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Rabies is definitely present in Nigeria, even in cities. There have been cases where pets have developed rabies in compounds where missionaries live, and even in the homes of missionaries. Someone who is exposed to rabies and has not been previously immunized is supposed to be given human rabies immune globulin (HRIG) immediately, along with 5 doses of rabies vaccine over one month. A previously immunized person only needs two booster doses and no HRIG. HRIG is pre-formed human antibodies to rabies that can go right to work against the rabies virus without waiting for the person to respond to a vaccine by producing his own antibodies.
As far as I know, HRIG is not available in Nigeria, or at least is not at hand here in Jos. That means that in case of rabies exposure, an unimmunized person would either have to be evacuated to where HRIG was available, or HRIG would have to be brought in, or a less-than-optimal treatment would be given, with some increase in risk of contracting rabies. It's the sort of thing that is hard to quantify as far as risks are concerned, but the expert opinion favors pre-exposure prophylaxis (vaccine before travel) for people who face possible exposure in rabies-endemic areas where there is not good access to post-exposure prophylaxis. The CDC site says, "Preexposure rabies prophylaxis is administered for several reasons. First, although preexposure vaccination does not eliminate the need for additional therapy after a rabies exposure, it simplifies management by eliminating the need for RIG and decreasing the number of doses of vaccine needed -- a point of particular importance for persons at high risk for being exposed to rabies in areas where immunizing products might not be available or where lesser quality biologics might be used placing the exposed person at increased risk for adverse events. Second, pre- exposure prophylaxis might protect persons whose postexposure therapy is delayed. Finally, it might provide protection to persons at risk for unapparent exposures to rabies." (Rabies Prevention and Control) The CDC recommends pre-exposure prophylaxis for "Veterinarians, animal control and wildlife workers in areas with low rabies rates; veterinary students; and travelers visiting areas where rabies is enzootic and immediate access to appropriate medical care, including biologics, is limited." (Travelers' Health: Yellow Book, section on rabies ). |
