Rabies vaccine before travel: what it does and what it costs

Why the shots before the trip matter after a bite

Rabies is almost always fatal once symptoms start, and it is prevented by prompt care after the exposure: washing the wound at once with soap and water, then vaccine, and for people never vaccinated, rabies immune globulin injected around the wound. That last product is the hard part abroad. It is made in limited quantities, and the Yellow Book says it is not available in many low- and middle-income countries; travelers sometimes have to fly to another city or country to receive it within the useful window. A traveler who had the two pre-exposure doses does not need immune globulin at all. Two vaccine doses, on day 0 and day 3, are enough, and the vaccine itself is far easier to find than the globulin.

Who CDC asks to discuss it

On each country page, CDC frames the decision around two questions: whether the traveler will do occupational or recreational activities that raise the risk of exposure to potentially rabid animals, and whether they might have difficulty getting prompt access to safe post-exposure care. The Yellow Book names groups for whom it is considered: animal handlers, field biologists, cavers, missionaries, veterinarians and some laboratory workers. Long stays, remote travel, cycling and running (dogs chase), and children, who play with animals and may not report a bite, are the situations clinicians usually raise. In many countries in Africa, Asia and Latin America dogs are the main source; bats can carry rabies anywhere, including where dogs are vaccinated.

The schedule

Two intramuscular doses of human diploid cell vaccine or purified chick embryo cell vaccine, given on day 0 and day 7, complete the pre-exposure series. The second dose must be in before the trip, so the series starts at least 7 days before departure. The Yellow Book says data support about three years of protection; people with a sustained risk beyond that, such as a long posting or work with animals, either have an antibody titer checked between one and three years after the series or receive a third dose, given between day 21 and the end of year three.

What it costs, and how to think about it

At the 8 health departments that publish a self-pay price, one dose costs $360 to $480, with a median of $419. The series is therefore often the largest single item on a list, and insurers rarely cover it for travel. Its value is not in the shots alone but in what it removes from an emergency abroad: the search for immune globulin, extra doses, and sometimes an evacuation to a city where they are stocked. Rabies vaccine is not on the CDC private-sector price list, so the health department lists are the public reference used here.

After a bite or scratch abroad

Whatever the vaccination status, the first step is the same: wash the wound right away for several minutes with soap and water, then apply povidone iodine or another virucidal product if available, and seek medical care the same day. Bites and scratches from dogs, cats, monkeys and bats all count, as does a bat found in a room where someone slept. The Yellow Book also advises delaying the suturing of a wound for a few days in an unvaccinated patient. CDC's final word on the subject is simple: avoiding bites is the best prevention, so not feeding or petting animals, even ones that look healthy, matters as much as the shots. Monkeys at temples and tourist sites are a frequent source of bites in Asia; keeping food out of sight and not approaching them avoids most of those incidents. A traveler who comes home after a bite that was not treated abroad still needs to see a clinician at once: post-exposure care is only useful before symptoms begin.

The trip cost page adds the rabies series to the other vaccines of an itinerary, and the clinic fees page shows what the two visits add.