Are Rabies shots essential before going to Thailand?

[shy coconut]

On 6/6/2018 at 11:33 AM, 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.)

Did your doctor sell bottles of tonic out of the back of a wagon? ?

[uffe123]

I got bit by the neighbors dog, and went to the hospital. The doctor told me to get rabies shots, better to be safe than dead. There are my side effect to the shots, and unless you are going to be around soi dogs, i woudnt suggets it.

[impulse]

 

5 hours ago, shy coconut said:

On 6/6/2018 at 6:33 PM, 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.)

Did your doctor sell bottles of tonic out of the back of a wagon?

 

The longer story is that there was some controversy at the time related to QA on some of the vaccines and the ethics of the companies producing them.  His contention is that I was better off taking my chances with germs in the wild than the dodgy vaccines.  I can't blame him for not wanting the liability- legal, financial, or moral.

 

He was actually an excellent doctor because he didn't just dictate a treatment and shuffle me out the door.  He explained the reason for what he was doing, the pros and cons of the various options, and the discrepancies between the conflicting research being used to peddle the mainstream meds and the studies that looked into alternative treatments.  It wasn't unusual to spend a half hour (or more) with the guy, where a normal doctor tried to get me in and out in less than 5 minutes. 

 

And keep in mind that was before WebMD and other internet sites, so he was often my only source of information that we take for granted today.   

 

 

Edited June 8, 2018 by impulse

[LandOfSmiles99]

13 hours ago, uffe123 said:

I got bit by the neighbors dog, and went to the hospital. The doctor told me to get rabies shots, better to be safe than dead. There are my side effect to the shots, and unless you are going to be around soi dogs, i woudnt suggets it.

 

Soi dogs are alley dogs right? Doesnt everyone have to walk down a Soi and pass these dogs at some stage in Thailand?

 

Bangkok in particular

 

 

[BwindiBoy]

On ‎6‎/‎6‎/‎2018 at 11:30 AM, 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.

 

I strongly disagree with this. My understanding is that you need to get yourself to hospital within 24 hours, and get treatment (jabs). All having the advance jabs does is, I believe, buy you some more time before you need treatment, plus reduce the subsequent number of jabs needed after you've been bitten.

 

However, if you want to die, do as recommended in the quoted post.

[moojar]

I'm late to the thread... 

 

I spend time in Buriram province - four months this year.  And earlier this year a 14 yr old girl died of rabies in the province, apparently contracted from her pet dog's saliva.  So back in Australia I looked into rabies vaccination, and it's bloody expensive - something like $500 or $600 (B13K or so) for the course of shots.  That may be because Australia does not have rabies, not so many people are asking to be vaccinated.  

 

Anyway, I decided due to cost I'll take the risk - get shots in Thailand if I were to be bitten.  And dogs there are more aggressive than in western countries I find, so there's a fair chance of a bite one day.    

 

Once you have rabies it's a death sentence.  

Edited June 9, 2018 by moojar

[sanuk21]

12 hours ago, moojar said:

So back in Australia I looked into rabies vaccination, and it's bloody expensive - something like $500 or $600 (B13K or so) for the course of shots. 

A course of intradermal rabies vaccine shots is available in travel clinics for under $200. With intradermal shots you actually share the same rabies vaccine vial with others with appointments pre-arranged for that day.

[sanuk21]

13 hours ago, BwindiBoy said:

I strongly disagree with this. My understanding is that you need to get yourself to hospital within 24 hours, and get treatment (jabs). 

I agree. I would suggest waiting a few days would not be advisable in all cases.

The factors determining the urgency of treatment for a rabies exposure are many fold.

Factors such as depth and location of bite, type of rabies virus, age and immunocompetence of the person etc.

Bites to the face have a shorter incubation period than those to the limbs because of the distance from the bite to the brain is shorter. 

In such cases, symptoms may appear just nine days after the original infection.

With rabies vaccine taking seven days for an antibody response to offer protection you would be relying heavily on the availibility and effectiveness of HRIG.

With an incurable disease such as rabies why take risks.

Edited June 9, 2018 by sanuk21

[LandOfSmiles99]

The vast majority on Reddit seem to say "not needed at all" on this matter

 

However, this thread has scared the living f*&k outta me ?

 

I'm going to ask them in the Vacs clinic tomorrow what I need and don't need for SEA. They've a doctor you talk to before booking what you need

 

 

Edited June 10, 2018 by LandOfSmiles99

[Katia]

On 6/7/2018 at 11:53 PM, LandOfSmiles99 said:

 

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

They can.  I have never had an issue with a street dog (they either ignore me or, at most, hope I have food), but I've told here before how I was bitten by a dog at a house.  The only thing I did to "provoke" him was walk past his house on the street, and he showed no signs of aggression (just looked at me as I passed, as every dog here has ever done) until he suddenly rushed from a few feet away and wrapped his jaws around my calf.  Luckily it was a light bite (barely broke the skin though I now have tooth holes in my pant leg, the tosser); he didn't seem very serious and almost seemed taken aback after he did it.  But I got the shots anyway (having had the preventive series when I first came here).  Figured I might as well be safe (even though I felt silly walking into the hospital saying I wanted the rabies shot because a dog had bitten me, they were all concerned and wanted to see it, and then it was barely anything).  Especially since it's not like in the U.S. where they'll observe the animal for a period after to see if it displays symptoms, so you'll never know.

 

Actually, I'm surprised it was the dog and not one of those damn monkeys at the temple I was walking to when it happened...

[LandOfSmiles99]

Me after re-reading this thread

 

https://i.gifer.com/1Jwe.gif

[LandOfSmiles99]

Update!

 

Earlier today I got shots for:

 

Hep A

Typhoid

Diphtera

and Tetanus

 

I had a 30 min consultation with a travel doctor before and she thoroughly went through all the options

 

I think - at this point - I'm not going to get the course of Rabies shots or Hep B shots

 

I've already got much more than most people I know who've gone there ?

 

This can be a bit like playing Dr Google with symptoms when you're not feeling well in that the more you look up the more anxious you can become

 

 

[LandOfSmiles99]

Change of plan

 

Hep B is " hyperendemic in Thailand " https://www.ncbi.nlm.nih.gov/pubmed/3024326

 

In my country 3 shots of Hep B will cost 120 euros. I think for peace of mind I'll get it

 

I may also get the Rabies shots and then not have to worry about that too

 

Rabies shots are 40 euros a shot X 3

 

So another 240 euros on top of the 165 I already paid for a total of 405 euros (!) 

 

This staying alive stuff is expensive! ?

 

 

[ivor bigun]

After 25 years visiting and living here only ever had the flu jab

Sent from my SM-A720F using Thailand Forum - Thaivisa mobile app

[NancyL]

When Hubby and I relocated to Thailand 10 years ago for retirement, it hadn't dawned on us to get any vaccinations.  So, we each went to CM Ram hospital and inquired as to what they'd recommend.  We went at different times and were given a very different list.  So much for the hospital supposedly being ISO certified. 

 

Doesn't that mean they're suppose to follow standard procedures, as in when someone in their late 50s from the U.S. turns up and says I plan to live here long-term in a condo in the city, with occasional side trips to country "resorts", what vaccinations do you recommend?  You think we'd have been given the same advice.

 

Somehow they thought I needed pre-exposure rabies vaccinations, but not Hubby.  I didn't find the jabs painful, just needless expense when I was told that they don't have a lifetime effectiveness.  Hubby went on to do some volunteer work at a dog charity where maybe, just maybe it would have made sense for him to have pre-exposure rabies vaccination, but the people running the charity said, nope, he could always go get the shots if was bitten by a dog.  (he wasn't.  We have more problems with Mr. Bitey, our cat, but he's been vaccinated.)

[Sheryl]

As an aside, Nancy, I hope Mr. Bitey never bites you! I am currently under treatment for a whopping cellulitis (left hand, which is excruiatingly painful and swollen ) with possible ulnar nerve damage (hopefully temporary) thanks to this little angel:

 

 

 It wasn't me he was after, it was the other little angel in my avatar, I just got in the way.

 

Excluding rabies  (more prevalent in dogs, though cats can get infected if a dog bites them), cat bites are far more likely to cause tissue infection than dog bites. Something like 80% of them lead to a tissue infection. Because of how cat's teeth are shaped the wounds are deep punctures that seal up almost immediately,  trapping all sorts of nasty bacteria within.

[grollies]

50 minutes ago, Sheryl said:

As an aside, Nancy, I hope Mr. Bitey never bites you! I am currently under treatment for a whopping cellulitis (left hand, which is excruiatingly painful and swollen ) with possible ulnar nerve damage (hopefully temporary) thanks to this little angel:

 

 

 It wasn't me he was after, it was the other little angel in my avatar, I just got in the way.

 

Excluding rabies  (more prevalent in dogs, though cats can get infected if a dog bites them), cat bites are far more likely to cause tissue infection than dog bites. Something like 80% of them lead to a tissue infection. Because of how cat's teeth are shaped the wounds are deep punctures that seal up almost immediately,  trapping all sorts of nasty bacteria within.

Hope that clears up for you, sounds nasty.

[Katia]

Ouch, Sheryl!  Who knew someone so cute could cause so much (admittedly unwitting) damage?

 

Isn't there something about the bacteria in cats' mouths also being not-so-nice?  (I've heard the same about people, that human bites can be quite nasty for that reason.)  Or is this an old wives' tale?

[NancyL]

That sounds awful, Sheryl.  Did that little dear intend to inflict that kind of damage on your other sweetheart?  Ours run around, wrestle and kick each other, but don't bite each other very hard.  Never seen any penetration wounds.  

 

And with us, Mr. Bitey is a "nipper" as in what Hubby calls "love nibbles", doesn't do deep wounds, but the nipping is annoying enough.  

[Sheryl]

18 hours ago, Katia said:

Ouch, Sheryl!  Who knew someone so cute could cause so much (admittedly unwitting) damage?

 

Isn't there something about the bacteria in cats' mouths also being not-so-nice?  (I've heard the same about people, that human bites can be quite nasty for that reason.)  Or is this an old wives' tale?

Not a tale, very true. Bartonella and especially Pasteurella species bacteria. This last one is anaerobic. The narrow, deep and self-sealing nature of the bite wounds traps the bacteria deep into the tissue.

 

Antibiotics should be taken prophylactically after a deep cat bite and - very important -- the usual antibiotics what a pharmacist may suggest will not work. Augmentin is usually first line. If the cat's vaccination status is unknown, rabies vaccine is also a must. Basically, just go to an ER without delay. I made the great mistake of delaying antibiotics till there were signs of infection (day 2) and am paying dearly for that....day 6 of unremitting pain and inability to use the hand, daily IV antibiotics had to be added to the oral etc. Good chance that had I started high dose  augmentin immediately I could have avoided this. Believe me, I won't make that mistake again and from now on will always have at least 2 doses on hand to get started on (needs to continue 10-14 days, but the idea is to ensure immediate treatment if it is at night, or the injury makes it hard to drive. (as it will esp. if you drive a stick shift).

 

While the bite of a large dog is more likely to cause serious blunt trauma to tendon, bone etc. , the bite of a cat is much more likely to cause an infection afterwards.

 

Human bites are nasty but, like dogs, more open so that a good flushing and cleaning afterwards will help. With cat bites, while you should do this, effectiveness is limited as it will not penetrate deep into the narrow wound track.

 

With all bites, it is best to allow a certain amount of bleeding to flush out the wound ... within reason, obviously. If an artery or major vein was nicked causing serious hemorrhage then pressure to control bleeding is essential. Otherwise allowing say 15-20 cc immediate blood loss is good. Unfortunately there is little external bleeding with a cat bite. Follow that with copious flushing with water or saline, disinfectant like betedine, antibiotics for 10 days (star prophylactically, don't wait for signs of infection like redness and swelling). And of course immediate rabies vaccine and immunoglobulin if there is any doubt of the animal's vaccination status.

 

Nancy, my little Amnat Lemur is also not normally an attacker, in fact he is very loving and sweet. This happened because he felt threatened by another cat and I was holding him at the time. Might not be a bad idea to keep 2 doses of augmentin 1000 on hand just in case (it's 12 hourly dosing so 2 doses should be enough for you to get to hospital for additional).

 

 

[NancyL]

Good idea to lay in some Augmentin 1000 in case Mr. Bitey gets rambunctious.  I suffered a nasty cat bite on the back of my leg in my early 20s when I did exactly what you did.  Somehow my parents and I thought it would be a good idea to bring my cats over to their apartment.  We thought because we got along, our cats would.  When one of their cats started going after one of mine, I picked up my cat and got attacked by one of my mother's little darlings.  

[bkkbudddy]

Greetings, 

 

I received my rabies vaccination from Red Cross Clinic and the price was very reasonable  compared to private  clinics or hospitals!  The clinic is located directly front of the snake farm in Silom area!

[jak2002003]

10 hours ago, bkkbudddy said:

Greetings, 

 

I received my rabies vaccination from Red Cross Clinic and the price was very reasonable  compared to private  clinics or hospitals!  The clinic is located directly front of the snake farm in Silom area!

Yes OP..... get the rabies jabs here if you really feel you need them.

 

I went to my local government hospital and had them after a dog bite... only about 150 Baht a time... no way I would spend the amount of money you doctors are charging... no wonder they are 'recommending' you get them lol. 

 

 

[JimmyJ]

On 6/9/2018 at 9:10 AM, sanuk21 said:

A course of intradermal rabies vaccine shots is available in travel clinics for under $200. With intradermal shots you actually share the same rabies vaccine vial with others with appointments pre-arranged for that day.

 

Where? What country?

[Sheryl]

He means Thailand.

[moojar]

FWIW, I was attacked by a dog on my recent visit to Thailand.  I'll list some costs here for the benefit of people reading the thread. 

 

Roughly B7500 for medicines for my five wounds is the short answer, plus daily wound care / dressing totalling around B1500.  Close to $300 USD all up?     

 

The bites were to the hand and leg and there was plenty of blood (that's relevant).  The local district hospital cleaned the wounds and administered the first two rabies vaccine injections, as well as dispensing a course of antibiotics and some panadeine.  Total cost was B940, and I think most of that (B710) was for the antibiotics.  On subsequent days I went back either just for wound care (B140), or care + more vaccine shots (B180 total).  Maybe you don't pay for wound care when you get the shots, coz only B40 extra for the shots seems a hella bargain.    

 

The course of vaccine is administered over 29 days - on day zero (D0), D3, D7, and D28.  They said if the dog doesn't die within 10 days I don't need to worry about the D28 shots.  And having had at least three of the four, I'm now good for five years. 

 

Speaking to the travel insurance nurse later, there is also a rabies serum that should be injected into any bite wound that bled - he called the serum 'HRIG', of which there is a worldwide shortage.  And it is expensive - he said around $700 USD per vial.  So I trotted off to the larger provincial hospital where they told me they only administer the serum for bites to the head / face (close to the brain), but you're paying for it so we'll give you some.  They had no HRIG, but told me locally produced ERIG is just as good and much cheaper.  So I had that - B6557 total of which B6407 was for the five vials of serum (and maybe included the allergy tests).  

 

The serum is injected directly into the wound, one vial per wound - not a lot of fun!   

[taxout]

HRIG is in short supply, but the Red Cross in Bangkok normally has it. They don't limit it to head/face bites, but usually do give ERIG instead, unless a skin test first shows you're sensitive to ERIG. At least this was my experience a few years ago. Cost of HRIG there then was on the order of US$100 or so.

 

The point of HRIG/ERIG is to provide immediate protection until the protection provided by the vaccine builds up in your system.

 

 

Edited October 25, 2018 by taxout

[Sheryl]

Not needing the immune globulin is one of the main advantages of getting  pre-exposure rabies vaccination.