Rabies

What to do immediately after a bite or exposure

1. Wash the wound right away with soap and running water for at least 15 minutes. This greatly reduces the risk of rabies.
2. Apply an antiseptic such as povidone-iodine or alcohol if available.
3. Seek medical care the same day. Do not wait for symptoms.
4. Report the bite to local animal control or health authorities.
5. Note details about the animal: type, behavior, whether it is a pet, vaccination status, and where it is now.
6. Do not try to capture a wild animal yourself. If a bat is in your home and there may have been contact, safely confine it for testing without touching it, if possible.

How rabies spreads

The virus is in the saliva and nervous tissue of infected animals. It spreads through:

• bites, the most common route (see animal bites)
• scratches or licks on broken skin or mucous membranes (eyes, nose, mouth)
• rarely, organ or corneal transplants from infected donors

Bat bites can be tiny and painless, so people may not know they were bitten. Rabies does not spread through blood, urine, feces, or touching an animal's fur.

Which animals carry rabies?

Symptoms

After the bite, the virus travels slowly along nerves to the brain. Symptoms appear after the incubation period, usually 1 to 3 months.

Early (prodromal) phase

• fever, headache, tiredness and feeling unwell
• pain, tingling, itching or burning at the bite site
• anxiety

Acute neurological phase

Furious rabies (most common):

• agitation, confusion, hallucinations, aggression
• hydrophobia: violent throat spasms when trying to drink, so the person fears water
• aerophobia: spasms triggered by a breeze on the face
• excessive saliva, fever
• seizures

Paralytic rabies (about 20%):

• gradual weakness and paralysis starting at the bitten limb
• often mistaken for Guillain-Barré syndrome or other causes of paralysis

Both forms are a type of encephalitis and progress to coma and death, usually within days to a couple of weeks.

Diagnosis

Before symptoms there is no test to show whether a person is infected, which is why treatment decisions are based on the type of exposure and animal. Animals can be observed (healthy dogs, cats and ferrets for 10 days) or tested after euthanasia. In people with symptoms, tests on saliva, skin biopsy, spinal fluid and blood can confirm rabies.

Post-exposure prophylaxis (PEP)

For people who have never been vaccinated:

• wound cleaning
• human rabies immune globulin (HRIG): given once, with as much as possible infiltrated around the wound, to provide immediate antibodies
• rabies vaccine: 4 doses on days 0, 3, 7 and 14 (a fifth dose on day 28 for people with weakened immune systems)

For people previously vaccinated: 2 vaccine doses on days 0 and 3, without immune globulin.

PEP should start as soon as possible but is still recommended even if days or weeks have passed, as long as symptoms have not begun. The vaccines are given in the arm and are much less painful than the old stomach injections.

Treatment once symptoms start

There is no proven treatment. Care focuses on comfort and intensive support. Only a handful of people have survived, most with severe disability.

Prevention

• vaccinate dogs, cats and ferrets
• avoid contact with wild animals and stray dogs; teach children not to touch bats or unfamiliar animals
• bat-proof your home
• pre-exposure vaccination for veterinarians, animal handlers, cave explorers, lab workers and some travelers to high-risk areas
• seek PEP promptly after any significant exposure, and check your tetanus vaccination after any bite

Frequently asked questions

What should I do if I'm bitten by an animal?

Wash the wound immediately with soap and water for 15 minutes, apply antiseptic, and see a doctor the same day. Report the bite to animal control. Your doctor will decide whether you need rabies vaccine, immune globulin, a tetanus booster or antibiotics.

How long does it take for rabies symptoms to appear?

Symptoms usually appear 1 to 3 months after exposure, but it can be as short as a week or longer than a year. Bites closer to the head tend to have shorter incubation. Treatment should start as soon as possible after exposure, not after symptoms.

Is rabies always fatal?

Once symptoms appear, rabies is almost always fatal. However, rabies is nearly 100% preventable if the wound is washed and post-exposure vaccination is given promptly before symptoms start.

Do I need rabies shots if a bat was in my room?

Possibly, yes. Bat bites can be tiny and go unnoticed. If you wake up with a bat in the room, or a bat is found near a child, a sleeping or intoxicated person, contact a doctor or health department. If the bat can be safely captured and tested, treatment may be avoided.

How many rabies shots do you need after a bite?

People who have never been vaccinated receive rabies immune globulin plus 4 vaccine doses over 2 weeks (5 doses if the immune system is weak). People previously vaccinated need 2 doses. Your doctor or health department guides the schedule.