Rabies Prevention in Nepal
In Nepal, most animal exposures to travelers occur in Kathmandu and monkey bites/scratches account for 43% of all exposures in tourists in a study done at CIWEC Clinic. Monkey bites are sustained most commonly at the monkey temple (Swyambu) and in the Pashupati temple area. Contrary to popular belief, trekking in Nepal does not pose any added risk to the traveler.
There is no way to kill the rabies virus with antibiotics. Treatment is based on immunizing a person who has been bitten, with a combination of borrowed antibodies from other humans (Human Rabies Immune Globulin or HRIG), and vaccines that stimulate the production of large amounts of antibodies that can kill the wild virus before it reaches the brain. It takes 7-10 days for antibody production after starting the vaccine series and HRIG is protective during this time. One can also prevent rabies by being immunized with three injections of rabies vaccine before bite or exposure occurs. These “pre-immunized” persons, if they are bitten, need only two shots of the vaccine, 3 days apart, as a booster. Persons who have not been pre-immunized require injections of HRIG into the wound and 5 injections of the vaccine over one month. Both strategies are effective at preventing rabies after an exposure. If it is more than 8 days since the vaccine was started (not since the bite occurred), then HRIG should no longer be given, as it may interfere with antibody production from the vaccine.
Summary approach to Rabies prevention:
|Person has completed a pre-exposure rabies series||Exposed to a possibly rabid animal||Two shots as a booster, 3 days apart|
|Person has not had pre-exposure rabies injections||Exposed to a possibly rabid animal||Human Rabies Immune Globulin (HRIG) injected around the wound; 5 injections of rabies vaccine on days
0, 3, 7, 14, and 28
To avoid animal bites: Do not pet or pick up puppies, do not take in stray dogs, do not carry food while visiting temples, do not get too close to baby monkeys, and do not enter houses or temples that are guarded by dogs without making sure that the animal cannot get to you.
(Revised: April 2010)