The Health Protection Agency is working with colleagues in South Africa and Northern Ireland to trace volunteers who have worked at the Riverside Wildlife Rehabilitation and Environmental Education Centre in Limpopo, South Africa. This follows the recent death from rabies of a young woman in Northern Ireland who had worked at the centre in December 2006.

The woman is thought to have acquired rabies following a bite from a dog whilst working at the animal sanctuary. The Centre has written to all those who have volunteered there since July 2006 as a precautionary measure.

It is understood that approximately 230 UK citizens have worked at the centre since July 2006. However, the number who have had direct contact with a dog or mongoose may be very small. Aside from dog bites, rabies can occasionally be transmitted by scratches or licks on the face or cuts. However simply touching or stroking a dog does not constitute a risk.

Volunteers are being advised that if they have been bitten, scratched or licked on the face or on an open wound by a dog or mongoose either within the Centre or in the surrounding area, they should seek medical advice from a health professional to determine whether they require preventive treatment with rabies vaccine. For UK citizens this should be from their GP or NHS Direct. Rabies vaccine is extremely effective at preventing rabies even when this is given some time after an exposure.

Dr David Brown, a rabies expert at the Health Protection Agency, said: "This is a tragic event and is a very real example of the need to get health advice before you travel to countries where rabies is common or if you know you will be working with animals. Talk to your doctor or nurse about whether or not a rabies vaccine is appropriate. And remember not to touch animals when you are abroad as you cannot know that there is no risk."

"It is important that people intending to travel to endemic areas are reminded to consider pre-exposure vaccination, especially if they are going to be working with animals.

"All travellers should avoid contact with dogs and wild animals wherever possible, and must take action if an exposure occurs. If they are bitten, scratched, or licked by a warm blooded animal in a rabies-endemic country, they should wash the wound or site of exposure (e.g. mucous membrane) with plenty of soap and water, and seek medical advice without delay, even if they are previously vaccinated.

"If they do not seek medical treatment while abroad, they should still seek it when they come home, even if this is some time after the exposure event."

Although rabies vaccine is not routinely advised for all travellers, pre-exposure immunisation is recommended for those:

- working abroad (eg veterinary staff or zoologists) who by the nature of their work are at risk of contact with rabid animals.
- living in or travelling for more than one month to rabies-enzootic areas unless there is reliable access to prompt, safe medical care.
- travelling for less than one month to enzootic areas but who may be exposed to rabies because of their travel activities.
- who would have limited access to post-exposure medical care.

In addition, this advice should be specifically brought to the attention of those planning to do voluntary work with animals in rabies-endemic areas.

Notes

1. The recent rabies case in Northern Ireland was confirmed on December 15th 2008 and sadly the patient died on the 6th January 2009.

2. Volunteers may have received cuts and scratches while handling monkeys at the Centre however there have never been any reports of rabies among monkeys at the Centre or in the area. Therefore, provided such cuts and scratches were not licked by a dog or mongoose, this should not pose a risk for rabies.

3. GPs, A&Es and other health care professionals are being asked to be vigilant in assessing people who report dog bites which occurred at the same sanctuary in South Africa since July 2006.

4. Rabies is an acute viral infection that is extremely rare in the UK; the last case of classical rabies acquired in this country was a century ago, in 1902. Very occasionally cases occurring since then have all been acquired abroad, usually through dog bites. Since 1946, twenty-three cases have previously been reported in the United Kingdom, all imported. This is the 24th case. Since 2000, there have been 3 other cases; two unconnected cases occurred in 2001, imported from the Philippines and Nigeria, and one in 2005 followed a dog-bite in Goa. Transmission is usually through saliva via the bite of an infected animal; there are no documented cases of human-to-human transmission. A person who is bitten by a rabid animal but given treatment with rabies vaccines can expect not to develop rabies. Rabies vaccine is very safe and highly effective at preventing rabies, but should be given promptly once the risk has been identified.

5. Travellers should seek advice before travel about whether they need rabies vaccine; while this is generally not recommended for travel in Western Europe, for example, it may be recommended for visits of more than a month to some countries, especially developing countries where rabies is common in animals.

6. When travelling, stay away from stray or unattended animals.

7. If bitten in a country where rabies is present clean the wound thoroughly with soap and plenty of water and seek medical advice immediately. If a person has not had treatment in that country they should still seek medical advice immediately on return, even if the bite was weeks before.

8. Further information on rabies is available at the Agency's website.

9. Healthcare professionals and members of the public can find more information about travel health (including country specific advice) by logging onto the National Travel Health Network and Centre (NaTHNaC) website nathnac or the Fit for Travel website at fitfortravel.nhs/

Health Protection Agency

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