Recently I was bitten by a dog in Siem Reap. It was a dog who was known to me, a dog I had pet with no issue a few days before, and a dog I was fairly certain had received at least one rabies vaccination a couple of years earlier. But the bite broke the skin, there was a little bit of blood, and I was yet again faced with the question, do I really need to get more rabies shots?
This is a question that many people living in and visiting Cambodia have. The hassle of getting a series of rabies shots can seem onerous, and the risk miniscule. But after talking to friends and a few friendly doctors, I quickly came to realize that rabies is one of the few illnesses that you don’t want to mess around with.
Although Cambodia has committed to eradicating rabies by 2030 (an extremely ambitious and probably unattainable goal) it is still a high-rabies country where the disease is prevalent. This is why you need to get treatment if you get bitten, even by a dog that is known to you, and even if it’s just a scratch. Although this post focuses on dogs, you can also get rabies from any mammal, including cats, monkeys, and bats.
I went from being quite cavalier about my little bite to being a frightened doomsayer after reading about the death of a 23-year-old French expat who was bitten while feeding a stray dog in Kep. She went to a doctor in Kampot who cleaned the wound and gave her an injection (it is unknown what he gave her, but it is believed to have been a tetanus injection). She returned to the doctor a month later for wound care, and he again cleaned it and sent her home. A few days later she started showing symptoms of rabies: diarrhea, vomiting, difficulty swallowing, high fever, hypersalivation and what is known as hydrophobia. A day later she was dead.
Rabies is 100% fatal once you start showing symptoms, at which point treatment is not possible. What is so sad about the young woman in Kep is she did seek treatment, and had she been given the post-exposure rabies injections she would be alive today. This may be one of the few stories of foreigners getting rabies, but Cambodians die of rabies every year. Children are particularly susceptible, probably because they are more likely to get bitten by dogs.
Dr. Nick Walsh, MD PhD and public health expert, says “Rabies is potentially fatal, and treatment is limited, so vaccination is strongly recommended where rabies is present in the animal (dogs, bats, monkey) population.”
So what can you do? Nick advises that if you aren’t vaccinated and get bit or otherwise exposed, you should:
- Clean the wound thoroughly with antiseptic, e.g. iodine
- Get an immediate rabies immunoglobulin infiltration around the wound site
- Follow the full vaccination schedule, with the first within 24 hours, and the following at 3, 7, and 14 days
If you have already been vaccinated when you’re exposed:
- Clean the wound thoroughly with antiseptic e.g. iodine
- Get two does of the vaccination, the first within 24 hours and the next at 3 days after exposure
Get pre-exposure vaccinations. You can do this before you come to Cambodia (the series costs $34 at the Pasteur Institut, or once you arrive. Get a booster if you’ve had your pre-exposure shots more than 3-5 years ago. You can get a titre test to check your antibody level — some people only need boosters every 10 years.
Don’t pet stray dogs and be wary of dogs that aren’t stray but spend a lot of time on the street. They’re more likely to have been exposed to rabies, and most have had bad experiences with people and thus are more likely to bite.
If you have a dog in Cambodia, make sure they are up-to-date with their rabies vaccinations.
Where to get rabies vaccinations in Cambodia
Phnom Penh’s Pasteur Institute is the gold standard. Only $15 total for both shots, the clinic is efficient and best of, reliable. You can be certain they aren’t giving you vaccinations that are expired or haven’t been kept at the right temperature. You can walk-in between 8 and 10 a.m., and the earlier you arrive the more quickly you will be treated.
Dr. Gavin Scott, a British physician, also offers pre- and post-exposure rabies vaccinations in Phnom Penh. The cost is $65 each, and he’s also available to talk to you about other tropical diseases or STIs.
I also called Phnom Penh Royal Hospital, just for a laugh. This hospital’s pricing is designed to take advantage of people’s insurance policies, and is to be avoided if you are paying yourself. We were quoted $300 for a series of rabies injections, plus you’re required to see a doctor first that costs an additional $200.
In Sihanoukville, I have gotten post-exposure vaccinations at CT Clinic, where they charge $45 per injection (although the price has probably gone up since then).
In Siem Reap, I have gotten post-exposure vaccinations at Neak Tep Clinic, who charge $45 per injection. They are another reliable clinic that is popular with locals and expats.
A friend recently called around the clinics in Siem Reap and said that Prasat Keo on Wat Bo, was the least expensive in town, at $20 per shot.
In Kampot, Sonja Kill Hospital allegedly offers rabies vaccinations, but when I called they weren’t sure if they had any, and weren’t certain of the price.
Please do not take this post as medical advice. I am not a medical professional! If you get bitten or otherwise worry you have been exposed to rabies, please see a doctor immediately.