Rabies Infection

Animal bites and scratches can lead to infections that spread inside your body. Some animals also carry diseases like rabies.

Rabies is a rare disease, but it doesn’t mean you shouldn’t take steps to protect yourself, your family and your pets. Read on to understand its causes, symptoms, treatment and steps you can take to prevent rabies.

What is rabies?

Rabies is a rare but very serious disease caused by the rabies virus (RABV). The virus spreads when the spit (saliva) or central nervous tissue of an infected animal gets into an open wound after a bite. With bats, however, a scratch can appear the same as a bite, so bat scratches are handled the same as a bat bite.

Rabies mainly affects your brain and spinal cord, which together make up your central nervous system. When you get infected by a rabid animal, the virus travels through the blood and can enter the brain. This is referred to as the incubation period and can last for weeks to months after a bite. Once in the brain, rabies can  result in flu-like symptoms like fever, headache, and weakness that will progress to severe neurologic changes. Once symptoms appear, rabies is almost always 100% fatal, therefore early risk assessment after an animal bite is crucial in preventing infection.

What animals carry rabies?

Any warm-blooded animal (mammal), including dogs and cats, can carry rabies if they are infected. However, the most common carriers of the rabies virus include:

• Bats - Contact with infected bats is the most common cause of human rabies deaths in the United States
• Raccoons
• Coyotes
• Skunks
• Foxes
• Stray dogs – dogs that are not vaccinated can carry rabies

Rabies is rarely seen in rodents such as mice, rats, squirrels, hamsters and rabbits. Birds, fish, turtles, lizards and insects cannot carry rabies.

What are the signs of rabies?

Once rabies symptoms start, there is no antidote (or cure) for it and it is almost always deadly. This makes it a serious concern in many parts of the world, including the United States. In developing countries, where it is harder to get health care, rabies is an even bigger concern.

If you or someone else gets in contact with rabies, it’s very important to seek medical attention right away. 

The time between getting infected and getting sick (incubation period) can vary from days to months. But if you get treatment soon after being exposed to rabies, you can avoid getting sick.

Symptoms often happen in stages and may include:

• Prodromal phase: At first, rabies may seem like the flu, with symptoms like fever, headache, muscle aches, and just feeling sick or tired. 
• Furious (neurologic) stage: This phase brings rapid changes, like becoming very angry (aggressive), confused, having trouble sleeping, and seeing or hearing things that aren’t there (hallucinations). People with rabies may “foam at the mouth” (make a lot of spit and have throat muscle spasms). This may also lead to fears of choking or drinking water (hydrophobia).
• Dumb (paralytic) stage: In this last stage, the patient’s muscles slowly stop working (paralysis). Eventually, they will fall into a coma, which can lead to death.

What to do if someone is exposed to rabies

If you or someone else has been bitten by an animal you believe may have rabies, do these things:

• Wash the wound: Clean it really well with soap and water for at least five minutes. This helps reduce the risk of infection. Cover the wound with a clean bandage.
• Contact your local health department immediately for assessment: Most health departments have a 24/7 hotline answered by specialty-trained pharmacists and nurses who will determine the likelihood of rabies transmission and/or the need for preventive therapy. If you are unable to contact the health department, immediately go to your closest ED (emergency department) for evaluation.
• Report the incident: Let your local health department (see above) and animal control know if you have been bitten or scratched by a stray or wild animal. This information helps track and prevent rabies outbreaks.

How is rabies treated?

If drug therapy is recommended to prevent infection, it is important to start treatment right away. A series of shots called post-exposure prophylaxis (PEP) can stop the virus from reaching your brain. PEP is recommended for everyone who may have rabies, even if they are vaccinated against it.

PEP includes:

• Rabies vaccine: You will get four shots over two weeks. If you have had the vaccine before your exposure to rabies, you’ll only need two shots. This vaccine helps your body learn how to stop the rabies virus from causing harm.
• Human rabies immune globulin (HRIG): These shots are given near the wound. The HRIG contains antibodies that give you fast protection.

Preventing rabies infection

Rabies is 100% preventable. Here are steps you can take to reduce your risk:

1. Vaccinate your pets: Keep your pets’ rabies shots up to date. It protects them and keeps them from spreading rabies to people.
2. Avoid wild animals: Don’t try to touch or handle wild animals, especially stray dogs, cats, bats, raccoons and skunks. Tell your local animal control if you see animals acting strangely.
3. Learn about rabies risks: Find out about the risk of rabies in your area. Children are often at higher risk, so make sure they know not to touch or feed stray cats and dogs and to stay away from wild animals.
4. Plan ahead for travel: If you are going to a place where rabies is more common, talk to your health care provider about pre-exposure prophylaxis (PrEP), a series of rabies vaccinations given before coming into contact with an infected animal. Most importantly, avoid any contact with wild animals while abroad.
5. Assume exposure: Bat bites are small and fade quickly. If you find a bat in your home, assume you have been bitten. Contact your health care provider about PEP.

Take action to prevent rabies

Rabies is a serious and deadly disease, but you can prevent problems with quick action and proper care. If you or someone else has been exposed to rabies, get immediate medical help and tell your local health department and animal control.