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Last Updated: Friday, 2 September 2005, 00:10 GMT 01:10 UK
Rabies warning over minor bites
Stray dog
Stray dogs often spread rabies
Experts have warned travellers not to be complacent if bitten by an animal in a country where rabies is common.

Writing in the British Medical Journal, they describe how a woman from Greater Manchester died after a nip from an infected dog left only a tiny graze.

The University of Liverpool researchers advised travellers to seek urgent attention if bitten or scratched.

Visitors to many countries in Africa, Asia, the Middle East and Latin America should get vaccinated, they said.

Travellers to these countries were also advised to avoid animals.

Rabies is an acute viral infection of the central nervous system. The virus is usually transmitted through a dog bite, and results in at least 40,000 deaths worldwide every year.

Most patients present with furious rabies, a highly disturbed state associated with phobias and severe difficulty breathing
However, up to a third present with the paralytic, or "dumb" form of the disease
This can be harder to spot, and is sometimes confused with other conditions
Symptoms include headache, fever, itching, and severe pain in the bitten limb, which may be weakened

Around 90% of deaths occur in the developing world, particularly in India, where dogs that roam freely are largely responsible.

Rabies is rare in the UK, where just 12 cases have been reported since 1977 - 11 contracted abroad and one rare case acquired from a bat in the UK.

Shooting pain

The researchers described the case of a woman, aged 39 and from Bury, who was admitted to hospital with shooting pain in her lower back and left leg.

Three and a half months earlier, during a two week holiday in Goa, India, she had been bitten by a puppy on a lead.

It left a slight graze, but she did not seek medical help, and she had not received a vaccination before travelling.

She was diagnosed with rabies and died after 18 days in hospital.

Writing in the BMJ, the researchers said: "This case serves as an important reminder of the risk of rabies for any traveller to a country where rabies is endemic, even tourists on a short visit to a holiday resort, and provides several useful lessons.

"Most importantly, travellers need to know whether they are visiting a country where rabies is endemic, and that any dog bite in such a country must be taken seriously by the recipient and any medical staff dealing with the patient subsequently."

Early stages

The researchers said that rabies was more likely after the bite of a stray or rabid dog.

But they said: "Our case shows that even an apparently innocuous bite from a pet must be considered carefully, especially if it was unprovoked: such an animal may be in the early stages of rabies."

Professor Derrick Pounder, an expert in forensic medicine at the University of Dundee, said people travelling to regions where rabies was a problem had to weigh up whether it was sensible to get vaccinated before setting off on their travels.

"For example, hiking in a rural area of the Indian subcontinent where dogs commonly roam free carries a sufficient risk of exposure - combined with potential difficulties in obtaining early, safe and effective post-exposure prophylaxis - to warrant vaccination before travelling," he said.

Vaccination before exposure does not eliminate the need for treatment after infection, but it simplifies treatment and may provide protection after unrecognised exposure.

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