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Do I need rabies and tick-borne encephalitis vaccinations for Central Asia?

Posted: Fri Jun 09, 2017 6:28 am
by lissie45
No I'm not trolling! I'm trying very hard to make a call on getting vaccinated for Rabies pre-exposure and Tick-born encphelatis. They are rare diseases but are fatal and/or permanent paralysis.

Ive travelled for 30 odd years and never had them - but its been a long time I'm been as far from a modern hospital as we will be on our route. We're travelling from Xinfang to Krygistan - then Tajikistan, southern Kharzakistan , Uzbeckistan, across the Caspian to Azerbijan, Georgia and through to Turkey. We will arrive in Krygistan around 24 August - and will get to Turkey mid-October. We're be in China for about a month before.

So to figure out the risk I figured look at the main culprits - forests which house the ticks and dogs which are rabies infected. From the pictures I've seen of Krgyistan and Tajikistan I thought it was more grasslands than forest? Which parts of the country are forested. We aren't hard-core multi-day hikers - but we do plan on staying in yurts and doing day walks.

The rabies risk is more wide-spread - but how common are dogs? Do the roam as packs of strays like parts of SE Asia ? Both of us are confident around dogs and not stupid enough to be patting strange ones. Traditionally I wouldn't expect muslim-majority countries to be big into dogs - but not sure...

Any insight would be helpful - these are not cheap vaccines

Re: How Common are Forests and Dogs?

Posted: Fri Jun 09, 2017 9:59 pm
by sakara
I ll give you my view as a physician and traveller to those areas: dogs are common in all the countries you go to, except china. Muslim countries are probably among the countries with the most wild dogs (e.g. Morrocco, Tunisia). This is no protection. If you are a frequent traveller to rural areas I d probably recommend the rabies vaccination.

Tick born encephalitis is a rather rare disease. There is evidence of it in Kyrgizstan - e.g. in Ala Archa valley - a popular area for day trips close to Bishkek. Thus said, theres not too many forested areas you plan to visit east of the caspian.
The vaccination is recommended for people who a regularly outdoor in an endemic area. Based on what you plan to do, this seems rather not the case.

Giving medical advice ovef the internet is generally not very accurate. I ll therefore advice you to consult a specialist in travel medicine personally. Especially as you plan a longer trip and there might be more issues to think about.

Re: How Common are Forests and Dogs?

Posted: Sat Jun 10, 2017 3:35 am
by lissie45
Thanks Sakara - appreciate and know that advice on a forum is not a substitute for medical advice. We are seeing a specialist travel doctor in a couple of weeks - as you rightly note - there are other issues which we need to understand the risks around. I've been given the option of a Rabies vaccination before - and it is a head-scratcher.

Re: How Common are Forests and Dogs?

Posted: Mon Jun 12, 2017 9:03 am
by steven
Will tell you what I do: no rabies shot (if I see a dog I just back up slowly), but I do get a encephalitis booster shot every 3 years. I like to go hiking in the mountains for several days and I just want to feel secure.

If you are going as a couple, just for a single-day hike, dress up in long sleeves, not too far away from civilization: all things that make it less likely you will get a tick on you for the amount of time it takes for the virus to take hold.

Re: How Common are Forests and Dogs?

Posted: Fri Jun 16, 2017 11:31 pm
by sakara
Another thing that travellers should consider, is the measures that have to be taken in case of an animal bite and their logistical consequences:
If the patient has previously been vaccinated there will be 2 additional vaccine injections over 2- 3 days.
If the person was not previously vaccinated there will be 5 injections(basically over 15 days) + injections of immunoglobulines at day 0. Immunoglobulines are expensive and generally not available in rural areas. In the case of an animal bite the not vaccinated traveller will probably have to change his travel plans, go to a large city and stay close to healthcare for the next two weeks.
Staying away from dogs (and cats) is a good idea (not just because of rabies) - I do the same. But e.g. in Murghab there were dozens of dogs that came to us anyway...

And just for the interested ones: in contrast to the equally tick borne lyme disease, tick born encephalitis (RSSE in central asia, russia) is typically transmitted in the first minutes of the tick bite.

Anyway, even without the vaccinationa your chances of dying in a car accident or of a heart attack during the trip are much higher than getting infected. Personally I like to minimize risks - so I am vaccinated for both (but I also live in a tick born encephalitis endemic area).

Re: How Common are Forests and Dogs?

Posted: Sat Jun 17, 2017 1:46 pm
by steven
I also have to add: due to an exceptionally rainy spring, ticks are much more common this year than previously, even in non-foresty places like Altyn Emel NP ticks have been reported. Also, global warming is beneficial to tick populations in general. ... ate-change

Re: Do I need rabies and tick-borne encephalitis vaccinations for Central Asia?

Posted: Tue Jun 20, 2017 5:13 pm
by Seradane
We went for rabies vaccination but not encephalitis. The logic being that rabies is 100% fatal if contracted and you're not near a hospital that can treat it. Wheras encephalitis is both pretty rare and even if contracted has only (ha!) a 10-20% chance of permanent issues. Pretty awful of course but we also weren't going to be spending long periods of time out in the wilds so figured that was an acceptable risk.

Also if it makes a difference, when we were getting vaccinated for this trip it turns out the rabies vaccine which used to be a big, painful and expensive one-off shot now has an alternative option available that is three much smaller, not-very painful jabs which were a fair bit cheaper. There were some trade-offs (like more time required for the course) but that made the decision even easier.

We got vaccinated in Australia though so your mileage may vary in terms of that being available in your country.

Re: Do I need rabies and tick-borne encephalitis vaccinations for Central Asia?

Posted: Tue Jun 20, 2017 5:28 pm
by TomasS
I thought a lot about it during preparation of my trip and took both of them. I read one study about encephalitis (i think it was from czech university, you can google it), that convinced me, and there was something about two types of ticks, and the one living in central asia is potentialy many times more deadly. But there was a map and the really dangerous area was north of Almaty, especially Siberia.

Re: Do I need rabies and tick-borne encephalitis vaccinations for Central Asia?

Posted: Wed Jun 21, 2017 4:25 am
by lissie45
OK update time. The eastern encephalitis vaccine is unavailable in New Zealand - dr advised to ensure we covered legs and feet when walking in tick-prone areas. We are doing the rabies pee-exposure as the chance of getting the immunoglobulin shot in Central Asia if we did need it would be low to zero in Central Asia. Cost is NZ$140 per a shot. At least it's a one off cost as it's considered cover for life for travellers.

Also, and I'd not thought of this, we're getting Hep B (already have A) - the reasoning is that although we are unlikely to be having unprotected sex or tattoos - we maybe exposed if we were in an accident and ended up in hospital. Again its 3 shots - $40/pop for that.