Rabies

Rabies is a deadly viral disease that attacks the brain and nervous system, but it can be completely prevented if you get medical treatment quickly after being bitten or scratched by an infected animal.

Table of contents

• What is rabies
• How rabies spreads
• Animals that carry rabies
• Symptoms of rabies
• How rabies affects your body
• Global impact and risk
• Treatment after exposure
• Prevention

What is rabies

Rabies is a viral disease that attacks the central nervous system (the brain and spinal cord). The disease is caused by the rabies virus, which belongs to a group of viruses called lyssaviruses. Once symptoms appear, rabies is nearly always fatal, with close to 100% of cases ending in death.^[1][2]

The good news is that rabies is completely preventable. If you receive proper medical treatment quickly after being exposed to the virus, you can stop the disease from developing. This makes rabies one of the few deadly diseases that medical care can fully prevent, as long as treatment begins before symptoms start.^[1]

The time between when the virus enters your body and when symptoms appear is called the incubation period. This period usually lasts from one to three months, but it can be as short as less than one week or as long as more than one year. The length of this time depends on how far the virus must travel along your nerves to reach your brain.^[5][4]

How rabies spreads

The rabies virus spreads primarily through the saliva of infected animals. The most common way people get rabies is through a bite from an infected animal. The virus can also spread if an infected animal scratches you, or if its saliva gets into your eyes, nose, mouth, or an open wound on your skin.^[1][4]

When the virus enters your body through a bite or scratch, it doesn’t immediately make you sick. Instead, it travels very slowly along your nerves toward your brain and spinal cord. This slow journey is why there is time to get preventive treatment after exposure. However, once the virus reaches your brain, it causes severe damage that leads to the symptoms of rabies.^[4]

It’s important to know that you cannot get rabies from touching dried saliva or blood, and the virus does not spread through intact skin. Animals like reptiles, amphibians, birds, fish, and insects cannot get or spread rabies.^[8]

Animals that carry rabies

Any mammal can get rabies, but some animals are more likely to carry the disease than others. The animals most commonly infected vary depending on where you live in the world.^[1]

In the United States, more than 90% of reported rabies cases in animals occur in wildlife. The most common wild animals found with rabies include bats, raccoons, skunks, and foxes. Bats are particularly important because contact with infected bats is the leading cause of human rabies deaths in the United States. At least seven out of 10 people who die from rabies in the U.S. were infected by bats.^[1][3]

Dogs rarely have rabies in the United States thanks to effective vaccination programs. However, worldwide, domestic dogs are responsible for more than 95% of human rabies cases. In Asia, Africa, and parts of Central and South America, dogs are the main source of rabies infections in people. These areas account for 95% of human rabies deaths globally.^[2][5]

Some small animals almost never get rabies. Rabbits and small rodents such as squirrels, chipmunks, rats, mice, guinea pigs, gerbils, and hamsters very rarely carry the disease. While it is possible for these animals to get rabies in rare circumstances, such as if they are attacked but not killed by a rabid animal, the risk is extremely low.^[8]

Symptoms of rabies

During the incubation period, before the virus reaches your nervous system, you will have no symptoms at all. This is the time when treatment is most effective at preventing the disease.^[4]

The first symptoms of rabies often feel like the flu. These early symptoms, which appear when the virus has entered your nervous system, may include:^[1][4]

• Fever
• Tiredness and weakness
• Headache
• Muscle pain
• Nausea and vomiting
• Cough and sore throat
• Burning, itching, tingling, pain, or numbness at the site where you were bitten

These early symptoms typically last between two and 10 days. After this initial period, more severe symptoms develop as the virus damages your brain and spinal cord. There are two main forms of advanced rabies symptoms:^[4][5]

Furious rabies affects about two-thirds of people with rabies. Symptoms include extreme agitation, aggression, confusion, hallucinations (seeing or hearing things that aren’t there), excessive saliva production, difficulty swallowing, seizures, and an intense fear of water. This fear of water happens because trying to swallow causes painful spasms in the throat. Furious rabies symptoms may come and go with periods of calm in between, and this phase typically lasts a few days to a week.^[4][5]

Paralytic rabies causes weakness and paralysis that starts at the site of the bite and gradually spreads throughout the body. This form can last up to a month. Many people with rabies eventually fall into a coma before death occurs.^[4]

How rabies affects your body

Understanding how rabies progresses through the body helps explain why early treatment is so critical. The disease moves through several distinct phases:^[4]

During the incubation phase, the virus can spend anywhere from days to weeks in your body before entering your nervous system. You have no symptoms during this time. If you receive treatment during this phase, the virus will not develop into rabies disease.^[4]

The prodromal phase begins when the rabies virus enters your nervous system and starts traveling through your nerve cells toward your brain and spinal cord. Your immune system tries to fight back, which causes the flu-like symptoms described earlier. The virus also damages nerves as it travels, which can cause unusual sensations at the bite site. This phase lasts two to 10 days, and there are no effective treatments once rabies reaches this stage.^[4]

In the acute neurologic phase, the virus reaches your brain and spinal cord and begins causing severe damage. This is when the distinctive symptoms of furious or paralytic rabies appear. Furious rabies can last a few days to a week, while paralytic rabies can last up to a month.^[4]

Finally, many people enter a coma in the final stages of rabies infection. Without the most intensive medical support, death typically occurs within two to three days after coma begins.^[4][7]

Global impact and risk

Rabies is a serious public health problem in more than 150 countries and territories, mainly in Asia and Africa. Globally, an estimated 59,000 people die from rabies each year. This makes it one of the deadliest infectious diseases in the world. Children are particularly vulnerable, with 40% of rabies deaths occurring in children under 15 years old.^[2][4]

The economic burden of rabies is enormous, estimated at around 8.6 billion dollars per year. This includes the cost of lost lives and livelihoods, medical care, and other associated costs, as well as psychological trauma that cannot be easily calculated.^[2]

The situation varies dramatically between different parts of the world. In the United States, human rabies is rare, with fewer than three people dying from rabies each year. However, about 60,000 to 100,000 Americans still receive vaccination treatment after potential rabies exposure each year. In the U.S., more than 90% of animal rabies cases occur in wildlife rather than domestic animals.^[1][4]

The picture is very different in developing countries, particularly in rural parts of Asia and Africa. In these regions, dog bites cause 99% of human rabies cases. Access to preventive treatment after exposure may be difficult to obtain, and the cost of treatment can be unaffordable for many people in need. As of 2018, the average estimated cost of rabies treatment after exposure was 108 U.S. dollars, which represents a significant financial barrier for many people in affected regions.^[2]

Since 1990, more than 80 people in the United States have died after being infected with rabies during travel to other countries. This highlights the importance of being cautious around animals when traveling internationally, especially in areas where rabies is common in dogs.^[1]

Treatment after exposure

If you have been bitten or scratched by an animal that might have rabies, immediate action can save your life. There are three critical steps to take:^[1][10]

First, wash the wound immediately and thoroughly with soap and water for at least 15 minutes. This physical washing can remove the virus before it enters your body. Follow with an antiseptic solution if available, but don’t delay the water rinse to search for one.^[1][17]

Second, seek medical attention right away, even if the bite seems minor. Do not wait until you get home if you are traveling abroad. Healthcare professionals will assess your risk and determine whether you need treatment. In the United States, you should ask for an urgent appointment with your doctor, call a healthcare helpline, or go to an emergency department.^[1][15]

Third, report the bite to your local animal control department. This helps authorities track and observe the animal that bit you, which is important for determining your treatment needs.^[1]

Once a rabies infection is established and symptoms appear, there is no effective cure. However, if you receive treatment before symptoms start, the disease can be prevented. This treatment is called post-exposure prophylaxis or PEP, and it is nearly 100% effective when given properly and promptly.^[1][2]

Post-exposure prophylaxis includes several components. After thorough wound washing, you will receive a fast-acting shot called human rabies immune globulin (HRIG). This provides immediate protection by giving your body antibodies that can fight the virus right away. The immune globulin is injected into and around the wound if possible, as soon as possible after the bite. This step is crucial for people who have not been previously vaccinated against rabies.^[10][13]

You will also receive a series of rabies vaccine injections. The vaccine helps your body learn to identify and fight the rabies virus, providing long-lasting protection. If you have never had the rabies vaccine before, you will receive four injections over 14 days (on days 0, 3, 7, and 14). If you have previously been vaccinated against rabies, you will need only two vaccine injections over the first three days. The vaccines are given as injections in your arm, or in the thigh for young children.^[10][12]

Sometimes, if the animal that bit you can be found and observed or tested, treatment may be stopped if the animal is proven not to have rabies. This is why reporting the incident to authorities is so important.^[1]

Some people who are at high risk of rabies exposure may receive vaccination before any exposure occurs. This pre-exposure prophylaxis is recommended for people who work with rabies virus in laboratories, veterinarians, animal control workers, and people traveling to areas where rabies is common, especially if they will be in remote areas where treatment might not be readily available. Pre-exposure vaccination does not eliminate the need for treatment after a bite, but it simplifies the treatment by eliminating the need for immune globulin and reducing the number of vaccine doses required.^[12][14]

Prevention

The best way to protect yourself from rabies is to avoid contact with animals that might carry the disease. Here are important steps you can take:^[1][8]

Never feed or touch wild animals, stray dogs, or stray cats. Keep your distance from any wild animal, even if it appears friendly or injured. Animals with rabies may act unusually tame or affectionate, which is actually a sign of illness. Wild animals that are normally active at night but appear during the day should be treated with extra caution.^[1][8]

Make sure your pet dogs, cats, and ferrets are up to date on their rabies vaccinations. Vaccination protects your pets if they encounter a rabid animal. Pets that are too young to be vaccinated should be kept indoors and allowed outside only under direct observation. Keep family pets indoors at night and do not let them roam free.^[1][8]

Make your home and yard less attractive to wild animals. Don’t leave pet food outside, keep garbage cans tightly sealed, and secure any openings to your attic, basement, porch, or garage. If wild animals are living in parts of your home, consult with a wildlife control expert about having them removed safely.^[8]

Teach children never to touch any animal they don’t know and to tell an adult immediately if they are bitten or scratched by any animal. Children are more likely to get rabies than adults because they may not report bites and scratches, and they often interact more closely with animals.^[1][8]

If you are traveling to other countries, find out before you go whether rabies is present in dogs or wildlife at your destination. When traveling, keep your distance from wild animals and unfamiliar dogs and cats. Do not feed any animals, including in zoos or animal sanctuaries. Consider getting pre-exposure vaccination if you will be traveling to areas where rabies is common, especially if you will be in remote locations or staying for more than a month.^[1][15]

At a community and global level, controlling rabies in animal populations is the most effective way to prevent human cases. Mass vaccination of dogs is particularly important in areas where dogs are the main source of human rabies. Health organizations worldwide are working toward the goal of eliminating human deaths from dog-transmitted rabies through comprehensive programs that combine dog vaccination, public education about preventing bites, improved access to treatment after exposure, and better disease surveillance.^[2]