Rabies is a deadly virus spread to people from the saliva of infected animals. The rabies virus is usually transmitted through a bite.
Animals most likely to transmit rabies in the United States include bats, coyotes, foxes, raccoons and skunks. In developing countries of Africa and Southeast Asia, stray dogs are the most likely to spread rabies to people.
Once a person begins showing signs and symptoms of rabies, the disease nearly always causes death. For this reason, anyone who may have a risk of contracting rabies should receive rabies vaccinations for protection.
- Rabies is a vaccine-preventable viral disease which occurs in more than 150 countries and territories.
- Dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans.
- Interrupting transmission is feasible through vaccination of dogs and prevention of dog bites.
- Infection causes tens of thousands of deaths every year, mainly in Asia and Africa.
- Globally rabies causes an estimated cost of US$ 8.6 billion per year
- 40% of people bitten by suspect rabid animals are children under 15 years of age.
- Immediate, thorough wound washing with soap and water after contact with a suspect rabid animal is crucial and can save lives.
- Engagement of multiple sectors and One Health collaboration including community education, awareness programmes and vaccination campaigns are critical.
- WHO leads the collective “United Against Rabies” to drive progress towards "Zero human deaths from dog-mediated rabies by 2030".
Rabies is a vaccine-preventable, zoonotic, viral disease. Once clinical symptoms appear, rabies is virtually 100% fatal. In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. Yet, rabies can affect both domestic and wild animals. It is spread to people and animals through bites or scratches, usually via saliva.
Rabies is present on all continents, except Antarctica, with over 95% of human deaths occurring in the Asia and Africa regions. Rabies is one of the Neglected Tropical Diseases (NTD) that predominantly affects poor and vulnerable populations who live in remote rural locations. Approximately 80% of human cases occur in rural areas. Although effective human vaccines and immunoglobulins exist for rabies, they are not readily available or accessible to those in need. Globally, rabies deaths are rarely reported and children between the ages of 5–14 years are frequent victims. Managing a rabies exposure, where the average cost of rabies post-exposure prophylaxis (PEP) is currently estimated at an average of US$ 108 can be a catastrophic financial burden on affected families whose average daily income may be as low as US$ 1–2 per person[1].
Every year, more than 29 million people worldwide receive a post-bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths annually. Globally, the economic burden of dog-mediated rabies is estimated at US$ 8.6 billion per year.
Symptoms
The first symptoms of rabies may be very similar to those of the flu and may last for days.
Later signs and symptoms may include:
- Fever
- Headache
- Nausea
- Vomiting
- Agitation
- Anxiety
- Confusion
- Hyperactivity
- Difficulty swallowing
- Excessive salivation
- Fear brought on by attempts to drink fluids because of difficulty swallowing water
- Hallucinations
- Insomnia
- Partial paralysis
Causes
Rabies infection is caused by the rabies virus. The virus is spread through the saliva of infected animals. Infected animals can spread the virus by biting another animal or a person.
In rare cases, rabies can be spread when infected saliva gets into an open wound or the mucous membranes, such as the mouth or eyes. This could occur if an infected animal were to lick an open cut on your skin.
Animals that can transmit the rabies virus
Any mammal (an animal that suckles its young) can transmit the rabies virus. The animals most likely to transmit 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 rare cases, the virus has been transmitted to tissue and organ transplant recipients from an infected organ.
More Information
Risk factors:
Factors that can increase your risk of rabies include:
- Traveling or living in developing countries where rabies is more common, including countries in Africa and Southeast Asia
- 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 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
Diagnosis
At the time a rabid animal bites you, there's no way to know whether the animal has transmitted the rabies virus to you. For this reason, treatment to prevent the rabies virus from infecting your body is recommended if the doctor thinks there's a chance you have been exposed to the virus.
Current diagnostic tools are not suitable for detecting rabies infection before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, clinical diagnosis may be difficult. Human rabies can be confirmed intra-vitam and post mortem by various diagnostic techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin or saliva)
Treatment
Once a rabies infection is established, there's no effective treatment. Though a small number of people have survived rabies, the disease usually causes death. For that reason, if you think you've been exposed to rabies, you must get a series of shots to prevent the infection from taking hold.
Treatment for people bitten by animals with rabies
If you've been bitten by an animal that is known to have rabies, you'll receive a series of shots to prevent the rabies virus from infecting you. If the animal that bit you can't be found, it may be safest to assume that the animal has rabies. But this will depend on several factors, such as the type of animal and the situation in which the bite occurred.
Rabies shots include:
- A fast-acting shot (rabies immune globulin) to prevent the virus from infecting you. Part of 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. You receive four injections over 14 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.
