Rabies

Rabies is a fatal illness you get from the bite of an infected animal — usually a dog or a bat. Seek treatment right away to prevent rabies if you get an animal bite.

After you’re bitten, the rabies virus (RABV) travels slowly along your nerves to your brain. This takes time — anywhere from days to weeks. During this time, you don’t have symptoms. Once the virus gets to your brain, it causes flu-like symptoms. A few days later, you’ll develop neurological symptoms, like aggression, seizures or paralysis.

It’s extremely rare for someone to survive after rabies symptoms start. People who do survive usually have severe brain injuries.

Rabies is preventable if you’re treated soon after a bite, before symptoms start. Contact a healthcare provider as soon as possible if you:

• Have been bitten or scratched by a wild animal
• Have been bitten or scratched by any animal you think could have rabies
• Found a bat in a room with a child or someone who was sleeping — assume they’ve been bitten
• Have reason to believe you’ve been exposed to rabies in any way

Your provider might ask you questions about how you got injured and what kind of animal it was. The more information you can share, the better they can help you.

Symptoms of rabies

Rabies isn’t treatable once you feel sick (anywhere from days to weeks after exposure). Symptoms start like many other illnesses — with a fever, muscle aches, fatigue and other flu-like symptoms. You might also have tingling, pain or numbness where you were bitten.

A few days later, most people develop “furious” rabies symptoms. These include:

• Agitation and aggression
• Restlessness
• Seizures
• Hallucinations
• Muscle twitching
• Racing heart
• Fast breathing (hyperventilation)
• Excessive salivation
• Different-sized pupils
• Facial paralysis (facial palsy)
• Fear of water/drinking (hydrophobia)
• Fear of air being blown in your face/drafts (aerophobia)
• Delirium

These symptoms may come in episodes with periods of calm in between.

About 1 in 3 people develop “paralytic” rabies instead. These symptoms include:

• Fever
• Headache
• Neck stiffness
• Weakness, often starting from the body part that was bitten and moving to other body parts
• Tingling, “pins and needles” or other strange sensations
• Paralysis
• Coma

Rabies causes and transmission

You usually get rabies through the bite of an animal infected with the RABV virus. You might also get it from a scratch that gets an infected animal’s saliva in it.

Bats, skunks, raccoons and foxes most commonly carry rabies. But other animals — including your pet dog or cat — can also get infected. The RABV virus can spread through saliva a few days before symptoms start.

In the U.S., most people get rabies from bat bites. The bite marks are so small — about the size of the tip of a pencil — that many people don’t know they’ve been bitten. That’s why it’s important to see a healthcare provider if you’ve had any contact with bats and don’t know if you could’ve been bitten. This includes finding a bat in a room where you’ve been sleeping or in a room with a child who can’t tell you if they’ve been bitten.

Outside the U.S., bites from domestic dogs are a more common way to get rabies. Rarely, people have been infected from receiving donated organs.

Risk factors

Any warm-blooded animal (mammal), including people, can get infected with the RABV virus. But certain jobs and hobbies put you at higher risk for exposure. You might be at higher risk if you:

• Work with wildlife or domestic animals (this includes veterinarians, veterinary technicians, wildlife biologists, animal control officers and others)
• Are around bats or in caves often
• Live in or travel to areas where rabies is common in dogs
• Work in a lab where you handle rabies virus

Consider getting vaccinated for rabies on a regular schedule if your job or hobbies put you at higher risk. How frequently you need boosters depends on how high your risk of exposure is.

How doctors diagnose rabies

Don’t wait for symptoms to see a doctor. See a healthcare provider right away if you’ve been bitten or scratched by a wild animal or a pet that might have rabies. They’ll examine your wound and ask you about how you got it to determine whether you need treatment.

If you already have signs of rabies, a provider will diagnose you based on symptoms and any possible exposures. They may also get pictures of your brain with an MRI or test your:

• Saliva
• Skin
• Cerebrospinal fluid (lumbar puncture)
• Blood

Can rabies be cured?

There’s no approved treatment for rabies once you have symptoms. You need treatment before symptoms start. If you’ve been bitten or had any contact with an animal that might be infected, see a healthcare provider right away (within 24 hours if possible). Quick and proper treatment is nearly 100% effective at preventing rabies.

Rabies prevention includes:

• Wound cleaning: You should wash the bite or scratch with soap and water as soon as possible. Your provider may also clean the wound.
• Rabies vaccine: The vaccine teaches your body to destroy the rabies virus before it enters your brain. You’ll get four shots over 14 days. If you’ve already been vaccinated before exposure, you’ll only need two shots. It’s important to complete the entire series of recommended shots.
• Human rabies immune globulin (HRIG): HRIG destroys the virus near the wound until the vaccine teaches your body to create its own antibodies. Your provider will give you shots around the wound. You shouldn’t get HRIG if you’ve been vaccinated before your exposure.

What should I do if I’ve been bitten by an animal?

If you’ve been bitten or scratched by an animal that may have rabies:

• 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?)
• Get medical attention for the wound and get rabies treatment if needed.
• If you’ve been attacked by an aggressive wild animal, contact animal control (in addition to the steps above).

Can you survive rabies?

Without early vaccination and antibody treatment, rabies is nearly always fatal. You can survive being bitten by an animal carrying the virus if you’re treated within a few days of exposure, before you have symptoms. Once you have symptoms, there aren’t any effective treatments available.

Rabies is preventable if you get treatment right away after being bitten or other exposure. You can get vaccinated before getting a bite or other exposure if you’re at higher risk due to your job or hobbies. You’ll need to get boosters regularly, and you’ll still need additional shots if you have an exposure.

You can also reduce your risk by:

• Making sure your pets’ vaccinations are up-to-date; this includes dogs, cats and ferrets.
• Not letting your pets roam free without supervision; they could get attacked by infected animals.
• Leaving wildlife alone; don’t touch injured animals or try to capture animals yourself.