Getting rabies post-exposure treatment in the Philippines
Any traveller to South-East Asia will undoubtedly have come across the dilemma of whether or not to get vaccinated against rabies.
As an incredibly deadly disease that’s almost impossible to treat, rabies is always going to scare and intimidate people. Most people fortunately won’t come across it during their travels.
When I was in the Philippines, unfortunately I did have an encounter where subsequently I needed post-exposure rabies treatment.
In this article, I’ll share with you some more information about rabies and my own slightly traumatising experience with it in the Philippines. I hope it’ll give you an idea of what to do if you ever need to seek out treatment, or at least reassure you that you aren’t on your own in this situation!
Just a quick note
Just to note: I am not a healthcare professional or in any way qualified to be giving health advice.
However, when I required treatment, I was desperate for any kind of help or reassurance from the Internet. I just couldn’t find any accounts of other travellers going through what I was.
If you’re in this situation, please check out the guidance your country gives with regards to rabies. If you’re in doubt, speak to a doctor, either local or back home. With how deadly rabies is, precautionary action is so important!
What is rabies?
Rabies is a viral infection which affects the central nervous system of mammals.
Rabies is most commonly transmitted from the bite of animals like dogs, bats and foxes. It’s incredibly deadly; once symptoms appear, the disease is normally fatal.
In the UK, we’re fortunate in that rabies is very rare – generally the only animals to carry the disease are bats. So travelling to other countries where rabies is more prevalent can be quite different and discombobulating. Suddenly you have to worry about how you act around animals and how animals act around you.
Rabies vaccination
On a more positive note, modern medicine has given us the option to get vaccinated against rabies.
The rabies vaccine available in the UK normally takes 3 doses given over 21 to 28 days. Most people will get some level of protection from the rabies vaccine for several years, which will cover you if you’re backpacking or travelling to a new country for a finite period of time.
However, if it sounds too good to be true, that’s because it is. The rabies vaccine costs £60 to £100 per dose, so expect the full schedule to cost £180 to £300. There are also regular shortages of the vaccine at travel clinics. When I was looking, only a couple of clinics had shots available across the entirety of England!
Also, you require further treatment regardless of whether you’ve had the vaccination or not, so it doesn’t provide full protection.
Ultimately it’s up to you whether you take the vaccine. We decided not to due to a combination of the cost, scarcity of the vaccine and requirement to have three doses (our closest clinic was already 1 hour’s drive away); plus we thought we’d be unlikely to need it. How wrong was I!
What happens if you’ve been exposed?
Rabies is most commonly transmitted via a bite or scratch from a rabid animal – the top animal being dogs abroad.
What you should do depends on the country. Rabies is incredibly rare in some regions, but is much more common in certain areas of Asia, Africa and South America. I’d recommend checking up the guidance for where you’re visiting. The NaTHNaC website is the resource I always use for checking travel health abroad; it will give you an indication of whether there’s a risk.
In a country where rabies is more prevalent, it’s key to seek treatment once you’ve had a possible transmission, whether it’s a bite or scratch, and regardless of the animal. As rabies is so deadly, even if you think it’ll be fine, it’s always better to check with a healthcare professional as soon as you can.
I should say that whilst healthcare can be poor in certain regions of the world, I didn’t find the NHS to perform much better with regards to rabies. Cases of it are just so rare that I didn’t find them to have much expertise – my GP surgery told me I was the first person they’d dealt with that needed post-exposure treatment!
Rabies post-exposure treatment
Post-exposure treatment varies significantly but normally consists of further doses of a rabies vaccine. How many you have and when depends on what’s available in the region. Personally for what I received in the Philippines, the regimen was 4 doses across 14 days.
If you’re already vaccinated, the number of doses you’ll have tends to be less compared to someone who is unvaccinated.
In more severe cases, post-exposure treatment will also include rabies immunoglobulin. I didn’t have to have this fortunately.
My rabies scare story
I mentioned at the start of this article that I had a run-in with rabies. This occurred in May 2023, in Bohol, Philippines.
Now, I adored the Philippines and especially Bohol, an island near Cebu in the centre of the country. It’s a big island with a similar size to Bali, and there’s so much to do. We went to beaches, inside caves and around waterfalls. We even went paddleboarding to see fireflies.
On our third day in Bohol, we headed to Panglao, the neighbouring island. We ate at a gorgeous restaurant for lunch.
However, I made a major mistake when at this restaurant. A cat had come to sit with us and I put some leftovers on a napkin. The wind blew the napkin so I went to grab it. The cat patted my hand away territorially: it had scratched me.
Seeking post-exposure treatment
The scratch wasn’t deep and it didn’t draw blood. Having cats at home, I’m used to this kind of scratch and would call it mild at worst.
Generally in the Philippines most rabies is transmitted via dogs as opposed to cats, and normally through bites instead of scratches. However, because the Philippines has a high incidence rate of rabies, and of course cats can still catch rabies, I decided to seek treatment. With how fatal rabies is, I didn’t want to leave it to chance.
I immediately washed the cut and put antiseptic on it. Next was a search around for more information – Google absolutely wasn’t helpful for this. We then headed to the nearest Animal Bite Clinic on Panglao.
The first one we went to didn’t exist, whereas the second one did not have any vaccines. So we headed to the private hospital in Tagbilaran, the capital of Bohol province.
At the hospital I had no issues and was impressed by the quality of care I received. The doctor administered me with the first dose of the vaccine and gave me all the information I needed to finish the course, as we were leaving the island in two days’ time.
Getting the rabies vaccine in El Nido
My next two doses of the vaccine were due in El Nido. Getting the rabies vaccine here was similarly challenging to getting it on Bohol. I attended the Rural Health Unit, which is the local centre; it felt very different from the high-quality hospital in Tagbilaran.
The nurses at the clinic sent me to find the vaccine myself from the nearby pharmacies, which was challenging as most didn’t have any. However, after my third or fourth pharmacy I found it. I brought it back to the Rural Health Unit and they administered it for me. Three days later, I repeated the process for my third dose, which went more smoothly now that I knew which pharmacy stocked it.
Treatment back in the UK
The vaccine I had been given needed four doses for post-exposure cases, at 0, 3, 7 and 14 days. As I flew back home to the UK between days 7 and 14, I needed to complete the course back home.
Easy? Most definitely not! It made getting treatment in the Philippines seem like a doddle.
My GP surgery told me I needed to go to a travel clinic for the vaccination, so I booked to receive it at literally the only travel clinic I could find in England that had the vaccine available. (As I said, there is a shortage of the vaccine at travel clinics in the UK!) The only appointment I could attend was two weeks later after I went to Glastonbury, so I resigned myself to waiting.
However, at my appointment I could not receive the vaccine. I was informed these clinics are only allowed to administer it as a travel vaccine rather than for post-exposure. My GP surgery would later tell me they misunderstood my request, saying I was the first person to come in with this.
My GP surgery informed me it would take at least a week to get the vaccine in as only had vaccine deliveries on Thursdays (and it was a Friday). As I was going on holiday the next week I wasn’t exactly impressed. They suggested going to A&E to see if they could get it any faster, but of course A&E said they couldn’t help either.
Finally getting my fourth dose
The day before my holiday to Cornwall, I got a call from the doctors. They said they’d got in contact with the Health Security Agency, who would send the vaccine to my GP for the next day. However, if I couldn’t take it then, I wouldn’t receive any treatment.
I was pretty annoyed given the circumstances and especially given disinterested they were about whether or not I received treatment. “It is what it is” was the general principle.
I ended up delaying my holiday to get the vaccine. I just wouldn’t have been able to relax knowing I hadn’t had the full course.
Interestingly, because of my IBD, I ended up receiving a fifth dosage and a blood test to ensure my antibody levels were high enough. From the point at which the Health Security Agency had issued an exact plan of what needed to happen and when to my doctors, it was smooth sailing. I just wish my surgery had contacted them in the first place!
Conclusion
From my experiences in getting post-exposure treatment in the UK, I would say it’s a mess. If you need to, point your GP surgery in the direction of the Health Security Agency’s rabies guidance as there’s a good chance they’ll never have seen this before.
My experience with getting rabies post-exposure treatment isn’t that positive, but I hope that others will have a better time. Ultimately if you’re visiting a country where rabies is common, the protocols will be more understood even if the quality of treatment is lower. And it’ll depend on your exact surgery back home as well.
The main thing is that, if you’re not sure, you should seek out medical advice and go from there.
I hope this article has been useful. Best of luck if you are in this situation, and enjoy your travels!
