Am I going to get rabies?

August 15, 2007 7:55 AM

I'm going on vacation in two weeks...the vacation was planned sort of on a whim about a month ago, and one thing I hadn't considered was vaccines. Now, being a worrywart and knowing I have hypochondriac potential, I am freaking out wondering if one of the planned activities is too risky. Please help me decide whether I should cancel this activity, or whether I am being insane.

We are going on a Western Caribbean cruise and one of the stops is Belize, where we have planned to go on this jungle walk + cave tubing excursion. Last week, I read something that reminded me to check about any required or recommended vaccines.

After reading the CDC's Travel page for Belize, it seems to recommend both anti-malaria stuff as well as a rabies vaccine if there is a risk of exposure.

I know from reading about the excursion that there will be a place that we go through that has bats. And I know bats are major rabies carrier. So is potentially being near sleeping bats in a cave during the daytime and a walk through the jungle a significant risk?

I know I don't have time for any sort of vaccinations, but I'm panicking so much that I'm considering cancelling this activity and hiding out on the cruise ship with a daquiri under some mosquito netting.

I'm a lot more concerned about rabies, because I fully plan on dousing myself with mosquito repellant.

Please let me know if you think my worries are unfounded, or if you think it is better to be safe than sorry and not go into the jungle or caves.

posted by catfood to health (16 comments total)

This is, of course, a personal decision -- but in my view your worries are unfounded. The risks are minimal, and probably outweighed by traffic-related risks you face daily.
posted by aramaic at 8:06 AM on August 15, 2007

IANAD. However, having just visited a doctor to get vaccinations for a trip to a much less developed country (Madagascar), in which I would have had more exposure to rabies-carrying animals, I will say that your worries are reasonable but overblown.

(1) Your exposure will be minimal. The CDC usually recommends the rabies vaccine for people with significant exposure - e.g., handling animals or spending a long time in remote locations. A single-day caving excursion is not significant exposure.

(2) There are possible adverse effects of the vaccination. My doctor recommended against vaccination because the risk of adverse effects outweighed the risk of exposure.

(3) Most important: remember that post-exposure prophylaxis is highly successful. So even if you are exposed, you can get treatment. I would venture to guess that it may even be available on your cruise ship.
posted by googly at 8:14 AM on August 15, 2007

Here's some relevanant information for assessing risk, from http://www.phac-aspc.gc.ca/tmp-pmv/info/rage_e.html


Although rabies is rare in international travellers overall, a significant proportion of deaths caused by rabies is reported among people in the developed world who acquired the disease while travelling. Over a period of 17 years, 33% of rabies cases reported in the United States acquired their infection in other countries. The UK reported 12 cases of rabies over 20 years, 10 of which came from the Indian Sub-Continent. In France, 18 of the 19 cases of rabies reported over a 20-year period were acquired abroad, the vast majority in Africa. There has been one Canadian case of rabies acquired abroad in the seven decades since statistics have been kept.


And from the Wikipedia article on rabies:

Treatment after exposure, known as post-exposure prophylaxis or "P.E.P.", is highly successful in preventing the disease if administered promptly, within fourteen days after infection. The first step is immediately washing the wound with soap and water, which is very effective at reducing the number of viral particles.

In other words - a couple of people a year gets rabies while traveling. (Mostly from dogs, I think, not bats.) And it's treatable. So you are facing a one-in-several million chance of contracting a treatable disease. I think you'll be okay. :)

(For people who in developing coutries without good access to health care, rabies a whole 'nother problem, of course. But we're talking about you here...)
posted by ManInSuit at 8:23 AM on August 15, 2007

I've been cave tubing in Belize and I think you may be worrying yourself needlessly. You're not about to be bitten by a bat.

Within the cave itself, you'll likely see only the occasional airborne bat. Most will be sleeping clustered in recesses in the ceiling and will only flutter a bit when the light hits them...remember, you'll be going through during the daytime so they won't be very active.
posted by JaredSeth at 8:29 AM on August 15, 2007

JaredSeth - so did you not have the rabies vaccine? What about anti-malarial drugs?
posted by catfood at 8:35 AM on August 15, 2007

IANAD.

I've also done cave tubing in Belize and have traveled to 70 countries doing all kinds of hiking / camping / wildlife excursions. Like JaredSeth said - your exposure is extremely limited and the chance of you spending half a day in a cave moving about with a group and then getting bit by a rabid bat is one in a gazillion.

I had a friend who worked for a conservation group and lived with bats in a cave for eight months and she never got bit.

Don't worry about it - go have fun. Bring bug spray, wear lightweight long-sleeved shirts. As for malaria, again, your chances are pretty minimal. The pills are once a week if you decide on a prescription. Me, personally, I wouldn't bother. Again, your EXPOSURE factor is very limited.
posted by HeyAllie at 8:53 AM on August 15, 2007

I've never been to Belize, but I do have a suggestion concerning anti-malaria medicine, should you take it:

Avoid Mefloquine.

It's a once-a-week drug, very convenient, and for most, pretty harmless, except for some wacky dreams. I was not part of the majority, however.

After taking it on Mondays for a month or so, I noticed that every Wednesday, I'd feel sad. By Thursday night I would be in a paranoid, crushing depression that made "The Downward Spiral" sound like a Celine Dion album. By Saturday, I'd be fine again only to repeat the process every week.

I finally talked to a medic, who informed me that it was a side effect of the Mefloquine.

I switched to Doxycycline, a daily pill, and felt a whole lot better.

The moral: regardless of the medicine, always ask about side effects, and closely monitor your mood.
posted by rentalkarma at 9:03 AM on August 15, 2007 [1 favorite]

I agree with aramaic and others, but if it helps ease your mind any, malarial mozzies only come out between dusk and dawn.
posted by wayward vagabond at 9:05 AM on August 15, 2007

catfood, I didn't bother, but then again I've engaged in far riskier travel than that. Friends tell me I have an underdeveloped sense of self preservation.
posted by JaredSeth at 9:28 AM on August 15, 2007

Most of the people in my department (Entomology) and I do not bother with the anti-malarial meds, and we spend time in the jungles of Costa Rica, Honduras, Columbia, etc. It's a waste of time. Just make sure you have an insect repellent that's at least 30% DEET. I don't recommend the 100% DEET (I think it's in OFF! Sportsman or whatever). I had a reaction to it and my face started going numb. (I just washed it off, BTW). When I went to Costa Rica last month and was more concerned with Dengue fever, even though malaria exists there.

So try not to worry and just make sure you put on insect repellent. And have fun!
posted by bolognius maximus at 9:38 AM on August 15, 2007

From Wikipedia on Larium (mefloquine):

Mefloquine may have severe and permanent adverse side-effects. It is known to cause severe depression, anxiety, paranoia, nightmares, insomnia, seizures, peripheral motor-sensory neuropathy,[2] vestibular (balance) damage and central nervous system problems. For a complete list of adverse physical and psychological effects — including suicidal ideation — see the most recent product information. Central nervous system events occur in up to 25% of people taking Lariam, such as dizziness, headache, insomnia, and vivid dreams.[5] In 2002 the word "suicide" was added to the official product label, though proof of causation has not been established. Since 2003, the Food and Drug Administration (FDA) in the USA has required that patients be screened before mefloquine is prescribed.

Of course, thousands of people take Larium with no side effects at all. And malaria is to be avoided perhaps more than rabies. But if you have any history of depression, etc., or generally don't want to risk ruining your vacation, take Malarone (expensive) or Doxycycline (cheap, less effective).
posted by bluenausea at 9:39 AM on August 15, 2007

Larium is some nasty stuff, dont take it. Made me feel like I was on watching the world through a too-tightly-wound plastic bag over my head. I was about ready to take header off the hotel balcony when I was in Thailand on that stuff. I bailed on that drug right away after that. I'll take malaria any day over that experience.
posted by elendil71 at 9:50 AM on August 15, 2007

I've traveled in multiple countries in Africa, SE Asia, East Asia, and Central America (Belize, Costa Rica). After the first trip (to the Senegalese bush) I've not taken anti-malarials nor have I had the rabies shot. Take extra tylenol (this is what the peace corps workers do) and if you get malaria drink lots of fluids and use the tylenol to control the fevers (its the temperature swings that kill you). I have gotten the following shots: Tetanus, Hep A&B, and Meningitis. Belize is quite (relatively speaking) developed and if you are only going for a week or two, I would worry more about parasites, take cipro for bacterial dysentry (and immodium), don't wade through standing bodies of water, don't sit on the bare ground (put a bamboo mat down or something - you'd be surprised what little critters can lay eggs under your skin if you give them the opportunity), be meticulous with any wound (clean it and keep it covered), take some heavy duty antibiotics in case of trauma where you can't get to the doctor, and syringes (of different types). Take all the usual food and water precautions. The other thing you can get (to make yourself feel better is evacuation insurance - I think its about $50-100 for a trip like yours and if you have an accident it pays for the private jet to airlift you to a hospital in a western country.

All that aside, with a few precautions, nothing bad will happen and you'll have a wonderful time. Enjoy!
posted by zia at 10:04 AM on August 15, 2007

Oh and every time I've asked about the rabies shot, my doctors have told me not to be ridiculous (plus it doesn't give you that good coverage anyway). If something (other than a human being) bites you just get treated when you get back.
posted by zia at 10:06 AM on August 15, 2007

I went cave tubing in Belize in the beginning of July and was never even made aware (by the cruise or the third-party tubing company) that vaccines were recommended/necessary.

(FWIW, I don't think we even saw any bats in the two caves we tubed through).
posted by boreddusty at 10:20 AM on August 15, 2007

I just got back from Africa last night...there were bats everywhere at night - one even got stuck in a friend's hair (seriously), but no bites. I got lots of shots, and my doc asked me about animal exposure. He said that generally it's vets and people who are working directly with livestock or other animals that get the rabies vaccine, not tourists.

I am taking the malaria pills, though. Better safe than sorry on that one, I figure. You have to continue taking them for 2-4 weeks AFTER your return - that's important. Don't spend the money, then figure you are OK once you get back in the states and quit taking them.
posted by clh at 12:30 PM on August 15, 2007