What is rabies and how do you avoid getting it?

A grandmother from South Yorkshire has died from rabies after returning from a holiday in Morocco, where she was scratched by a puppy with the virus.

Yvonne Ford, 59, from Barnsley, visited the North African country in February but only became ill two weeks ago. Her family now want to raise awareness about the virus.

What is rabies? Rabies is a virus transmitted between mammals, nearly always through bites and scratches from an infected animal. Rabies is always fatal once symptoms appear - even if someone is treated for it - but post-exposure treatment is very effective if given quickly enough.

How rare is it? Although cases in UK travellers are very rare, rabies is endemic in many parts of the world, including popular holiday destinations such as Morocco, Turkey, India, Thailand, the Philippines and Indonesia. While most developed countries are considered safe, the government says there is a risk from rabies in foxes in some European countries.

Since 1946, 26 cases have been reported in the UK. The most recent incident involved a person bitten by a cat in Morocco in 2018.

The only domestic case was in Scotland in 2002 when a person was bitten by a bat. There are around 59,000 cases of rabies globally each year, but there have been no incidents of human-to-human transmission.

How do you get infected? Rabies is usually transmitted to humans through the bite or scratch of an infected animal, most often dogs, but also cats and bats. Even a minor scratch can pose a risk, but there is also a risk of transmission where the animal has licked the eyes, nose or mouth, or a wound.

What if you are bitten, scratched or licked? Immediate medical help is essential. Anyone who is bitten, scratched or licked by an animal abroad should wash the site with plenty of soap and water and contact a doctor or medical centre.

The NHS says the same applies for people who are bitten or scratched by a bat in the UK. Treatment, called post-exposure prophylaxis (PEP), includes a course of rabies vaccinations and, in some cases, rabies immunoglobulin.

What are the symptoms? Once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. Initially, people with the virus may exhibit flu-like symptoms, which develop into a fever, headache, nausea, vomiting, agitation, anxiety, difficulty swallowing and excessive saliva.

Spasms of the muscles used for swallowing make it difficult for the patient to drink and people can suffer hallucinations and paralysis. The incubation period between being infected and showing symptoms is typically between 3 and 12 weeks, but can it can be as soon as a few days and can take many months.

How do you avoid rabies? It is possible to get the vaccination before travelling abroad, but anyone who is bitten, scratched or licked is still advised to seek help even if they have had a course of jabs. The NHS says the rabies vaccine is recommended for anyone travelling to a part of the world where rabies is more common, especially if they're going somewhere where it may be hard to get medical help quickly; they might come into contact with infected animals (for example by doing lots of outdoor activities like cycling or running), or they're staying for over a month.

But the rabies vaccine for travel is not available on the NHS meaning it will require a visit to a travel health clinic or pharmacy with travel health services. Dr Chris Smith, clinical associate professor at the London School of Hygiene & Tropical Medicine (LSHTM), said that while treatments are "highly effective when started early.