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Rabies is an infection caused by a
virus. It affects the brain and spinal cord (central nervous system) of mammals, including humans. It is nearly always
deadly if not treated before symptoms begin.
Animals that are
infected with rabies—rabid animals—can spread the disease through their saliva or through
is rare for people in the United States or Canada to get rabies. It is more common in
People usually get rabies when a rabid animal bites them. People in the U.S. and Canada are most likely to get rabies
from bats.1 People in many other countries are most
likely to get rabies from dog bites.2, 3
raccoons, skunks, foxes, and coyotes are the animals most likely to have rabies
in the U.S. and Canada. Small mammals such as mice and squirrels almost never have
Sometimes the rabies virus can spread to pets, such as
dogs, cats, and ferrets. But household pets rarely get rabies, because most of
them get rabies vaccines. Pets that stay indoors are very unlikely to get
It's possible to get rabies even when you don't see an
animal bite. For example, bat bites or scratches may be so small that you don't
notice them. If you or your children come in direct contact with a bat, or if
you find a bat in a closed room with a sleeping person, call your doctor right
People also can get rabies by handling animals with rabies or inhaling
the virus, but these cases are rare.
Signs of rabies in animals
may include drooling, foaming at the mouth, or
paralysis. A pet with rabies also may behave
differently than usual, such as acting shy when the pet usually is friendly. A
wild animal with rabies may have no fear of humans.
humans begins with symptoms such as fever, cough, or sore throat. Later,
symptoms become more serious and can include restlessness,
seizures. The final stage is coma and death.
If you think you've been exposed to the rabies virus, it's very important to get medical care before symptoms begin. If symptoms appear, it's too late for a cure, and the infection will probably lead to death. The time from exposure to the virus until symptoms appear
usually is 2 to 3 months. In rare cases, it may be shorter or much
The treatment for someone who has been exposed to rabies is a series
of shots known as postexposure prophylaxis (PEP). These shots help
immune system destroy the disease in its early stages.
Getting PEP before symptoms appear usually prevents infection, and you are
likely to recover.
In the U.S. and Canada, PEP has two parts, usually given at the same time:
Some vaccines that aren't approved for use in the U.S. or Canada are used in developing countries. The World Health
Organization (WHO) approves of these vaccines.4 But they may cause worse reactions than
newer vaccines. If you are exposed to rabies outside of the U.S. or Canada and have any choice, request HDCV (human diploid cell vaccine), RVA (rabies
vaccine, adsorbed), or PCEC (purified chick embryo cell culture). If these aren't available, it is
better to accept one of the other vaccines than to get no vaccine at all. As soon as you can return home,
ask your doctor about whether you should get any more vaccines.
First, wash the animal bite, scratch, or open sore with
soap and water. Then call your doctor and local health department right away.
They can advise you on what to do next.
If you've been bitten by or exposed to an animal at
low risk for having rabies, such as a pet, the animal
will be captured and watched
for signs of rabies. If there's a chance that the
animal is rabid, you will start getting shots right away.
If you've been bitten by or exposed to an animal at high risk for having rabies, you will start getting
shots right away. If possible, the animal will be watched for signs of
rabies or will be killed for testing. If it turns out that the animal doesn't have rabies, you can
stop the shots.
If an animal shows signs of rabies but
can't be captured for testing, it often is assumed to be rabid.
contact with the rabies virus:
Preventive rabies vaccinationPreventive rabies vaccination(What is a PDF document?) may be recommended if you
are at high risk of exposure because of your work or hobbies. It may also be
recommended if you plan to travel in areas where rabies
is a risk, such as parts of Asia, Africa, and Central and South America. Contact your doctor or local public health department for
Learning about rabies:
Plotkin SA, et al. (2009). Rhabdoviridae: Rabies virus. In RD Feigin et al., eds., Feigin and Cherry’s Textbook of Pediatrics Infectious Diseases, 6th ed., vol. 2, pp. 2494–2511. Philadelphia: Saunders Elsevier.
Centers for Disease Control and Prevention
(2008). Human rabies prevention—United States 2008. Recommendations of the
Advisory Committee on Immunization Practices (ACIP). MMWR, 57(Early Release): 1–28. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm.
Rupprecht CE, Givvons RV (2004). Prophylaxis against
rabies. New England Journal of Medicine, 351:
World Health Organization (2011). Rabies Fact Sheet. Available online: http://www.who.int/mediacentre/factsheets/fs099/en.
Other Works Consulted
American Public Health Association (2008). Rabies. In DL Heymann, ed., Control of Communicable Diseases Manual, 19th ed., pp. 498–508. Washington, DC: American Public Health Association.
Bassin SL, et al. (2010). Rhabdoviruses. In GL Mandell et al., eds., Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed., vol. 2, pp. 2249–2258. Philadelphia: Churchill Livingstone Elsevier.
Centers for Disease Control and Prevention
(2010). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies. Recommendations of the
Advisory Committee on Immunization Practices (ACIP). MMWR, 59(RR02): 1–9. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm.
Jackson AC (2012). Rabies virus and
other rhabdovirus infections. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1,
pp. 1161–1167. New York: McGraw-Hill.
Lewis LM, et al. (2011). Bites and stings. In EG Nabel, ed., ACP Medicine, section 8, chap. 2. Hamilton, ON: BC Decker.
National Association of State Public Health
Veterinarians, Inc. (2008). Compendium of animal rabies prevention and control,
2008. MMWR, 57(RR-02): 1–9. Available online:
Peterson LR, Gubler DJ (2006). Viral zoonoses. In DC
Dale, DD Federman, eds., ACP Medicine, section 7, chap.
31. New York: WebMD.
Wikerson JA (2012). Rabies. In PS Auerbach, ed.,
Wilderness Medicine, 6th ed., pp. 1175–1197.
Philadelphia: Mosby Elsevier.
Willoughby RE Jr (2011). Rabies. In RM Kliegman et al., eds.,
Nelson Textbook of Pediatrics, 19th ed., pp. 1154–1157.
Philadelphia: Elsevier Saunders.
August 27, 2012
E. Gregory Thompson, MD - Internal Medicine & W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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