Dear Bhutan Students and Parents:
We would like to call your attention to the rabies pre-exposure inoculation. Please reference the Bhutan Course Preparation Manual (mailed to you in hard copy and available on your MyDragons account) for the following response:
Q: Should we get the pre-exposure for rabies?
A: We strongly recommend it for this course, but please consult with a professional physician first. Rabies is a uniformly fatal disease transmitted by the bite of a rabid animal. In the developing world, dogs are the most common carriers of rabies. Rabies pre-exposure vaccine exists and is effective, but even with these vaccines, exposure to rabies requires follow-up therapy. The pre-exposure vaccination does not eliminate the need for additional therapy after a rabies exposure; however, it simplifies therapy by eliminating the need for human rabies immune globulin (HRIG). HRIG, suggested by the Center for Disease Control as part of the post-exposure treatment, is NOT AVAILABLE in many developing countries, and families who wish to treat potential exposure with HRIG may have to evacuate to a country where HRIG is available. Students who have been inoculated with the pre-exposure vaccine will most likely not need to evacuate the country if bitten. Students who have not been inoculated with the pre-exposure vaccine and who require evacuation will incur evacuation costs not covered by Dragons. Please note: Rabies pre-exposure vaccine involves a series of shots which need to be started at least a month before departure. Please make sure to plan accordingly. If you do not have time to complete the full series of pre-exposure shots before your departure to Nepal, you can receive the final pre-exposure shot in Nepal within the first week of your arrival in country.
Our experiences in Bhutan have shown that dogs are a prevalent risk that we actively mitigate through training and other proactive measures. However, we have also learned that in the case of a dog bite, HRIG is not readily available in Bhutan. Therefore, depending on the circumstances of the bite, students without the rabies pre-exposure inoculations would likely need to be evacuated to Nepal or another nearby country where HRIG is available. HRIG is administered according to body weight, and often costs $160 per milliliter, and students may require on average 10 ml of the drug, making the HRIG vaccination quite costly.
While Dragons cannot formally recommend any inoculation, we want to clearly communicate the benefits of the pre-exposure vaccine, available through any travel clinic and through most family physicians, since in the rare event of an animal bite it may allow a student to remain in-country without program disruption and additional expense.