This post is aimed at anyone who is faced with a probable rabies encounter in Ethiopia. We spent hours of costly mobile data reading medical websites and blogs getting up to speed on the fatal disease. Also, it is important to note that I have no medical background and this is only an outline of the events that we were exposed to whilst travelling in Ethiopia.
1 January 2016, New Year, new start. Our first day in the Omo Valley region of Ethiopia, on a day-trip to Omorate, the morning was spent wandering with some new friends from the Daasenech tribe.
For lunch, we ate together in a local open-air eatery. Halfway through the meal, a small black bat flew into the restaurant hitting Zlat, my partner straight in the eye. The bat fell on our injera plate glared at Zlat with its fangs out, then fell on the floor and scrambled out the door as fast as it had come in. It all happened in a matter of seconds.
We cleaned the black dust that remained around Zlat’s eye area, couldn’t see any blood or clear broken skin, however there were two small marks on the side of his nose (could have been there before, however not sure). Our main concern was the transmission of bat saliva to the eye, as rabies can be passed on this way. And the bigger worry, why was a bat flying around in the middle of the day? Was this a sign of the animal being rabid?
Over my years of travel I had never educated myself on the severity of rabies, ie, if symptoms arise, it’s too late, medicine will only comfort you while you wait to die. Neither of us had had our pre-vaccination shots, and had been previously told by a doctor that if we were bitten we would need more shots anyway. It wasn’t something we worried about.
After much phoning around, reading endless rabies blogs and contacting travel insurance and family, we paid a visit to the local clinic in Turmi. Miraculously they ensured us they had the anti-rabies vaccine (we had initially thought we’d need to make a beeline back for Addis Ababa to receive medical care). The doctor told us she had the Human Dipoid Cell Culture Vaccine (HDCV), and that it would be administered in a 1ml dosage on Day 0,3,7,14 & 28. Great, a shot in the bum, and we could continue our southern Ethiopian travels with only minor disruptions.
All good, or so we thought. On our Day 3 shot, I noticed the bottle of anti-rabies vaccine was due to expire the following day. I brought this to the attention of the clinic staff. They insisted the date was when the vaccine was opened and someone had written it incorrectly. I physically made them check again, they finally agreed it was the expiration date. Great, but not great. We now needed to travel to another town several hours away to get the Day 07 anti-rabies vaccination.
With almost no public transport in Turmi, it was a big struggle to organise a ride to the next town Jinka.
After more internet based reading between shots, we found The World Health organization advises ‘(The anti-rabies) Vaccine should never be administered in the gluteal region’ Another heart-sinking moment, as the past two vaccinations had been administered that way. We would ensure the next clinic in Jinka would inject in the correct location.
Arriving in Jinka for our Day 7 shot, the hospital staff were confused with our medical requests. (And it wasn’t because we couldn’t speak Amharic). The Doctor told us we were taking the wrong dosage of the anti-rabies vaccine and that it should be administered in a 5ml dosage every day for 14 days, and given in the stomach. With all this new information and further reading, we realised we were not given the ‘real’ anti-rabies vaccine, but the ‘horse serum’ version. This stuff is banned in many places around the world such as Thailand and India, Indonesia etc.
After consulting with our travel insurance, as we suspected, straight back to Addis. It’s worth noting the Nordic Clinic is the only place we found who stocks VeroRab (well, the only place who would answer the phone) and it costs approximately $30 USD a jab.
For post-prophylaxis exposure you will need shots on Day 0,3,7,14 & 28. Pre-exposure vaccinations shots should be given on Day 0,7 & 21 or 28.
For information of what to avoid; we were given the Nerve Tissue Vaccine (NTV), a vaccine created over 100 years ago, made from sheep brains. For this particular vaccine, the World Health Organisation states:
The use of brain-tissue vaccines should be discontinued. WHO does not recommend any schedule using brain-tissue vaccine. National authorities should recommend a schedule of immunization that has been shown to induce an adequate level of protection when brain tissue vaccines are available in that country.
As far as we could ascertain, if in need of an anti-rabies vaccination look for anyone of the following: HDCV (Human Dipoid Cell Culture Vaccine), PCECV (Rabipur TM) or PVRV (Verorab, Imovax, Rabies vero, or Verovax).
Oh, and if you have a serious bite and need the immunoglobulin, it doesn’t exist in Ethiopia. Flying to Nairobi is your closest/best bet.
Lessons learnt, in countries such as Ethiopia, it is integral to take control of any medical issues. Be aware of what medication is given to you and definitely check expiration dates. Always cross check the information you have been given, even if it’s from a doctor. The doctors and medical staff may laugh at your overreacting farangi (foreigner) ways, but don’t let this put you off. It’s your health.