncommon in Thailand and the vaccines not particularly effective.

 

Other post mentioning yellow fever and malaria tablets was way off the mark. there is NO yellow fever in this part of the world. Malaria in Thailand is limited to dense jungle areas and malaria prophylaxis is not indicated.

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3 hours ago, Muzarella said:

I only knew that I can get 2 preventive shots before moving to Thailand...... after get biten by a street dog and have to pay here $700 for the 8 shots.

 

Where did you get bitten and how? Did the dog just attack randomly?

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