Rabies Pre-Exposure Vaccine: Will Not Getting One Come Back To Bite You In The Butt?

by Laurel Miller on

Recently, a well-traveled friend of mine, whom I’ll call Jules, went to Belize on vacation. While on an idyllic, live-aboard sailing trip, Jules, her husband, and mother decided to explore some cays by sea kayak. What happened next is one of my worst developing nation nightmares.

While poking around what appeared to be an abandoned cay (this is why poking sans guide isn’t recommended, but few true travelers can resist), two semi-feral dogs “jumped out from beneath an overturned rowboat, barking ferociously.” Jules explains, “They were tied up, and we immediately headed back to our kayaks, when we saw a man. He told us the cay was ‘privado (private),’ and I started apologizing in Spanish as we pointed at our kayaks and picked up our pace. The next thing I knew, one of the dogs was let loose, and barreling after us. I started to run, and it bit the back of my right calf.”

The dog released her leg after Jules’ husband waved his arms at it while yelling, “NO, NO, NO, NO!” Then it re-launched itself at her, so she employed the same tactic, and eventually they made their way to their boats and escaped.

As if this story isn’t harrowing enough, the really terrifying part is that they were 10 miles out to sea and had four days left aboard ship. Fortunately, Jules’ mom is a medical professional. Immediately following the attack, she soaked her leg in sea water to flush the wound, then her mom accessed their first-aid kit and cleaned it with hydrogen peroxide, and applied antibiotic ointment. For the remainder of the trip, her mother repeated this procedure, changing the bandages up to three times a day.

I asked Jules why she didn’t insist upon returning to land immediately and seeking medical treatment.

“That’s an emotionally hard question to answer,” she explained. “The dogs weren’t foaming at the mouth, they didn’t look rabid, but rather in aggressive/protective mode. My mother was on the boat with us and she nursed my wound and kept checking my vital signs for any dangerous symptoms. Luckily, nothing bad came of it. There were no clinics in Placenia where we were, so I made the decision to go to the hospital as soon as I returned home six days later.”

There, she was advised to get rabies shots, which had to be administered through the ER (general practitioners apparently won’t provide them). Jules said the series of four treatments – eight shots the first visit, and one per follow-up – was awful. “I got one in each shoulder, one in each upper thigh, one in my butt, and three directly into the wound. The serum they inject feels thick and made my blood feel sluggish. I couldn’t think clearly and needed to nap every day.” She also wasn’t up-to-date on her tetanus, so that was the first shot she received.

Since Jules is one of the most energetic people I know, the shots really affected her ability to work, and she had to take a number of sick days on top of her two weeks vacation. That, of course, is the least concern in this scenario, and I asked my infectious disease doctor, John Szumowski, a fellow at the University of Washington, what the best course of action would be in such a situation.

“Once a person has symptoms of rabies, there’s little that can be done,” he says. “Only a handful of persons have survived even with intensive care. But the rabies pre-exposure prophylaxis vaccine series is felt to be very effective if administered to a person who doesn’t have symptoms.”

I’ve been telling myself for years that I should get rabies prophylaxis (a series of three recommended vaccinations) because I’m in what’s considered a high-risk group when I travel. I have a lot of exposure to animals, and I spend extended periods in rural areas where a delay in medical evaluation is likely. Thus, it’s a safe generalization to say that most adventure travelers would do well to get the series, even if they’re not animal lovers (for the record, despite my crazy dog/cat lady tendencies, I usually give creatures in developing nations a wide berth for this reason). I know I’m going to do it before my next big trip.

Getting the series, says Dr. Szumowski, “Also allows for a simpler course of post-exposure prophylaxis following a bite: fewer vaccinations and immunoglobin (which may not be readily available or of good quality internationally) isn’t needed. The pre-exposure series is available in travel clinics, but can be easily given in a primary care setting, too. Clinics may not have it immediately available, so calling the office ahead of time is a good idea.”

Dr. Szumowski is quick to point out that getting the pre-exposure series does NOT mean medical evaluation should be skipped after an animal bite. Aside from rabies, bites can transmit other, primarily bacterial, infections. “Thorough cleansing of the bite site is an important step, regardless of vaccination status,” he adds. “Animal bites, even those that took place some time in the past, should be discussed with your medical provider because the incubation period for rabies can be up to years afterward.”

Need more compelling reasons for why adventure travelers should get pre-exposure shots? I’ve witnessed a puppy play-biting (drawing blood) a fellow traveler while we were visiting a Myanmar refugee camp in Thailand. I’ve seen a late-stage rabid dog staggering down the main street of a small village in Ecuador. I’ve been chased down an alleyway by a pack of mangy Vietnamese dogs, and had to scale a fence to escape. Gadling contributor Kyle Ellison has been chased by a dog while going for a run in a developing nation. I’ve been attacked and bitten two separate times by seemingly friendly cats here in the States, and still had to go to the ER, while animal control was required to quarantine and test the animals.

Rabies definitely isn’t limited to developing nations, nor is it restricted to dogs and cats. You should never get to close to wildlife, wherever you may be, for any number of safety reasons. But animals like raccoons, opossums, and bats are also frequent carriers of this deadly disease domestically.

For more information on rabies and other infectious diseases related to travel, the CDC’s Yellow Book is an excellent resource. And don’t let fear of rabies make you paranoid about indulging your fondness for animals when you travel.

Says Jules, “I’m an animal lover, and even after this horribly scary incident, I’ll continue to look for the wagging tails of approaching dogs. This was a minor blip on our trip, and will in no way stop me from continuing to see the world. It’s a part of traveling that makes us stop and re-evaluate taking precautions. We’re very protected in the U.S., and take that for granted. We need to respect the places that we visit and be our own advocates to protect ourselves and fellow travelers. From now on, I’ll also always consider travel insurance when visiting developing nations.”

[Photo credits: German shepherd, Flickr user State Farm; dog bite, Jules; dog, Laurel Miller]

Living In Cairo’s City Of The Dead

by Sean McLachlan on


Life can be hard in the developing world, as is shown in this video of a poor neighborhood in Cairo done by IRIN Films. The film doesn’t show your typical slum. This is the City of the Dead, a vast necropolis where poor people have moved in and set up homes and shops inside the tombs.

The capital of Egypt is a sprawling metropolis of some 12.5 million people. Actually, nobody is really sure how many people there are. Cairo has been a huge city for many centuries, and so its necropolis is also huge, some four miles long and filled with tightly packed tombs and mausoleums. The dead have been buried here since the 7th century A.D. Most tombs are simple buildings with little inside except a basic stone marker. Thus poor people can move in, put a lock on the door, and have a ready-made home.

Like with Cairo, nobody knows exactly how many people live in the City of the Dead. Some say half a million; some say ten times that number. They scrape out a living working odd jobs in the city or taking care of tombs for more wealthy Egyptians. A lucky few have saved enough money to set up small businesses serving the needs of their neighbors. A whole city of life has sprung up among the bones of the dead.

%Gallery-159771%Many locals say they like the neighborhood. There’s a chronic housing shortage in Cairo and people here can have a much bigger place than they could ever afford in more traditional neighborhoods. Also, they say people here are friendlier. Perhaps the proximity of death makes folks more aware of their behavior, or perhaps they feel they’re all in the same boat and are thus kinder to their neighbors.

There are downsides too. Living in the tombs is illegal, although the government hasn’t done anything about it, and infrastructure is minimal. Still, the people of the City of the Dead have created their own community where most people wouldn’t even consider living.

Several companies in Cairo offer tours of the City of the Dead. This allows the locals to make some money off the curious who come to see life in the tombs.

Check out the gallery for more images of this strange neighborhood.

10 Alternatives To The Galapagos Islands

by Jessica Festa on

The Galapagos Islands are well known for their endemic wildlife, unique flora and strong ecological philosophy. However, the destination isn’t the only place in the world to experience an unparalleled natural setting. In fact, islands in Asia, South America, Europe and even the continent of Antarctica all feature one-of-a-kind encounters for those interested in seeing something new in the outdoors.

Scuba dive one of the most diverse coral reefs in the world in Vanuatu, relax on pristine white beaches on Brazil‘s Fernando de Noronha and witness the hundreds of sunbathing sea lions on Kangaroo Island in Australia. These are just a few of the experiences to be had in these worthwhile destinations.

For a more visual idea of these Galapagos alternatives, check out the gallery below.

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[Image above via Jessie on a Journey. Gallery images via Big Stock, mariemon, Hairworm]

12 Stunning Desert Landscapes Around The World

by Jessica Festa on

There are many beautiful landscapes to be seen all over the world. Sparkling oceans, lush flora, tall mountains, barren tundra and unique rock formations cover the Earth, giving contrast to its many destinations. One of the most interesting types of scenery to take in, however, is the desert.

While many automatically think of sandy, infertile, colorless areas of land, there are actually many vibrant and unique desert landscapes to be visited. Vast expanses of salt plains in Bolivia, curvaceous sand dunes in Jordan, enormous rock pinnacles in Australia and unworldly vegetation in Yemen make up some of the planet’s must-see deserts. For a more visual experience, check out the gallery below.

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[images via Big Stock]

How To Spot Deceptive Hotel Websites And Fraudulent Trip Advisor Reviews

by Dave Seminara on

I was seduced by a lovely brunette lounging in what looked like a gorgeous pool. But I was looking for a hotel in Naxos, not a date, and should have known better. The website of the Aeolis Hotel looked superb, the price was right, and when I read a review of the place on Trip Advisor, which claimed the hotel offered “5 stars rooms,” I was sold.

But when I showed up at this hotel with my family a couple weeks ago and saw the pool (see photo above), I immediately knew we were in for some surprises. It was a tiny little affair, completely surrounded by the building on three sides, with just a couple feet of walking space. Clearly the hotel had a very clever photographer who was able to mask how humble this little pool was.

Our “junior suite” was advertised on the website as a “spacious suite” with a Simmons mattress but was, in fact, cramped and featured a bizarre, broken bed canopy that was hanging by a thread, drooping into our faces (see photo below) and an old mattress about as comfortable as a bed of nails. Shortly after checking in, I logged back into Trip Advisor to read the “5 stars” review that had stuck in my head. The review, allegedly written by one David Lockett from Liverpool, England, is pasted here in its entirety:

“Excellent holidays in this hotel”
Reviewed March 20, 2010
it is an excellent hotel with comfortable 5 stars rooms and bathrooms. The breakfast was very good, and so was the service.The owener was very friendly and cooperative. My family and I are looking forward visiting again the hotel this summer!Why hadn’t I noticed that this was the only review “David Lockett from Liverpool” had written on Trip Advisor? How had I not noticed the broken English? Clearly someone affiliated with the hotel wrote this review but I hadn’t caught the deception on first glance. After suffering through this hotel’s appalling breakfast for four mornings, I was 100 percent certain the review was false because no one in the their right mind would make a point of commending the Aeolis’s breakfast.

Trip Advisor claims that it monitors reviews and attempts to weed out bogus ones but they obviously miss some, including this one. Additionally, they refused to publish my review of this hotel because I referred to the bogus review from “Liverpool.” On the other end of the spectrum, they also cave in to business owners in removing negative reviews without justification.

Two years ago, I left a negative review for a truly awful Mexican restaurant in Big Fork, Montana. Trip Advisor published the review but days later it, and 3-4 other awful reviews from other diners were mysteriously all gone. If you look at this restaurant’s reviews on Trip Advisor now, they’re all 4 and 5 stars, apparently because the owner somehow intimidated TA into deleting the negative ones.

I complained at the Aeolis hotel in Naxos and was offered a 5-euro per night discount and, in fairness to this hotel, the place was adequate for the price we paid. It just wasn’t nearly as nice as the website and the bogus review I’d stumbled across suggested. I’ve been burned by deceptive websites and bogus reviews on many occasions. Here are a few tips to try to avoid a similar fate.

Don’t assume the hotel will be as nice as it looks on the website. Photographers know how to use wide-angle lenses to make things appear more spacious than they are. Be suspicious of hotels that show photos of just a fraction of their pool. Several years ago, my wife and I stayed at a place called Enchanted Waters on the island of Tobago, and were sucked in by a photo of a seemingly luxurious pool with a waterfall next to it.

The reality turned out to be a very small little pool with a non-functional waterfall that was situated right next to be a very busy road. Take website photos with a massive grain of salt and also be very suspicious of hotels that show photos of everything but their actual guest rooms.

Look at the traveler photos on Trip Advisor for an unvarnished look at the hotel. Clicking through the traveler photos on TA can be tedious, as some people put up extraneous photos of themselves posing with iguanas and other nonsense that does nothing to inform one’s hotel selection decision. But you can also see the reality of what you’re getting into, unedited by hotel management. If we had looked at the traveler photos of Enchanted Waters on TA, we never would have booked there.

Ask if there are specific photos of the room you’ll be staying in. If you’re staying in a big chain hotel, chances are there isn’t much variation in rooms, but if you’re staying at a smaller, independent place, the differences between rooms can be very significant. Many hotels will just vaguely say, “Look at our website,” but try to pin them down more if you can.

Last week, I booked a “family room” at the Halepa Hotel in Hania, Crete, and was enticed by the photo you see on the right. But when we checked in, we were given two rather small, very ordinary looking connecting rooms that were nothing like the photos we saw that were labeled “family room.”

“We have lots of different family rooms,” the manager said.

When I pointed to the photo of the family room I saw on booking.com they said, “Oh, that’s a mistake, that is our executive VIP suite.” False advertising to be sure, but if I had to do it over again, I would have asked them if the photo I was looking at was indeed the suite I’d be getting.

Use Google Maps and Google Earth to pinpoint the location, not the hotel website. Almost every hotel claims to have a central location but in some cases, a place will claim they’re a ten minute walk from the center, when in fact, Usain Bolt couldn’t sprint there in ten minutes. Also, use Google Earth and user reviews of the place to determine if the area is pedestrian friendly and if the walk might be uphill or unpleasant in some other way.

Read the 1 and 2 star reviews of the place on Trip Advisor and disregard 5 star reviews from users with only 1 review. Let’s face it, some people are never satisfied and they trash nice hotels online for bizarre reasons. Read through the bad reviews and determine if their complaints are pertinent to you. If reviewers note that the place is not how it appears on the website, be very leery. Likewise, it’s probably safe to disregard glowing 5 star reviews from reviewers that haven’t reviewed anything else on Trip Advisor.