Featured Article - 14 January 2024
Vacation cut short and unwanted medical bills: A possible rabies exposure while traveling
The following story tells the tale of a potential rabies exposure. Luckily, the victim, Samantha M. had good knowledge about rabies and its prevention, ensuring that she took appropriate action. Samantha is now also a REC graduate.
In September 2023, I was enjoying dinner with my friend at a hotel in Ashgabat, Turkmenistan. We were traveling there for a week on a tour of the country.
During dinner, my friend was feeding 3 stray kittens at our table. I never feed animals - stray or owned - mostly because it breeds bad habits. Rabies was not on my mind at all so I just ignored the kittens and continued with my meal.
After finishing dinner, I leaned back in my chair and stretched out my arms in a yawn. I suddenly felt a sharp sting in my finger. I recoiled and saw that one of the kittens had bitten me, presumably thinking the napkin in my hand was food. The bite broke the skin and I immediately thought of rabies.
I washed the wound thoroughly and texted several friends in the healthcare industry for advice. They helped me look up information on rabies in Turkmenistan since the internet is strictly limited there. Despite their research, they could not find much information on Turkmenistan, so they all recommended receiving rabies PEP.
That same night I emailed my travel insurance to request help finding care in Ashgabat. Over the next several days my insurance attempted to set me up with a doctor's visit there. Unfortunately, they were unable to make an appointment in Turkmenistan or in Ireland where I had a layover on my way back to the US.
By the time I arrived in Ireland, I was able to access the internet, but information on rabies in Turkmenistan is very limited and not always accurate. I found GARC online and reached out to them for information. They replied immediately with rabies statistics in Turkmenistan. The information they provided made me decide to move forward with treatment in the US despite the high cost.
The total cost of my treatment was $1480. My travel insurance did agree to reimburse me for the first shot due to their incompetence in helping me find care overseas. However, I am still left with a $1110 bill.
I'm telling my story to let everyone know that rabies risk does not always manifest in an aggressive dog or a swooping bat. Often, you can be put at risk by seemingly harmless interactions or by friends who can't resist feeding that cute street cat or petting that sweet stray dog.
My advice is to stay far away from stray animals wherever you are (at home or on travel). If you have any friends that insist on engaging with strays, then I recommend you step away from them during that interaction. This is especially important in a place where medical care is limited or difficult to access.
The unfortunate consequences of interacting with strays (no matter how adorable) can be, at worst, a death sentence and, at best (at least for Americans) a cost of $1000 - $2000 and a major inconvenience. It’s just not worth the risk.
Note from GARC:
Interactions from any unknown animal should be avoided. However, we want to highlight that this should not result in fear for all dogs or animals in your community. Precautions should always be taken when dealing with any animal, but these should remain healthy precautions, and in no way should these result in the persecution or mistreatment of any animals. It is important to remember that animals are also victims of rabies and suffer from the disease equally.
We encourage all travelers to consider rabies pre-exposure prophylaxis before traveling to rabies-endemic countries, as this eliminates the need for rabies immunoglobulin.