Rabies

What is rabies?

R abies is a preventable, widespread, viral infection of certain warm-blooded animals. It attacks the nervous system. Once symptoms develop, it's almost always fatal.

I n North America, rabies occurs mainly in skunks, raccoons, foxes, coyotes, and bats. In some areas, these wild animals infect pet cats and dogs, and livestock. In the U.S., cats are more likely than dogs to be infected (rabid).

Each state keeps information about animals that may carry rabies. It’s best to check for specific information in your local area if you aren't sure about a certain animal and have been bitten. Generally, rabies is rare in small rodents. These include beavers, chipmunks, squirrels, rats, mice, or hamsters. It's also rare in rabbits. The reason for this is that an animal generally has to be attacked by a rabid animal to contract rabies. Smaller animals are less likely to survive this type of attack and go on to develop rabies. In the mid-Atlantic states, rabies is increasing in raccoons. Groundhogs in this area can also be infected.

IIn developing countries, household pets are often not vaccinated against rabies. People traveling to these countries should talk with their healthcare provider about getting the rabies vaccine before their trip.

What causes rabies?

The rabies virus enters the body through a cut or scratch. Or it enters through mucous membranes, such as the lining of the mouth and eyes. The virus then travels to the central nervous system. Once the infection is in the brain, the virus travels down the nerves from the brain. It multiplies in different organs.

The salivary glands are most important in spreading rabies from one animal to another. When an infected animal bites another animal, the rabies virus is spread through the infected animal's saliva. Scratches by claws of rabid animals are also dangerous because these animals lick their claws.

Who is at risk for rabies?

Rabies is mainly spread when an infected animal bites a person and exposes them to infected saliva. In rare cases, rabies has been reported from nonbite exposures. These include being exposed in labs when the virus is being handled. Or by breathing in infectious particles in bat caves. In other rare cases, the virus has been spread during an organ or tissue transplant from an infected donor. In the U.S., this risk is reduced because of strict organ and tissue donation guidelines. And because rabies is extremely rare in humans.

If a person has been bitten by a rabid animal or exposed to infected tissue or saliva, it is very important to see a healthcare provider right away. The provider will figure out what treatment is needed.

Petting or handling a rabid animal is not considered an exposure. Having contact with infected urine, blood, or stool is also not considered an exposure. Environmental factors, such as temperature and sunlight, affect how fast the virus will become inactive. The rabies virus can’t be spread when it dries out and when it is exposed to sunlight. Always contact your healthcare provider to figure out your exposure risk and if treatment is needed.

What are the symptoms of rabies?

The time between your exposure to rabies and when the first symptoms appear (incubation period) can range from 5 days to more than a year. But the average is about 2 months. Symptoms may include:

Rabies: Stage 1	Rabies: Stage 2
Early period of vague symptoms, lasting 2 to 10 days Vague symptoms may include fever, headache, general discomfort (malaise), decreased appetite, or vomiting Pain, itching, or numbness and tingling at the site of the wound	People often have trouble swallowing (sometimes called "foaming at the mouth") due to the inability to swallow saliva. Even the sight of water may terrify the person (hydrophobia) Some people become agitated and disoriented, while others become paralyzed Immediate death, or coma resulting in death from other complications, may result

The symptoms of rabies may look like other conditions or health problems. Always see your healthcare provider for a diagnosis.

How is rabies diagnosed?

In animals, the direct fluorescent antibody test done on brain tissue is most often used to find rabies. In a few hours, diagnostic labs can figure out if an animal is infected. They provide this information to healthcare professionals. These results may save a person from going through treatment if the animal is not infected. This can only occur if the animal is known or captured.

Several tests are needed to confirm or rule out rabies in people. No single test can be used to rule out the disease for sure. Tests are done on samples of serum, saliva, and spinal fluid. Skin biopsies may also be taken from the back of the neck.

What is the treatment for rabies?

Unfortunately there is no known, effective treatment for rabies once symptoms of the disease appear. But there are effective vaccines that provide immunity to rabies when given soon after an exposure. They may also be used for protection before an exposure happens. They may be used for people such as veterinarians and animal handlers.

If you or someone you know is bitten by an animal, get medical care right away. Remember these facts to report to your healthcare provider:

Where the incident occurred
Type of animal (domestic pet or wild animal)
Type of exposure (cut, scratch, licking of open wound)
Part of the body affected
Number of exposures
If the animal has been immunized against rabies
If the animal is sick or well (if sick, what symptoms the animal had)
If the animal is available for testing or quarantine
The incidents that led up to the bite. Was the bite provoked or unprovoked? Unprovoked bites are more concerning for rabies

For bites or puncture wounds from any animal, or for any bite from a strange animal:

If the bite or scratch is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding.
Wash the wound with soap and water under pressure from a faucet for at least 5 minutes. Don’t scrub as this may bruise the tissue.
Dry the wound and cover it with a sterile dressing. Don’t use tape or butterfly bandages to close the wound. This could trap harmful bacteria in the wound.
Call your healthcare provider right away for guidance in reporting the attack. Also find out if more treatment is needed. This includes antibiotics, a tetanus booster, or rabies vaccine. This is especially important for bites on the face, hands, or feet, or for bites that cause deeper puncture wounds of the skin. It is also important for all cat bites that have a high rate of infection.
If possible, find the animal that caused the wound. Some animals need to be captured, confined, and watched for rabies. Don’t try to capture the animal yourself. Contact the nearest animal warden or animal control office in your area.
The affected person may need a series of rabies shots and a dose of rabies immunoglobulin. This may be the case if the animal can’t be found or is a high-risk animal (raccoon, skunk, or bat). Or if the animal attack occurred without any cause (was unprovoked).

Call your healthcare provider for any flu-like symptoms following an animal bite. This includes fever, headache, general feeling of discomfort (malaise), decreased appetite, or swollen glands.

What are possible complications of rabies?

Once symptoms of rabies start, rabies most often leads to death.

Can rabies be prevented?

Being safe around animals, even your own pets, can help reduce the risk of rabies. Some general guidelines include the following:

Don’t go up to or play with wild animals of any kind. Know that pets may also be infected with the rabies virus.
Watch pets so they don’t come into contact with wild animals. Call your local animal control agency to remove any stray animals.
Don’t try to separate fighting animals.
Stay away from strange and sick animals.
Leave animals alone when they are eating.
Keep pets on a leash when out in public.
Choose family pets carefully.
Never leave a young child alone with a pet.
Leave all wildlife alone, including injured animals. Teach children to do the same. Contact local animal control officers for assistance. Never touch an injured animal.
Immunize all pet dogs and cats against rabies and keep shots current.
Make sure your animals wear rabies vaccine tags with the vaccine history, name, and your contact information.
Before traveling to countries where rabies is more common, check with your healthcare provider. Ask about the best strategy for rabies prevention.

When should I call my healthcare provider?

Call your healthcare provider right away if you have any of these:

A bite or scratch from a wild animal that has broken the skin. This might be from a raccoon or skunk.
A bite or scratch from a pet animal that has broken the skin, and you can't be sure that it has had a current rabies vaccine.
You or your child may have been scratched or bitten by a bat. Bites and scratches from bats may not be noticed, especially by children.

Key points about rabies

Rabies is a viral infection of certain warm-blooded animals. It attacks the nervous system. Once symptoms develop, it is fatal.
In North America, rabies occurs mainly in skunks, raccoons, foxes, coyotes, and bats. In some areas, these wild animals infect pet cats and dogs, and livestock.
Rabies is mainly spread when an infected animal bites a person and exposes them to infected saliva.
If you or someone you know is bitten by an animal, get medical care right away.
Several tests are needed to confirm or rule out rabies in people. No single test can be used to rule out the disease for sure.
There is no known, effective treatment for rabies once symptoms of the disease appear. But there are effective vaccines that provide immunity to rabies when given soon after an exposure.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.