The death from rabies of a British woman, bitten by a dog in Goa, reported in the news1 and in an article in this week's BMJ,2 highlights the issue of rabies prophylaxis for people who travel to and live in endemic areas. Rabies is an acute, incurable, viral encephalomyelitis caused by a bullet shaped RNA rhabdovirus.3 It is a zoonosis, an animal disease that is transmissible to humans. Worldwide, most of the 30 000 to 70 000 human deaths annually result from dog bites, although cats and wild animals such as foxes, jackals, wolves, mongooses, racoons, skunks, and bats are the other culprits.4 5

Around 90% of deaths from rabies occur in the developing world, with more than half in the Indian subcontinent, where dogs that roam freely are largely responsible. The virus is transmitted through a transdermal bite or scratch, or by contamination with animal saliva of oral mucosa or skin wounds. The …