Rabies is a brain infection (encephalitis) caused by a virus carried in the saliva of infected animals. Rabies is endemic in Nepal, and dogs are responsible for more than 96% of cases. Monkeys and other animals, including bats, can also transmit it.
Any contact with an animal in Nepal that results in a wound, bite, scratch or mucous-membrane exposure should be assessed by a doctor, to decide whether rabies post-exposure treatment is needed. It is never too late to be treated, however much time has passed, because the incubation period can be very long.
Where exposures happen
Most animal exposures among travelers in Nepal occur in Kathmandu. In a study at CIWEC, monkey bites and scratches accounted for 43% of all exposures in tourists — most often at the Monkey Temple (Swayambhu) and around Pashupati. Contrary to popular belief, trekking in Nepal doesn't add any risk.
After a bite
Wash the wound thoroughly with soap and water to remove saliva, then apply an antiseptic.
If you have never had rabies vaccine, you need rabies immune globulin (RIG — human HRIG or equine ERIG) injected directly into the wound, plus four injections of rabies vaccine over two weeks. Antibodies take 7–10 days to form after starting the vaccine, and RIG protects you during that time. If more than 7 days have passed since the vaccine was started (not since the bite), HRIG should no longer be given, as it can interfere with the vaccine's antibody response.
Pre-immunization (pre-exposure prophylaxis, PrEP) is two doses of rabies vaccine, 7 days apart. Pre-immunized people need only two shots after an animal exposure. A booster between 3 weeks and 3 years after the primary series gives long-term protection.
Summary
| Your history | Exposure | Treatment |
|---|---|---|
| Completed a pre-exposure vaccine series | Possibly rabid animal | Two booster shots, 3 days apart |
| No pre-exposure vaccine | Possibly rabid animal | RIG injected into all wounds, plus 4 intramuscular vaccine doses on days 0, 3, 7 and 14 (5 doses if immunocompromised). A shorter intradermal schedule is also available at CIWEC. |
CIWEC Hospital has always made HRIG and ERIG available for patients with animal bites in Nepal. Because HRIG is very expensive and hard to find in many countries, we recommend that most travelers be pre-immunized.
Several acceptable rabies vaccines are used worldwide and can be interchanged within the same treatment series if necessary. All are "tissue culture vaccines": human diploid cell vaccine (HDCV), purified Vero cell rabies vaccine (PVRV) and purified chick embryo cell vaccine (PCEC).
Avoiding animal bites
- Don't pet or pick up puppies, or take in stray dogs.
- Don't carry food when visiting temples.
- Don't get too close to baby monkeys.
- Don't enter houses or temples guarded by dogs unannounced.