Dengue and rabies in Thailand: what to do after a bite

Rabies: why a bite needs prompt attention

Rabies is a viral infection spread through the saliva of infected animals, usually by a bite or scratch. Dogs are the main source of human rabies worldwide, and the US CDC notes that dogs infected with rabies are sometimes found in Thailand. Cats, monkeys and bats can also transmit it, so treat any bite or scratch from a mammal seriously, including from animals at temples and tourist sites.

The World Health Organization is clear about the stakes: once the virus reaches the central nervous system and symptoms appear, rabies is fatal in 100% of cases. The same fact sheet says deaths are preventable with prompt post-exposure prophylaxis (PEP), which stops the virus reaching the nervous system. That is why the right time to act is straight after the bite, not when you feel unwell.

What to do after a dog, cat or monkey bite

First aid comes first. The WHO advises immediately washing the wound with soap and water for at least 15 minutes. Then go to a hospital or clinic the same day, even if the wound looks minor or the animal seemed healthy.

At the hospital, a doctor will assess the exposure. The WHO groups exposures into three categories. Touching or feeding an animal, or a lick on unbroken skin, needs only washing. Nibbling of uncovered skin, or minor scratches without bleeding, calls for wound washing and immediate vaccination. Bites or scratches that break the skin, contamination of mucous membranes such as the eyes or mouth with saliva, and direct contact with bats call for washing, vaccination and rabies immunoglobulin or monoclonal antibodies, which give immediate protection while the vaccine takes effect.

PEP is given as a course of injections over several weeks. Ask for a written record of each dose, the vaccine used and the dates of the remaining doses, especially if you will finish the course in another town or country. If you had pre-exposure rabies vaccination before travelling, tell the doctor: it changes the treatment you need, but it does not remove the need for prompt care.

If you can, note where the bite happened and what the animal looked like. If it is a pet, the owner may know its vaccination status, but do not delay treatment while you find out.

Where to get rabies treatment in Thailand

According to the US CDC, rabies vaccines are typically available throughout most of Thailand. Hospital emergency departments, both public and private, are the usual first stop after a bite. Rabies immunoglobulin may be harder to find than the vaccine in smaller towns, so if the doctor says you need it, ask where it can be given promptly.

In Bangkok, the Thai Red Cross Society's Queen Saovabha Memorial Institute on Rama IV Road lists services for rabies and vaccinations among its work. The Department of Disease Control's call centre on 1422 can also give information on communicable diseases.

The CDC advises talking to a healthcare provider before travel about whether pre-exposure rabies vaccination is right for you, taking into account your likely contact with animals and how easy it would be to get prompt treatment where you are going.

Dengue: symptoms and how it spreads

Dengue is a viral infection spread mainly by Aedes aegypti mosquitoes, with Aedes albopictus also playing a role. The WHO notes that these mosquitoes bite during the day, so protection against bites matters in daylight as well as at dusk. Dengue occurs across Thailand, in cities as well as the countryside.

Many people have mild symptoms or none at all. When symptoms do occur, they usually start 4 to 10 days after infection and last 2 to 7 days. The WHO lists high fever (around 40°C), severe headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, swollen glands and a rash. People infected a second time are at greater risk of severe dengue.

There is no specific treatment for dengue. The WHO advises rest and plenty of fluids, paracetamol for pain and fever, and avoiding anti-inflammatory painkillers such as ibuprofen and aspirin, which can increase the risk of bleeding. If you have a fever in Thailand, it is sensible to see a doctor, who can test for dengue and other infections.

When dengue needs urgent care

The dangerous phase of dengue can come just as the fever is settling, which can catch people off guard. The WHO lists warning signs of severe dengue: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, blood in vomit or stools, restlessness, extreme thirst, pale and cold skin, fatigue and weakness. Seek care immediately if any of these appear.

In an emergency, call 1669, Thailand's medical emergency number, or go directly to the nearest hospital emergency department. Our emergency care guide covers what to bring and how payment works.

To lower your risk, use an insect repellent during the day, cover up where you can, and remove standing water around your home, where Aedes mosquitoes breed.

Frequently asked questions

Sources

1. World Health Organization — Rabies fact sheet
2. World Health Organization — Dengue and severe dengue fact sheet
3. US CDC — Travelers' health: Thailand
4. Department of Disease Control, Ministry of Public Health (Call Center 1422)
5. Thai Red Cross Society — Queen Saovabha Memorial Institute
6. GOV.UK — Thailand travel advice: Health