Why Are So Many Travellers Apprehensive Against Getting Their Rabies Vaccines?
I look into why travellers don't take rabies vaccinations seriously. Do Travellers actually understand the risks and that death is most likely once symptoms appear? Let's dive into it!
Why Do Travellers Underestimate Rabies Risk?
Rabies is one of the most serious infections in travel health medicine, yet surprisingly one of the most neglected. For UK travellers heading abroad, the risk is often dismissed as unnecessary or something that “only happens to other people.” But rabies is almost always fatal once symptoms appear and recent real-life cases show that complacency can cost lives. With global travel increasing and exposure risks rising, it is more important than ever to make rabies vaccination a priority in travel consultations.
Understanding Rabies: A Fatal but Preventable Disease
Rabies is a viral infection that attacks the brain and nerves. It is transmitted through the saliva of infected warm-blooded animals, most commonly dogs but also cats, monkeys and bats. Transmission occurs through bites, scratches or even licks to broken skin.
The Type Of Symptoms, Which Can Develop Are:
Fever
Headache
Confusion
Difficulty swallowing
Hydrophobia (Severe fear of water)
Paralysis
At this point, the disease is virtually untreatable. Death can follow within days to weeks or even years. The World Health Organisation (WHO) estimates that rabies causes around 59,000 deaths annually worldwide, with the majority occurring mainly in Asia and Africa.
In the UK, rabies is absent in domestic animals, though a small number of bats can carry a related virus. This absence has fostered a dangerous misconception that rabies is not something to worry about. Yet for travellers, especially those visiting endemic countries, the risk is real and immediate.
Why Travellers Don’t See the Risk
Despite the severity of rabies symptoms, many travellers fail to take vaccination seriously. A few factors can explain this:
Low Visibility in the UK: Because rabies is not a daily reality here, travellers underestimate its importance abroad.
Cost and Inconvenience: Pre-exposure vaccination is not part of the NHS routine schedule and must be arranged privately, which can put people off when they realise they have to pay.
Misunderstanding of Risk: Travellers assume urban or tourist areas are safe, ignoring the presence of stray dogs, cats and monkeys in temples, markets, and resorts.
Optimism Bias: Many travellers believe “it won’t happen to me,” even though minor scratches or playful animal contact can transmit the virus.
"This complacency is dangerous. Rabies is not a disease where one can afford to gamble".
A Tragic Reminder: The Barnsley Case
In June 2025, Yvonne Ford, a grandmother from Barnsley, South Yorkshire, died after contracting rabies during a holiday in Morocco. She had been scratched by a stray puppy. The wound seemed minor, but weeks later she developed symptoms and tragically passed away.
Her family has since spoken publicly, urging travellers to take rabies seriously and to seek vaccination before travel. The case was widely reported in UK media and serves as an important reminder that a single scratch can cost lives.
This tragedy is a reminder as to why rabies vaccination should not be seen as optional. It is a matter of life and death.
According to the UKHSA, around 2,000 people in the UK need rabies post‑exposure treatment (PET) each year. Amongst these cases, about 12% involve possible contact with bats within the UK, while the remaining 88% are linked to animal exposures that occurred abroad.
Vaccination:
UK guidance, including the NHS, Nathnac (Travel Health Pro) and the Green Book recommends rabies vaccination for those at risk. Two methods are available:
Intramuscular (IM) Injection: Usually given into the deltoid muscle. The Joint Committee on Vaccination and Immunisation (JCVI) recommends that the preferred administration route is intramuscular injection of rabies for both pre-exposure prophylaxis and can only be used for post-exposure treatment.
Intradermal (ID) Injection: It is important to note that even though rabies vaccines are licenced for ID (2 doses) and has been endorsed by the WHO (World Health Organisation), the Green Book hasn’t yet been updated to reflect this. The Green Book still states that The Joint Committee on Vaccination and Immunisation recommends the intramuscular route should be used rather than the intradermal route for rabies pre-exposure prophylaxis. This can be a cost-effective method, where smaller doses are injected just under the dermis of the skin, however it requires trained staff and strict protocols for it to be administered.
Subcutaneous (SC) Injection: If a client (or patient) has a bleeding disorder, that deep subcutaneous route can be used to administer the rabies vaccine.
Pre-exposure vaccination typically involves three doses over 21–28 days. Post-exposure treatment depends on:
The traveller’s current vaccination status
In which country the traveller is based
Unvaccinated travellers: In the UK, the traveller would have 4 post exposure plus RIG, however some countries may still require 5 doses
Vaccinated travellers need only two booster doses and no immunoglobulin.
The difference between both vaccinated and unvaccinated travellers is crucial. Rabies immunoglobulin stock can be often scarce or unavailable in resource-limited countries. Travellers obtaining their rabies vaccines before they travel provides an important safety net.
It is important that GP (General Practitioners) practices remain vigilant to patients presenting after animal attacks sustained abroad, particularly in regions where rabies is endemic. Under UK Health Security Agency guidance, rabies is almost always fatal once symptoms appear, but timely post‑exposure vaccination and, where indicated, rabies immunoglobulin can prevent disease.
It is therefore essential that GPs promptly identify such cases, initiate the correct vaccination pathways and know which specialist services to contact for urgent advice and referrals. Please find below links that can help guide you in this process:
Referral pathways: GPs should contact local infectious disease specialists or the UK Health Security Agency Rabies and Immunoglobulin Service for urgent advice. You can find this at:
Green Book guidance: Chapter 27 of the UK "Green Book" provides detailed national policy on rabies vaccination. You can find this at:
Advice for Travel Health Nurses: Talking to Clients About Their Rabies Risk
As we have already mentioned, many travellers may be reluctant to consider the rabies vaccine, often because of the cost. That’s why it’s important to focus on giving them clear, practical advice about what to do if they are bitten, scratched or licked on broken skin by any warm‑blooded animal.
Here are some tips you can use when discussing rabies risk in your consultations:
Keep the advice simple and step‑by‑step so it’s easy to remember.
Emphasise that quick action after an exposure can save lives.
Encourage clients to think ahead about how they would access treatment abroad.
Remember, every healthcare professional has their own style. The way you approach the subject of rabies vaccination may be different from how other healthcare professionals do it and that’s okay. What matters most is that you feel confident and comfortable in your consultation and that your client leaves with the knowledge they need to protect themselves.
1. Ask Your Traveller the Important Question
Ask your traveller ‘Do they know what to do if they get bit, scratched or licked on an open wound?’. Most travellers won’t know how to carry out this action but it gets them thinking and it is your chance to explain to them the techniques, which then allows you to lead onto the importance of why obtaining the rabies vaccine is crucial.
An example of how I would say it would be:
“If you are bitten, scratched, or even licked on broken skin by any warm-blooded animal (dogs, cats, monkeys etc), you need to:
Flush the wound under running water for several minutes.
Wash thoroughly with soap or detergent to remove saliva.
Apply a disinfectant such as 70% alcohol or povidone‑iodine.
Cover the wound with a simple, loose dressing.
If saliva enters the eyes, nose or mouth, rinse thoroughly with clean water.
2. Reinforce the Need for Urgent Medical Help
An example of how I would say it would be:
“Even if the bite or scratch seems minor, you must seek medical attention straight away. Do not wait until you return to the UK. Rabies post‑exposure treatment (PET) should begin abroad if advised as there is a high death rate if rabies gets into your brain.”
Tip: You can let your client know about the International Society of Travel Medicine (ISTM) website. This site allows travellers to search for travel clinics in the country they are visiting. Clinics that display the ISTM Certificate in Travel Health (CTH) logo are recognised as qualified to provide advice and care, including support for potential rabies exposures.
Global Travel Clinic Directory - International Society of Travel Medicine
Another website your client can use to get advice and warnings about travel abroad will be the FCDO (Foreign, Commonwealth and Development Office)
https://www.gov.uk/foreign-travel-advice
3. Explain Treatment Considerations
It is helpful for your client to understand the difference between pre‑exposure vaccination and post‑exposure treatment. If someone is not vaccinated and is bitten or scratched by a warm‑blooded animal, they may need rabies immunoglobulin as part of their treatment.
This medicine can be difficult to access in some countries and, when available, it can be very expensive, sometimes costing hundreds of pounds. By comparison, although the rabies vaccine itself involves an upfront cost, it often works out to be more practical and affordable than paying for emergency treatment abroad.
Important Tips to Explain to Your Client:
Post exposure treatment (PET) is required even if your client has already had a full pre‑exposure vaccine course. Extra doses are needed as a precaution for full protection. Your client does not want rabies entering the brain otherwise there are no treatment options and death is unavoidable.
Suturing should be delayed until PET has started.
A tetanus booster may be needed if they are not up to date.
Antibiotics may be prescribed to prevent wound infection.
4. Encourage Record‑keeping
It is handy to inform your client to keep written notes or photos of any rabies treatment they receive abroad, including the vaccine type and whether immunoglobulin was given. This helps UK clinicians continue their care if the client still requires further treatment.
Furthermore, make sure that when you administer the course of rabies vaccines, that you give your client a vaccination book with the rabies name, chosen rabies schedule, route of injection, type of injection (IM or ID), the date of vaccine administered and sign your signature.
5. Clarify Vaccine Compatibility Issues
Some countries use rabies vaccines that are not fully compatible with UK vaccines. Additional doses may be required on return.
Advise your client to carry their vaccination record if they receive pre‑exposure rabies vaccine before travel. I advise my clients to take a photograph and save it to their email so they have proof, in case they lose it while travelling on the road.
6. Prepare Them for Possible Challenges
Rabies immunoglobulin may be unavailable in many regions. In fact, a global study found that 204 out of 240 countries had limited or no access.
Clients may need to travel to a larger city or even another country to access appropriate treatment.
7. Summarise the Key Message
Again, reiterate what you have said:
‘If you have any contact with a warm blood animal abroad that breaks the skin or exposes you to saliva, treat it as a medical emergency. Start first aid immediately, seek local medical care without delay and keep records of any treatment you may have obtained. Rabies vaccination before travel gives you a vital safety net, but post‑exposure treatment is still essential.’
Why Travel Nurses Must Lead the Way
Travel health professionals are at the frontline of prevention. Your consultations are your opportunity to challenge misconceptions and empower your clients with accurate information.
Key Responsibilities Include:
Risk assessment: Identifying destinations where rabies is endemic, such as Morocco, S.E Asia, India, and much of Africa.
Education: Explaining that even minor scratches or licks can transmit rabies and that children are especially vulnerable (if children are involved in your client’s travel itinerary).
Vaccination advice: Discussing IM (Intramuscular) vs ID (Intradermal) injection options is important as the client should be given a choice of how they want the vaccination to be administered.
The Cost: I cannot stress enough the importance of discussing the cost of the rabies vaccines with your client. It is paramount to be clear and transparent. Always explain the price per dose, and where possible, provide this in writing and encourage your client to make a note or take a photo for their records. This helps ensure they fully understand the overall cost of completing the vaccine course. Clear communication at the outset reduces the risk of any misunderstandings later and supports a positive, trusting relationship throughout their care.
Benefits of The Rabies Vaccine: Make sure to discuss the benefits of the rabies vaccine and to tailor recommendations to your client’s itinerary and activities.
Bite Avoidance Strategies: Advise your client not to touch or feed animals, to supervise children closely and to avoid attracting strays with food or litter.
Real-world examples: Sharing cases like Yvonne Ford’s case makes the risk real and drives home the consequences of neglecting the rabies vaccination before travel.
By integrating rabies risk into your consultations, travel health professionals ensure that travellers make informed, lifesaving decisions.
Why Rabies Must Be a Traveller’s Priority!
The Barnsley case is not an isolated tragedy. Similar incidents have occurred worldwide, often involving tourists who underestimated the risk. The lesson is clear that rabies is preventable but only if vaccination and awareness are prioritised.
With global travel increasing, exposure risks are rising. Adventure tourism, volunteering and visits to rural or remote areas all heighten the chance of animal contact. Children, in particular, are at greatest risk, as they are more likely to approach animals and less likely to report bites or scratches.
Rabies vaccination should therefore be seen not as an optional extra, but as a core component of travel health. It is as essential as malaria prophylaxis or yellow fever vaccination for those visiting endemic regions.
Conclusion: From Complacency to Action
Rabies is almost always fatal once symptoms appear. Yet it is entirely preventable through vaccination and bite avoidance. The tragic death of Yvonne Ford is a reminder that complacency kills.
UK guidance is clear that travellers to rabies-endemic countries should consider vaccination, whether via intramuscular or intradermal injection routes. Travel nurses must integrate rabies risk into consultations, challenge misconceptions and advocate for prevention.
Below you will find informative resources regarding rabies, that you can give to your client to take away with them for further reading:
Or
https://travelhealthpro.org.uk/pdfs/generate/diseases.php?dis=148
References
UKHSA: Rabies Information for Travellers. Available at Rabies information for travellers - GOV.UK Accessed 12 November 2024
Nathnac (Travel Health Pro) Rabies. Available at http://travelhealthpro.org.uk/disease/148/rabies Accessed 14 November 2025
Nathnac (Travel Health Pro): Rabies Factsheet. Available at https://travelhealthpro.org.uk/pdfs/generate/diseases.php?dis=148 Accessed 14 November 2025
Nathnac (Travel Health Pro) Rabies. Available at https://travelhealthpro.org.uk/factsheet/20/rabies Accessed 20 June 2025
Nathnac (Travel Health Pro) Worldwide Rabies Risk Reminder: Available at https://travelhealthpro.org.uk/news/476/worldwide-rabies-risk-reminder Accessed19 June 2025
Sky News: British Woman Dies from Rabies - As Family Speak Out to Prevent This Happening to Others. Available at British woman dies from rabies - as family speak out to 'prevent this happening to others' | UK News | Sky News Accessed 19 June 2025
NHS: Vaccination Rabies. Available at https://www.nhs.uk/conditions/rabies/vaccination/ Accessed 8 February 2023
NICE (National Institute for Health and Care Excellence) Scenario: Rabies. Available at https://cks.nice.org.uk/topics/immunizations-travel/management/rabies/ Accessed July 2025
UKHSA: Rabies Information for Travellers. Available at https://assets.publishing.service.gov.uk/media/672e162bcc61d0a714ffdac0/UKHSA_13124_Rabies___information_for_travellers_leaflet_2024_01_WEB.pdf Accessed October 2024
UKHSA: Rabies Case Confirmed Following Contact With Animal Abroad. Available at: Rabies case confirmed following contact with animal abroad - GOV.UK Accessed 18 June 2025
The Green Book: Chapter 27 Rabies. Available at Rabies green book chapter 27 Accessed 27 May 2023
WHO (World Health Organisation) Rabies. Available at https://www.who.int/news-room/fact-sheets/detail/rabies Accessed 5 June 2024
UKHSA (UK Health Security Agency): Interim Recommendations for Human Rabies Immunoglobulin (HRIG) Use Interim recommendations for human rabies immunoglobulin (HRIG) use - GOV.UK Accessed 30 June 2025
Oxford Academic. Journal of Travel Health Medicine: A country classification system to inform rabies prevention guidelines and regulations. Available at country classification system to inform rabies prevention guidelines and regulations | Journal of Travel Medicine | Oxford Academic Accessed 13 June 2025
UKHSA: Guidance Rabies and Immunoglobulin Service (RIgS). Available at https://www.gov.uk/government/publications/immunoglobulin-when-to-use/rabies-and-immunoglobulin-service-rigs Accessed 17 September 2025