Health checklist before travel to Philippines

[ssbib]

My maximum time in the Philippines has been a month or less, over several visits since 1978 ( when I worked for a year at the University Hospital in Kuala Lumpur, Malaysia ). At no time did I consider it necessary to have rabies or Japanese encephalitis vaccines, or antimalarial tablets, because of the places I visited, and my home in Malaysia was on the University campus next to the hospital.



I can’t give advice to individual members, most of whom I don’t know personally. All I can do safely is to give information based on best available evidence. It’s a matter for each person to reach a decision according to their general health, where they plan to visit ( or live ), and what they intend to do during their visit - after consultation with their doctor / nurse, and reading reliable source(s).



So-called " pre-exposure prophylaxis " ( immunisation ) is different to " post-exposure prophylaxis ". Each depends on the age and general health of the patient, and ( after a bite ) whether or not the suspect animal can be shown to have rabies.


Essentially pre-exposure involves several intramuscular injections and booster dose(s) of vaccine. Post-exposure involves not only further vaccines but also immunoglobulin for immediate " passive " immunity.


Each regime is indeed expensive, either in UK or the Philippines. Of course, once there are symptoms - after a variable incubation period of usually 1 - 3 months, rabies is almost always fatal. It is preventable ONLY by vaccination ( and immunoglobulin ).

Forgive my ignorance Alan but does that mean if I get bitten by a rabies infected animal while in the Philippines and I have NOT had the pre-exposure vaccination then I am essentially screwed? if I get to the hospital straight away and take the post-exposure vaccinations ONLY will I be ok?

[Doc Alan]

Forgive my ignorance Alan but does that mean if I get bitten by a rabies infected animal while in the Philippines and I have NOT had the pre-exposure vaccination then I am essentially screwed? if I get to the hospital straight away and take the post-exposure vaccinations ONLY will I be ok?

You would NOT be " screwed " if bitten by a rabid animal without having had pre-exposure vaccination. The wound should be cleaned carefully and thoroughly with soap and water, and left open. A course of post-exposure vaccines should be started and immunoglobulin should be given as soon as possible after the bite.

Of course there are far more animal bites than cases of rabies in the Philippines. The management of each situation needs judgement according to circumstances and what is known ( or becomes known ) of the animal's rabies status ( positive, previously immunised, or negative ).

[ssbib]

You would NOT be " screwed " if bitten by a rabid animal without having had pre-exposure vaccination. The wound should be cleaned carefully and thoroughly with soap and water, and left open. A course of post-exposure vaccines should be started and immunoglobulin should be given as soon as possible after the bite.

Of course there are far more animal bites than cases of rabies in the Philippines. The management of each situation needs judgement according to the circumstances and what is known ( or becomes known ) of the animal's rabies status ( positive, previously immunised, or negative ).

Am I right in thinking that even after having the pre-exposure vaccinations you still go and have the post-exposure vaccinations. So the hospital will still try and find out information about the animals rabies status etc and act accordingly? Basically what I'm asking is having the pre-exposure vaccinations doesn't mean you are immune to rabies, just that you have longer to seek medical attention?

[Steve.r]

Best to keep shy of dogs really unless they are known to be negative or vaccinated. Doesn't mean you cant touch them, just be aware, but keep away from street dogs.

As Alan also says there are many other biting animals, snakes for example. In our brgy we had two cases of Cobra bites. One guy died within 2 hours, decided to have a local witch doctor remedy.... the other a good friend was bitten on his ankle on his doorstep, went to grab the snake to pull it off and got bitten again on the hand. He got directly to hospital and survived.

Just be streetwise, it's not such a bad place.

[ssbib]

Best to keep shy of dogs really unless they are known to be negative or vaccinated. Doesn't mean you cant touch them, just be aware, but keep away from street dogs.

As Alan also says there are many other biting animals, snakes for example. In our brgy we had two cases of Cobra bites. One guy died within 2 hours, decided to have a local witch doctor remedy.... the other a good friend was bitten on his ankle on his doorstep, went to grab the snake to pull it off and got bitten again on the hand. He got directly to hospital and survived.

Just be streetwise, it's not such a bad place.

I don't plan on getting overly close to dogs or anything like that. Just can't decide whether to play it super safe
and pay even more money to get he vaccinations. It's nearly as expensive as a months rent on the flat I'm eyeing up! I think learning a bit more about the diseases will help me make an informed decision.

[Steve.r]

I am not going to tell you what to do, but I know from my experience what I would do and have done. Better to look both ways when you cross the road in the Philippines imo.

[Michael Parnham]

My ex always used to say 'you only worry about Mosquito's in the cities because that's where you'll find the dirty water, it's the water in the Province that is clean'. I suppose there has to be some truth in that

[Doc Alan]

I can’t give individual advice or make diagnoses on this Forum, or anywhere else online.

If you wish more information than that already given, there are up to date links giving key facts on rabies here, and the hope for the future to eliminate human rabies altogether here.

[ssbib]

I can’t give individual advice or make diagnoses on this Forum, or anywhere else online.

If you wish more information than that already given, there are up to date links giving key facts on rabies here, and the hope for the future to eliminate human rabies altogether here.

Thanks Alan. You've offered a lot of help and advice and I'm very grateful.