Generally Practicing
Specifically for nurses working in General Practice or Primary care in the United Kingdom. Discussing upcoming changes or challenges and picking through the unique world of GP Nursing.
Disclaimer - this is for information purposes only and may reflect personal opinions. Nothing within this podcast constitutes medical advice and should not be taken as such. Always seek advice from a health care professional regarding any medical conditions or queries.
Generally Practicing
Unravelling Rabies: A Critical Guide for Travellers and Healthcare Providers
Rabies remains a deadly disease that can be overlooked, but with pretty much 100% fatality once symptoms develop and nearly 100% prevention with vaccines, it deserves our attention. Our guest Alys, a Travel Health Nurse Specialist and Immunisation Trainer, explains why every traveller should be aware of rabies risks regardless of destination.
• Rabies can be transmitted through minor contact with animal saliva – even a small scratch can be fatal
• The virus hides from the immune system while travelling to the brain, making it undetectable until it's often too late for treatment
• Pre-exposure vaccination requires three doses but simplifies treatment if bitten and eliminates the need for hard-to-source immunoglobulins
• All mammals can carry rabies – not just dogs but cats, monkeys, bats, pigs and even seals
• Children, long-stay travellers, and those visiting rural areas are at highest risk
• Immediate wound washing and prompt medical attention is crucial if bitten or scratched by an animal
• Post-exposure treatment in the UK is an NHS service that should be provided free of charge
• There is no time limit on when post-exposure treatment can begin – even exposures from years ago should be reported
If you're traveling abroad, especially with children or to rural areas, consider rabies pre-exposure vaccination and always avoid contact with animals, however cute and friendly they may seem.
Here are some helpful links
Alys’ Website - https://alyssclassroom.co.uk/
The Green Book - Rabies green book chapter 27
Rabies Post Exposure Treatment Guidelines - Rabies post-exposure treatment: management guidelines - GOV.UK
Rabies and Immunoglobulin Service (RIgS) - Rabies and Immunoglobulin Service (RIgS) - GOV.UK
Rabies Information for Travellers - Rabies – Information for travellers
Rabies Risk By Country - Rabies risks in terrestrial animals by country - GOV.UK
Robert Steffen’s ‘Steffenogram’ Research - https://academic.oup.com/jtm/article/30/7/taad085/7204327
Hello and welcome to Generally Practising. Today we're diving into a topic that's not talked about nearly enough rabies. We're also welcoming Latoya as a co-host.
La Toya:Hi everyone and welcome. I'm Latoya De Freitas, a General Practise Nurse and co-hosts of this space where we have real, honest conversation about healthcare and life as a healthcare professional working at the front line. I've been a general practice nurse for several years and I'm on my street. I know how much health and healthcare can impact general practice nurses and service users, from baby immunisation to managing long-term conditions. General practice nurses are there through it all, but often behind the scenes. I wanted to support Ashleigh in this space, to lift the curtains, to share the work that we do, the challenges we face and the impact we have in our communities. Whether you're here as a fellow nurse, a patient or just curious, we're glad that you're here.
Ashleigh:Now I know what you might be thinking rabies, that's something that happens in far-off places or in old horror films. But actually for travellers, especially those heading to certain parts of Asia, africa or South America, rabies is still very real and very deadly.
La Toya:As general practice nurses, we often we're often the first and sometimes the only healthcare professional to speak to people about travel health, and when it comes to rabies risks, it's not always as straightforward as just saying get the vaccine or don't get the vaccine. So today we joined by the very experienced travel health nurse specialist and immunisation trainer Alys, who is going to help us unpack a few facts about rabies.
Ashleigh:Hello Alys. Hello and welcome Alys. Would you like to tell us a little bit about yourself first?
Alys:Oh hello. Thanks so much for having me on the podcast. I'm very excited. It's my favourite subject, so I describe myself as an immunisation geek or enthusiast. I spend most of my evenings reading about the world of immunisation. I absolutely love it one of the best preventative medicines we have ever, really alongside clean drinking water as well. Well, it's saved so many lives and suffering. So I love immunization in general and I do lots of teaching in the field lots of Imms updates, travel health updates, foundation training, that kind of thing. I dabble with a bit of phlebotomy teaching as well, and sometimes BLS too.
Alys:I started my nurse career in emergency departments in Manchester and quickly decided I wanted to be more on the side of prevention and ended up stalking a local travel health clinic until they gave me a job and then I ended up being the lead nurse in one of the branches there for quite a few years forgotten how many now and then eventually became the education lead for the company and during that time we dealt with all kinds of travel and people going to all kinds of places and doing all kinds of things and it was just the best job in the world. But then the pandemic came along and just nobody was traveling anymore and it all got a bit bleak really. So I decided to revisit my old job, which was before. I was a nurse, I was a teacher and I decided to get back into training and stuff, and that's kind of how I've ended up here now really. Um, but it's lovely to be here.
La Toya:Thank you for being here, you're welcome so, whether you're a nurse giving travel advice, a frequent flyer or just curious, this episode will leave you better informed and maybe even a little bit surprised so there's been a lot in the media about rabies recently due to the passing of a female person who had recently returned from holiday.
Ashleigh:The story was very sad, but this has heightened awareness.
La Toya:So, Alys, you know, correct me if I'm wrong, but I talk about rabies to all traveller.
Alys:No, absolutely not, La Toya. No, not at all. I think everybody should know about rabies. Honestly, I think it's the responsible thing to do to talk about it. I always say to to travel health nurses. You know, give the consultation that you would want to have. And I have a feeling if you asked any of the family of that poor lady who died recently about awareness of rabies, they would all fully agree with this as well.
Alys:So that case you just referred to was a lady called Yvonne. She was a 59 year old lady. She was enjoying being a grandmother. She went to Morocco, played with a puppy. It got a very seemingly insignificant scratch from the puppy and you know, four weeks later she's having the rabies symptoms and and dead. You know it's just so sad, so sad, and I think take every opportunity to highlight babies, um the risk of it happening like it doesn't happen that much, but when it does, the stakes are really high. You know it's one of our most deadly diseases that we have. It's always fatal once you have symptoms and really bad consequences, and so, um, even just mentioning it as well, it meant it means that you're also highlighting the importance of um animal contact in general and bite avoidance. Of course, animals can do many other things as well. So, no, I think you're doing an absolutely smashing job, La Toya. Keep keep doing it. Mention it to everybody. It's very widespread.
Ashleigh:So would you be able to share with us your key facts about rabies and the vaccine that we have available?
Alys:Sure, sure, I mean I could talk about rabies for hours and hours. I'll try and keep this as brief as I can and direct you to other places. You can read a bit further. I think one of the key points is that it's a very, very deadly disease. It's 100 percent fatal pretty much once you've contracted it. And it's a very, very deadly disease. It's 100 percent fatal pretty much once you've contracted it.
Alys:And it's a very sneaky virus as well. It gets into the nerve cells through just a very small contact with saliva from an animal either a bite, a scratch, a lick to a wound, something like that and mucus membranes as well. You know any saliva in the eyeball or the mouth and, believe me, I've heard every kind of story as to how you can end up with animal saliva in your eye or your mouth. But it then the virus's goal then is to get to the brain, and it can take years and it's really good at hiding from the immune system. So your body doesn't know that it has rabies in it until it reaches the brain, where it then scrambles the brain and and causes these horrible, horrible symptoms. It's one of the worst ways to die. It's a couple of days of horrific spasms, lots of pain, and the patient knows all about it as they're dying. It's just so sad. And what's really striking about this virus as well is that we do have vaccines which are 100% pretty much effective too, and we don't get that much in the world of immunisation, where we have a disease that's 100% deadly and has a nearly 100% success rate with vaccines.
Alys:So the vaccines as well. They're inactivated. They're very safe for a lot of people. Typically it's a three dose pre-exposure schedule, and I always call it a good investment, because people often talk about how expensive vaccines are when you buy them privately of which this one is private pre-exposure anyway and but it's a great investment because it prevents you needing expensive immunoglobulins and flights to try and track down the treatment if you do happen to have a run-in with something cute and fluffy while you're away, and so it saves a lot of money in the long run.
Alys:And particularly if you're going for four weeks or more, a lot of insurance policies don't cover you if you've not had your rabies jabs, which a lot of people don't realize. So it's a really, really, really good vaccine and simplifies the treatment and prevents you needing blood products abroad and then that's it. You know that's pretty much your course for life. You don't need to repeat the course at any point. Some people would have boosters every so often, but, and of course, you'd have a couple of doses after you're exposed as well. Um, but, uh, but other than that, what an investment. I think it's a fabulous vaccine and a really nasty disease, um, so I would urge everyone to consider vaccines.
La Toya:Wow, thank you, I definitely learned a lot there. So how does the risk from bats compared to the risk from domestic animals change our risk assessment? You know, maybe dive into exactly what animals can carry rabies also okay, it's a really great question that.
Alys:Um, so yeah, bats can carry rabies, like viruses, lissa viruses, and in the uk we are declared as sort of rabies free in domesticated animals and terrestrial animals. In the uk we don't tend to worry too much if our pet dog bites us or something like that, but if a bat, if you come into contact with a bat in the UK and then you, we always treat that as a potential exposure and and so you would, you would definitely act. Uh, if it was a bat bite in the UK and then across the rest of the world, um, it's, it's going to be things like mammals, and some countries have rabies free domestic animal populations and others don't, but it's, um, generally very, very widespread in most places in the world. So, um, you get cases in all mammals, all mammals.
Alys:I mean there was a couple of years ago there was articles popping up about seals in South Africa and pigs. Ninety nine percent of the time it's going to be dogs that most of the time, but it's not always. We shouldn't think we're safe just because we're with a kitten. You know, dogs are the biggest threat, though, across the world, particularly in Asia and Africa and parts of the Americas as well the world, particularly in Asia and Africa and parts of the Americas as well.
Ashleigh:Gosh, I didn't realize it was such a variety of animals that can that can carry rabies.
Alys:Yeah, I could tell you so many examples of people who've had run-ins with with various animals. I mean one, one we had in the clinic, and one of our clinics was a chap who had decided to take a selfie with him next to a pig and he was eating a burger at the time and the pig went to bite the burger but nicked him in the face instead. That was in Vietnam and he ended up with post-exposure treatment because a bite to the face is actually incredibly severe, because it's really close to the brain. So you've got to really act on that quickly.
Ashleigh:So what if a traveller has left it until a few days before they travel?
Alys:I'd say it's even more reason to discuss it, actually, because that person might well be going either partially vaccinated or not vaccinated at all. So that is your opportunity to talk about the risk and how to avoid exposure in the first place and give people that valuable advice about avoiding animals and what to do if they are exposed, to make sure people know that if it is just a small, insignificant looking scratch, that they still got to go and get help and that kind of thing. I mean you can also signpost to local private travel clinics as well, because often they have same-day appointments.
Alys:We used to see a lot of people in the private clinics who had come from their GPs and going I'm leaving tomorrow and they won't see me and you know, I think that's probably 80% of our business was the last minute travelers. So we were very used to dealing with this kind of last minute thing, and then it's never too late to have a dose of rabies. I mentioned earlier that the course is is three usually in the UK, but even even having one or two is better than nothing. You've got some antibodies, then the only problem with, say, having one is if you were to be exposed abroad, you don't want them to mistake you as having a full course beforehand. They may not do the the full treatment then, so it can cause confusion. The other end and it's important to let a traveler know that if you've only got time for one, yeah, it's still going to give you some antibodies, but it's not necessarily classed as a full course. In a lot of the world now they're um. They're doing the two dose rabies pre-exposures as well and that is um.
Alys:In the SPCs in the UK, vaccines that we have, that you could can do two doses. I've heard of a lot of pharmacies doing this. But the reason the green book hasn't changed to reflect that is because we, if that traveler was to come back to the UK and they'd only had two pre-exposure doses, they would still be treated as partially vaccinated and that might happen in the country that they're visiting as well, that they're treated as partially vaccinated, not fully vaccinated. So until the whole world changes their views on the three dose versus two dose thing is probably going to still be three doses for a little while. Yes, but no, it's to answer your question. It's never too late to have those conversations. Absolutely, have them. We can still protect people with good advice, not just vaccines.
La Toya:I mean, some of this you might, you might covered, but what can travellers do to limit their risk? And is there anyone who's especially high risk?
Alys:Okay. So first line of advice is try and avoid the cute, fluffy things you know. Definitely avoid petting or feeding animals, even if they seem friendly, because a big misconception around rabies is that the animal has to look rabid and be foaming at the mouth and have red eyes. You know that classic thing, and so it's. Even if they just look absolutely fine, they don't tend to get symptoms until the last few days of the late stages of the disease, but they can harbor it for a couple of weeks before they show any symptoms. Um, so be especially alert for puppies, because they're cute and playful and they like to bite you and you know, like play, biting and stuff.
Alys:Also, monkeys can appear, they, they can be um scoundrels. I I worked with monkeys for a while in south africa and they, they literally just pop up anywhere and if you have something in your hand then they're having it. I used to have about 14 different piercings in my ears and when I went to South Africa they plucked them all out one by one and they were very interested in the earrings. Um, street dogs as well. Particularly, they can be quite hungry if you've got some food in your hand, and when you're away on holiday, often you eat outside as well. I mean, look at this lovely weather we've just had everyone's outside in the beer gardens and stuff, you know, and that's when food gets involved. So watching out for dogs and things, um, the higher risk travelers, so you can be putting on day one of your trip. So it doesn't matter how long someone's going. They've. You know there's still going to be a discussion about it, but generally long stay travelers are a more prolonged risk and people going to rural areas are at more risk as well, because they'll they'll struggle to get the treatment if they need it.
Alys:A really risky group is the young children, especially they're they're they often at sort of face height when they're bitten or scratched, so the rabies virus again can get to the brain a lot quicker and kids are not as likely to say if they've had a run-in. You know, if you're a parent, I always give this advice to parents. They say, obviously try and stop the kids playing with animals, but they're probably still going to anyway. So the most important bit of advice you can give to a kid is make sure you you tell the parent if you get exposed you're not going to get in trouble. There was a girl last year in Vietnam. And when you live in a country where it's rabies endemic, it's kind of drummed into you from an early age don't touch the dogs, don't go near them. So this 10 year old girl had been walking to school and she'd gone and pet a stray dog and it bit her and she didn't tell her mum. In fact she told her mum she'd cut her arm on a bit of barbed wire because she was worried she would get in trouble and a month later she died a horrible death of rabies. So it's really important to tell kids you're not going to be in trouble if you tell you if something happens. And they're also very keen to cuddle things. I know my kids know every dog in our local park. They're always there getting right up in their faces and stuff.
Alys:And then the other risk groups, of course, are animal workers. It seems fairly obvious, those who are going to be working with animals, especially these trips where you get voluntary placements abroad. I did that, volunteering with monkeys, and that's how I ended up as a post-exposure rabies patient myself. And then the immunosuppressed as well, who may not respond very well to the vaccines too and may not respond well to the treatment. So they're also a particularly high risk group. I think I've covered most of them. I probably missed somebody out there, but I hope that gives you an idea.
Ashleigh:Yeah, that's really really interesting and really helpful. Is there anybody that the vaccine is contraindicated for, though?
Alys:Well, what's quite good about these vaccines is they pretty much most people can have them. It's a very, very safe vaccine. There's quite good about these vaccines is they're pretty much most people can have them. There's a very, very safe vaccine. There's quite a lot of options as well around the world for different vaccines that, as I said before, they're inactivated, they're not live. So you can give it to pregnant ladies, you can give it to people who are immunosuppressed, in fact even more so. Give it to immunosuppressed people because they won't fight the virus as well, and it can absolutely save their life. So the risk of the vaccines in those cases are much less than the risks of disease.
Alys:There's no absolute contraindications in post-exposure situations. Again, even someone has quite a severe allergy to something in there. They're going to die if they get rabies. So it's it's that balance of risk and benefit. We do have to be careful with people who are allergic to eggs, because one of our vaccines, Rabipur, does contain eggs, but we have got an alternative, Verorab, in the UK, so we can't even get out of it that way with an egg allergy. There's still a vaccine for those people as well.
La Toya:I feel like, if I keep asking you things that you have mentioned before but it's really about I want to drive this home you know, if a traveler has been fully immunized and has rabies risks or contact with an animal that possibly raises risk, you know what do they need to do.
Alys:OK, it's a great question and, yeah, I have talked mainly about pre-exposure vaccines at this point, so I think we probably should talk about post-exposure. Definitely, so if they have a potential risk, they need to go and get help straight away. You know, you often hear and it says on the wording on travel health databases and Nathnac you know it does mention things like how many hours to go and get help, but you can't guarantee that you're going to find help straight away. You might end up having to be flown somewhere to a big hospital, somewhere. Um, you may, you may go to a big hospital and there's no immunoglobulin there. So I'd never leave it, always straight away. Go and get some advice straight away.
Alys:A person who's vaccinated beforehand will probably need two booster doses of the vaccine after exposure. So usually that's on day zero, which is the day of the bite, or as soon as they can after that, and then day three and then usually that's it a nice boost to their immune system and no immunoglobulin needed. But if you've not had any vaccines before you go, you're going to need blood products, usually injected into the site of the wound, and I've seen people bit in all kinds of awkward places. I'll tell you that and it's not not nice having to do that and it's really hard to source blood products. They can be often hard to find. They can be in short supply. In fact they're going into short supply at the moment because of all the calls to, because of this recent case we've had in the UK. The Riggs team have actually started, got some temporary guidance out now about risk assessment and immunoglobulin. So even in the UK we're running into shortages. We can't assume that we can get it and that's one of the big advantages of pre-exposure vaccines. Definitely you don't need that unless you're immunosuppressed.
Alys:There is a few exceptions there, but um, it's sort of the pre-vaccinations turns what could have been a complicated emergency and flights everywhere into just a simple booster top up and then you carry on with your holiday, you know. So again, it's that thing when people come back to rabies vaccines pre-exposure are expensive, it's going to. When people come back to rabies vaccines pre-exposure are expensive, it's going to be. They're going to think, well, what if I get bitten? It's going to suddenly get a lot more expensive and stressful at that point and it's just that thinking ahead really. But they need to get the help.
Alys:The other thing I've not mentioned which is super important is if you're bitten, scratched, licked in a wound at any point, wash the wound out straight away. Put in a wound at any point. Wash the wound out straight away, put alcohol or antiseptic on it and go straight to to get medical care. But washing the wound is is really key. No, none of this kind of sucking the blood if you've kind of caught on your finger, none of that. Um, just try and get the rabies virus away from that site, basically, and don't leave it, just go and get help.
Ashleigh:That's great. So what should we do if somebody comes to the surgery believing that they need post-exposure treatment? Logistically, how would we go about addressing that?
Alys:Okay. So your first one is always a bit nerve-wracking and, believe me, I've seen many nurses go through their first ever post-exposure and it seems a bit terrifying because it's quite a responsibility. I will just start by saying, though, a big area of confusion is whether this is an NHS service or not. And it absolutely is an NHS service. Just to reiterate that, because it comes up all the time in my courses that nurses don't think it's an NHS thing, it's free and it's a service that GP surgery should be providing. I can't tell you how many times someone's turned up in our private clinic say you know, I've been sent here because the GP said they don't do it there like it has to be offered, and so you, you treat it as urgent. You won't be saying, well, let's book you in next week. You know you'd be, you'd be trying to see them, squeeze them in as quick as you can. Um, you would gather all of the details about the exposure, the animal, the country, as much as you can, and then you would phone UKHSA RIGS team or the equivalent local public health, like in Wales it might be the duty virologist at Cardiff. You'd phone them and and thankfully you don't need to do much thinking here. You just need to relay all the information to them. They then advise you on what to do so that you'll get a PSD and you get the vaccine sent to the surgery. And they usually arrive the next day, unless it's on a Friday afternoon at 5 pm, which is frequently when people decide to announce things like this, and and then you get them pretty soon. So you can have hold some stocks and UKHSA do replace the vaccines, so you don't necessarily have to buy, buy them in um for each patient. You could already have some in and then get them reimbursed afterwards. If you've administered in good faith, they will reimburse them. So that's all free um don't order the usual channels. Order through collindale I'm sorry, not collindale, they don't stock it anymore. Uk hsa rigs team and and it's all very simple.
Alys:It's just a bit time consuming because you've got a lot of information to gather and then a lot of information to pass on and then you've got a patient to reassure as well. But you also want them to take it seriously. So you you don't want to reassure them too much. You know it's that delicate balance really. You also want to find out have they had any treatment abroad? So sometimes people come in and this one catches people out so I'll mention it. They'll come in and they'll say I've had a bite in Thailand and then Thailand will have started them off on a course of post exposure. So they'll come into the clinic and say to you something like oh, I just need my final dose of my post-exposure. Even in those situations you still phone UK HSA and you still get your PSD sorted from them, because other post-exposure schedules around the world are different and we want to be following the UK guidance. And I'm just going to take the chance to say I would recommend everybody reads the post-exposure rabies guidelines which I think Ashley is going to take the chance to say. I would recommend everybody reads the post exposure rabies guidelines which I think Ashley is going to put in the notes for the podcast. Definitely sit down, have a read.
Alys:That goes into a lot more detail about some of the questions you've asked as well. And yeah, just the other thing is people might mention. So if you're really good at your job Latoya was just talking about she mentions it to everybody. You know, if you're really good at your job and you're talking about rabies enough that people understand what you're saying, usually someone will say something like oh, but I got bitten by a kitten in Turkey five years ago. So this again is another situation you've got to act on.
Alys:It doesn't matter how long ago. I think our longest in our branches um of travel clinics was 40 years ago a dog got bit. A dog bit a man in india and we still started him on treatment. So it doesn't matter how long it's been, you're still going to be getting treatment for that person. And it often comes up in a consultation it's a pre-travel consultation and then you then you know you're going to miss your lunch and or be late home. It's just uh, you know one of those uh things. But if you know and again, don't forget, the bat bites in the uk as well, it's not just post travel, this, it's um could be a uk thing as well I had a bat bite declared in a travel consultation this week it had to ring.
Ashleigh:It was the first time it had to ring, so I was really nervous about ringing and like had to make sure that I'd got all the information, everything. But they were so helpful, uh, really helpful, really reassuring and, um, yeah, everything got sorted out really really swiftly. So it was it was. It was actually really good and really helpful and, yeah, I'll put all of the links to everything that's relevant um in the in the description yeah, no, that would be great.
Alys:I think the green book as well gives a lot of information, but just be the caution with spcs, because the spcs from the manufacturer, like I say, do have different schedules outlined in their, their spcs and and so you, you want to be following green book guidance and uk hsa guidance, not not what the spc says, that they don't always agree, really.
Alys:Um, I did want to raise one more point that I don't think we came across, but again, the, the, the risk, um, like, say we, we don't know how many people we save from rabies and we were just talking with me about measles before this podcast and and people wanting to know how many people have died from a disease.
Alys:But I generally think this is only half the story and we, nearly every week in the private clinics we would be treating someone for post-exposure. So whilst we don't hear about cases that much in the UK, we don't know how many people we're saving. And there's a chap called Robert Stephan who does a Stephanogram and he looks at unvaccinated travellers and the rates of disease and when you compare the the risk of an animal bite abroad with things like contracting hepatitis A and typhoid, it's way higher chance of getting bitten by an animal abroad than it is getting something like hep A or typhoid. So again, just another point to illustrate why we should be talking about it all the time. Stefan always says rabies is number one above all the others. Anyway, I think that's my, my final thought no, wow, you've definitely blown my mind.
La Toya:Um, that's for sure. Um I'm, my kids are gonna be traveling.
Alys:Oh yeah, I definitely would I was going to um. I know what my kids are like. They absolutely love animals. I think it's really common for a lot of kids, isn't it? They can't resist. But even a lot of adults can't resist something cute and fluffy. It's hard not to, isn't it? And especially being on holiday, you let your guard down a lot, don't you, and you don't tend to think so much about risk, and maybe there's a few too many gins flowing and you know that kind of thing, and you can be really sensible in the day and then you hit the cocktails and not so sensible after that.
Alys:Um, yeah, but kids definitely consider for children oh yeah, I mean I've got one more question which really isn't about rabies, but it is about travel vaccines. So private travel clinics they. They see um patients obviously, and it always amazes me or make me think why do patients pay for the NHS vaccines in private travel clinics? You know? Can you explain why?
Alys:absolutely. I mean, um, it's, these are. These are private services that are set up to sell things that you know. We just can't be done on the nhs because of limited times and it's a real shame actually having to see someone fork out a couple hundred quid for hep a, typhoid and tetanus vaccines. You know it is. It's a real shame knowing they could get it for free and in an ideal world they'd be able to get it all at the gp surgeries. But I know how busy you guys are, you know you're doing everything, so so, uh, completely, but it does. It is, then, a business opportunity for pharmacies and other private clinics. It's like anything you can. You know you can wait on nhs waiting lists and or you can go and pay privately for surgery. I think I am glad we have the choice and I'm glad we have that option that people don't have to leave uncovered, but it is a shame they have to pay.
Alys:And of course, I often get asked on courses about the funding in general for NHS vaccines and why is it that some of them are free and some aren't, and things like hepatitis A, typhoid, cholera. They're all free on the NHS because there are public health risks to the UK so somebody could bring it back. My friend who's a school nurse. She got called in the other day to vaccinate a whole school for hepatitis A post exposure because a child had travelled and then come back with hep A, and so they vaccinate the whole school, you know. So it's a public health issue if the disease is going to kill you out there or not cost much to the NHS on return if they're lucky enough to come back, of course.
Alys:Um then, uh, then then usually that's privately funded anyway as it stands. So, um, rabies, just going back to rabies, it's quite expensive to to put up a rabies patient in the final throes of rabies. It costs the NHS a lot of money. So it is cheaper for them to give post exposure than you know, and also, kinder, to not get them to that stage as well. But pre-exposure vaccines are always private for rabies, unfortunately. But it gave me a job, so no, I didn't.
La Toya:But it just makes me wonder that we've got different agreements, even with, you know, clinics, pharmacies and so on. So I just thought, why can't we have an agreement like that too, so you kind of widen it so that if they cannot get an appointment with us, you know it? It would be gentle to their pockets.
Alys:But I don't understand, I agree, I agree, I I really used to hate taking patients to a till. It took me a while as a nurse to get used to that idea of taking them to this hill and billing them all this money. I didn't like it at all, you know. But but then uh it's. Uh, they are private businesses at the end of the day and I think even if they were reimbursed by the nhs, they probably still wouldn't necessarily want to go for it because it's not going to be as much profit on it than if you're doing it just purely privately. So yeah, it's an itchy one, isn't it?
Ashleigh:Thank you for clearing that up for us. Um, I think we will put loads of resources in the description. Your website, Alys, is a fantastic resource, not just for rabies, but for every? Um sort of vaccine, preventable disease that there is is so useful, so I'll put that in there too. Um, but just, is there anything that you, um would want to sort of wrap up with our sort of take-home points for?
Alys:rabies I. So, yeah, my take-home message is if you're using any sort of travel databases as part of your consultations, um, you know, if you, as soon as you see rabies as listed as a risk in that country, make sure it gets mentioned the prevention advice. There's lots of useful fact sheets on nasnac as well that you can send. At the time of this recording, we're in July, aren't we? I believe that Travax and Fit for Travel have just temporarily suspended their updates, so, depending on when you're listening to this, at the moment we are being told to revert to Nathnac for advice. But yeah, patients can also read the green book if they're particularly interested in going deeper, they. You can recommend that to people.
Alys:But just get those messages out there, get the posters up in the clinics and in the waiting rooms. If you're not even doing a travel health consult, you're doing a diabetes review or something, and someone mentions that they're traveling, uh, just give them that friendly bit of advice about this horrible disease. It could save their life. It's one of the about this horrible disease. It could save their life. It's one of the few opportunities we get to actually save a life in general practice, you know, like immediately. So it's yeah really important.
Alys:Thank you so much well, thank you for having me. Hope I haven't waffled on too much, I'm sorry.
Ashleigh:No, that was brilliant and it's been really, really informative. I have and I'm sure Latoya will say the same um I like I've learned a lot, um, so hopefully our listeners will as well, I hope so too.
Alys:Thank you for listening, thank you.
