Rabies is a viral infection that attacks the brain and nervous system, spread through the saliva of an infected mammal via a bite, scratch or a lick over broken skin. Dogs cause the vast majority of human cases, though bats, monkeys, cats and other mammals can transmit it. It is almost always fatal once symptoms appear — but it is preventable if treated promptly after exposure. Singapore has been rabies-free since 1953, so for Singaporeans this is essentially a travel risk in rabies-endemic countries.
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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.
Any bite, scratch or lick on broken skin from a mammal in a rabies-risk area is a medical emergency — even if the wound looks minor. Wash it with soap and running water for at least 15 minutes and seek urgent medical care the same day. Do not wait for symptoms.
How it is caught
The virus is in the saliva of an infected animal and enters the body through a bite, a scratch, or a lick over broken skin or the eyes, nose or mouth. Dogs are responsible for most human cases worldwide, but monkeys, bats, cats and other wild or stray mammals can also transmit it. An animal that looks healthy can still be infectious, so a “friendly” or apparently well animal should not be assumed to be safe.
Who is at risk
The risk is to travellers in rabies-endemic regions, which include much of Asia (including nearby destinations such as Thailand, Indonesia, the Philippines and India), Africa, and parts of Central and South America. Higher-risk travellers include those on long stays, those doing outdoor or rural activities such as trekking or cycling, people working with animals, those far from good medical care, and children, who are more likely to approach animals, more likely to be bitten on the head or neck, and less likely to report a bite.
Symptoms
The incubation period is typically weeks to months after exposure, so symptoms often appear long after the bite. Early symptoms are non-specific and flu-like — fever, headache and malaise — often with tingling, pain or itching at the wound site. It then progresses to neurological disease, either an agitated form with hyperactivity, hallucinations and hydrophobia (fear and spasms with water), or a paralytic form with gradual weakness. Once these symptoms appear, rabies is virtually always fatal, which is why immediate post-exposure treatment, not waiting for symptoms, is everything.
Red flags — what to do after any exposure
Treat any bite, scratch or lick on broken skin from a mammal in a risk area as a medical emergency, even a minor-looking one with no visible blood. Immediately, without waiting for symptoms: wash the wound thoroughly with soap or detergent and running water for at least 15 minutes, which physically removes and inactivates virus and is a proven life-saving first step; apply an alcohol- or iodine-based disinfectant if available; and seek urgent medical care the same day to start post-exposure treatment, locally while abroad rather than waiting to return to Singapore.
Prevention and treatment
Before travel, a travel clinic or GP can assess your destination, trip length and activities to decide whether pre-exposure vaccination is advised, ideally well before departure since the course takes several weeks. Pre-exposure vaccination does not remove the need to seek care after a bite, but it simplifies later treatment. After a possible exposure, post-exposure prophylaxis (PEP) is a medical emergency and combines immediate wound washing, a course of rabies vaccine, and, for higher-category exposures in unvaccinated people, rabies immunoglobulin given into and around the wound. Start it locally — do not wait to fly home — and continue or complete it in Singapore, where rabies vaccine and immunoglobulin are stocked. There is no cure once symptoms begin, so all effective action is preventive.
Around animals abroad
The best protection is avoiding bites and scratches in the first place. In rabies-risk areas, do not approach, feed, pet or handle stray dogs, cats, monkeys or other wild or unfamiliar animals, however friendly they seem — this includes the monkeys common around some temples and tourist sites, which frequently scratch and bite. Supervise children closely, since they are drawn to animals and may not tell an adult if they are scratched or licked, and teach them to keep their distance. Do not try to break up animal fights or rescue injured animals yourself. It is also worth knowing before you go where post-exposure treatment is available at your destination, and keeping travel insurance and emergency contacts to hand, because if an exposure does happen you will want to start wound washing and treatment without delay. Bats deserve particular caution: any contact with a bat, even without an obvious bite, should be treated as a potential exposure and assessed.
When to see a doctor
See a travel clinic or GP before travel to a rabies-endemic area, especially for long, rural or animal-related trips or travel with children. After any possible exposure abroad, wash the wound for 15 minutes and seek care the same day wherever you are; back in Singapore, call 995 for an emergency or attend an emergency department urgently to continue or start post-exposure treatment.
Related travel-health topics
- Pre-travel health advice
- Travel vaccinations
- Travellers’ diarrhoea
- Food & water safety abroad
- Altitude sickness
- Motion sickness
- Travel-related DVT
- Japanese encephalitis
- Insect bite prevention
- Travelling with medication
- Malaria prevention
- Travel clinics in Singapore
Sources
- WHO — Rabies fact sheet: who.int
- HealthHub (Singapore) — Travel Vaccinations: healthhub.sg
- CDC — Rabies Prevention and Control: cdc.gov
- CDC Yellow Book — Rabies: cdc.gov
