Overview
Rabies virus (RABV) is spread through direct contact with saliva or brain or nervous system tissue from an infected animal (for example, through a break in your skin or mucous membranes in your eyes, nose, or mouth). Although devastating, rabies can be avoided. If they are bitten or scratched by a rabid animal, it can spread to people and animals.
Bats, coyotes, foxes, raccoons, and skunks are among the animals most likely to spread rabies in the US. Stray dogs are most likely to infect people with rabies in underdeveloped nations.
The disease almost invariably results in death once rabies symptoms start to appear. For protection, rabies vaccinations should be given to anyone who could be at risk of catching the disease.
Symptoms
Several weeks after rabies has entered your body, you typically don’t experience any symptoms. You suffer flu-like symptoms when rabies reaches your central nervous system (prodromal phase). You get neurological (brain) symptoms in the latter phases.
Prodromal symptoms of rabies
- Fever.
- Tiredness (fatigue).
- Bite wound burning, itching, tingling, pain or numbness.
- Cough.
- Sore throat.
- Muscle pain.
- Nausea and vomiting.
- Diarrhea.
Acute neurologic symptoms of rabies
Neurological symptoms of rabies are either furious or paralytic. Furious rabies symptoms may come and go with periods of calm in between (furious episodes).
Furious rabies symptoms
- Agitation and aggression.
- Restlessness.
- Seizures.
- Hallucinations.
- Muscle twitching (fasciculations).
- Fever.
- Racing heart (tachycardia).
- Fast breathing (hyperventilation).
- Excessive salivation.
- Two different-sized pupils (anisocoria).
- Facial paralysis (facial palsy).
- Fear of water/drinking (hydrophobia).
- Fear of air being blown in your face/drafts (aerophobia).
- Delirium.
Paralytic rabies symptoms
- Fever.
- Headache.
- Neck stiffness.
- Weakness, especially starting from the body part that was bitten and progressing to other body parts.
- Tingling, “pins and needles” or other strange sensations.
- Paralysis.
- Coma.
How do you get rabies?
Warm-blooded animals (mammals) carry rabies, which builds up in their saliva (spit). The most common way to contract rabies is through an infected animal’s bite.
Although bats, skunks, raccoons, and foxes are the animals most frequently infected with rabies, other animals, such as your pet dog or cat, can also contract the disease. You could contract rabies if a break in your skin comes into contact with an infected animal’s spit.
Rarely have recipients of donated organs contracted rabies.
Causes
A rabies infection is brought on by the rabies virus. The virus is transferred via infected animals’ saliva. By biting another animal or a person, infected animals can transmit the virus.
When contaminated saliva contacts an open wound or mucous membranes, such as the mouth or eyes, rabies can, in rare instances, be transmitted. If an infected animal licked an open wound on your skin, this might occur.
Animals that can transmit the rabies virus
Any mammal (an animal that suckles its young) can spread the rabies virus. The animals most likely to spread the rabies virus to people include:
Pets and farm animals
- Cats
- Cows
- Dogs
- Ferrets
- Goats
- Horses
Wild animals
- Bats
- Beavers
- Coyotes
- Foxes
- Monkeys
- Raccoons
- Skunks
- Woodchucks
In very rare cases, the virus has been spread to tissue and organ transplant recipients from an infected organ.
Risk factors
Factors that can increase your risk of rabies include:
- Traveling or living in developing countries where rabies is more common
- Activities that are likely to put you in contact with wild animals that may have rabies, such as exploring caves where bats live or camping without taking precautions to keep wild animals away from your campsite
- Working as a veterinarian
- Working in a laboratory with the rabies virus
- Wounds to the head or neck, which may help the rabies virus travel to your brain more quickly
Prevention
To reduce your risk of coming in contact with rabid animals:
- Vaccinate your pets. Cats, dogs and ferrets can be vaccinated against rabies. Ask your veterinarian how often your pets should be vaccinated.
- Keep your pets confined. Keep your pets inside and supervise them when outside. This will help keep your pets from coming in contact with wild animals.
- Protect small pets from predators. Keep rabbits and other small pets, such as guinea pigs, inside or in protected cages so that they are safe from wild animals. These small pets can’t be vaccinated against rabies.
- Report stray animals to local authorities. Call your local animal control officials or other local law enforcement to report stray dogs and cats.
- Don’t approach wild animals. Wild animals with rabies may seem unafraid of people. It’s not normal for a wild animal to be friendly with people, so stay away from any animal that seems unafraid.
- Keep bats out of your home. Seal any cracks and gaps where bats can enter your home. If you know you have bats in your home, work with a local expert to find ways to keep bats out.
- Consider the rabies vaccine if you’re traveling or often around animals that may have rabies. If you’re traveling to a country where rabies is common and you’ll be there for an extended period of time, ask your doctor whether you should receive the rabies vaccine. This includes traveling to remote areas where medical care is difficult to find.
What should I do if I’ve been bitten by an animal?
- Wash the wound right away with soap and water. Use a 10% povidone-iodine solution if available.
- Contact a healthcare provider or your department of public health as soon as possible. Tell them what happened and give them as much information as you know about the animal. (Was it a wild animal or a pet? What kind of animal was it? How was it acting?)
- Ask your healthcare provider how best to clean the wound and whether you need a rabies vaccine.
- If you’ve been attacked by an aggressive wild animal, contact animal control.
Rabies Postexposure Prophylaxis
| Animal Type | Evaluation and Disposition of Animal | Postexposure Prophylaxis* |
|---|---|---|
| Skunks, raccoons, bats,† foxes, and most other carnivores | Regarded as rabid unless proved negative by laboratory tests‡ | Consider immediate vaccination and rabies immune globulin. |
| Dogs, cats, and ferrets | Healthy and available for 10 days of observation | Do not begin immunoprophylaxis unless animal develops symptoms of rabies.§ |
| Unknown (escaped) | Consult public health officials.¶ | |
| Rabid or suspected rabid | Vaccinate immediately.Give rabies immune globulin. | |
| Livestock, small rodents (eg, squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice), lagomorphs (rabbits, hares), large rodents (eg, woodchucks, beavers), and other mammals | Considered individually | Consult public health officials.Immunoprophylaxis is almost never required for bites of squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, other small rodents, or lagomorphs. |
| * Clean all bites immediately with soap and water. |
Diagnosis
There is no way to tell if an animal that may be rabid has bitten you has exposed you to the rabies virus. Also typical is the absence of bite marks. To determine whether you are carrying the rabies virus, your doctor may request a number of tests, some of which may need to be repeated later. If you have a probability of having been exposed to the rabies virus, your doctor would likely advise treatment as quickly as possible to avoid the rabies virus infiltrating your body.
Treatment
There is no cure for rabies once the infection has taken hold. Although a few people have managed to survive rabies, the illness usually results in death. Because of this, you must receive a series of shots if you believe you have been exposed to rabies in order to stop the disease from spreading.
Treatment for people bitten by animals with rabies
You’ll get a series of shots if you’ve been bitten by an animal known to have rabies to stop the rabies virus from infecting you. It may be best to assume that the animal that bit you has rabies if the animal that bit you cannot be located. However, this will depend on a number of variables, including the species of the animal and the circumstances surrounding the bite.
Rabies shots include:
- A fast-acting shot (rabies immune globulin) to prevent the virus from infecting you. This is given if you haven’t had the rabies vaccine. This injection is given near the area where the animal bit you if possible, as soon as possible after the bite.
- A series of rabies vaccinations to help your body learn to identify and fight the rabies virus. Rabies vaccinations are given as injections in your arm. If you haven’t previously had the rabies vaccines, you’ll receive four injections over 14 days. If you have had the rabies vaccine, you’ll have two injections over the first three days.
Determining whether the animal that bit you has rabies
In some cases, it’s possible to determine whether the animal that bit you has rabies before beginning the series of rabies shots. That way, if it’s determined the animal is healthy, you won’t need the shots.
Procedures for determining whether an animal has rabies vary by situation. For instance:
- Pets and farm animals. Cats, dogs and ferrets that bite can be observed for 10 days to see if they show signs and symptoms of rabies. If the animal that bit you remains healthy during the observation period, then it doesn’t have rabies and you won’t need rabies shots.Other pets and farm animals are considered on a case-by-case basis. Talk to your doctor and local public health officials to determine whether you should receive rabies shots.
- Wild animals that can be caught. Wild animals that can be found and captured, such as a bat that came into your home, can be killed and tested for rabies. Tests on the animal’s brain may reveal the rabies virus. If the animal doesn’t have rabies, you won’t need the shots.
- Animals that can’t be found. If the animal that bit you can’t be found, discuss the situation with your doctor and the local health department. In certain cases, it may be safest to assume that the animal had rabies and proceed with the rabies shots. In other cases, it may be unlikely that the animal that bit you had rabies and it may be determined that rabies shots aren’t necessary.