13848 Rabies

Overview

Rabies is a rare but very serious viral infection that affects the brain and spinal cord. It is caused by a virus that is usually spread through the saliva of an infected animal, most often through a bite or a scratch that breaks the skin. Once symptoms appear, rabies is almost always fatal, but getting treatment quickly after exposure can stop the disease from developing.

Rabies is very rare in the United Kingdom and many other developed countries because of pet vaccination and strict animal control. However, it remains a serious public health problem in parts of Asia, Africa, and South America, where it causes thousands of deaths each year.

Anyone can get rabies, but it mostly affects people who live in or travel to areas where rabies is common in animals. People at higher risk include travelers to affected regions, veterinarians, animal rescue workers, laboratory workers, and children living in rural areas where bats and stray dogs are present.

Symptoms

Common symptoms

• Aching, tingling, or itching at the site of the bite or scratch
• Fever, headache, and a general feeling of being unwell
• Anxiety, confusion, or agitation
• Difficulty swallowing, drooling, or muscle spasms when trying to drink (sometimes called fear of water)
• Hallucinations, restlessness, or partial paralysis

Causes

Main causes

• Rabies is caused by a virus that is passed through the saliva of an infected animal.
• The virus usually enters the body through a bite, scratch, or open wound that is exposed to infected saliva.
• Very rarely, the virus can spread through infected saliva that touches the lips, nose, or eyes.

Risk factors

• Traveling to countries where rabies is common, especially rural areas
• Working with animals as a veterinarian, animal rescuer, or laboratory worker
• Having a bite or scratch from a stray, wild, or unvaccinated animal
• Living in or visiting caves or areas with large bat populations

When to see a doctor

See a doctor urgently if:

• If you are bitten or scratched by any animal and the skin is broken, wash the wound immediately with soap and water and go to your nearest emergency department.
• If you have had any contact with a bat, even without an obvious bite, seek urgent medical advice.
• If you have symptoms like confusion, agitation, difficulty swallowing, or muscle spasms and have recently been exposed to a potentially rabid animal, call emergency services immediately.

Book a routine appointment if:

• Before travelling to a country where rabies is common, talk to your GP or a travel health clinic about whether you need a pre-exposure vaccination.
• If you work with animals and have concerns about your risk, ask your employer about occupational health advice and vaccination.

Diagnosis

Diagnosing rabies is difficult because early symptoms look like many other illnesses. Doctors will ask about the animal exposure, your vaccination history, and your symptoms. In a living person, laboratory tests on saliva, spinal fluid, skin, or blood can help detect the virus or the body's immune response. Unfortunately, by the time symptoms appear, the disease is almost always fatal, so doctors focus on giving immediate preventive treatment after any possible exposure.

Tests that may be done

• A clinical examination and detailed history of the animal exposure
• Laboratory tests on saliva, skin, spinal fluid, or blood
• No test is usually needed before starting post-exposure prophylaxis if the bite happened recently

What to expect at your appointment

If you have been bitten, a doctor or nurse will ask how and when the bite happened, what animal caused it, and whether you have had rabies vaccination before. They will clean the wound thoroughly and decide quickly whether you need emergency rabies treatment. You may also need a tetanus vaccine or antibiotics if the wound is infected.

Treatment

There is no effective cure once rabies symptoms have started. The disease is nearly always fatal at that point. However, it is almost completely preventable if you receive post-exposure prophylaxis (PEP) soon after a bite or other exposure. PEP involves thorough wound cleaning, a course of injections to help your immune system fight the virus, and for some people, a dose of ready-made antibodies given near the wound to neutralise the virus while your body builds its own protection.

Self-care at home

• Immediately after any bite or scratch, wash the wound thoroughly with soap and running water for at least 15 minutes.
• Apply an antiseptic such as iodine or alcohol if available.
• Do not cover the wound tightly — go to a doctor or emergency department as soon as possible.

Medical treatments

Post-exposure prophylaxis is given as a course of several injections over a few weeks. If you have already been vaccinated against rabies before the exposure, the course is shorter. Some people also receive antibodies in and around the wound on the first day. In hospital, once symptoms have developed, care focuses on keeping the person comfortable and supporting breathing and circulation. There is no specific medicine that can kill the virus after symptoms appear.

Living with this condition

If you have received treatment after a possible rabies exposure, you will need to complete the full course of injections exactly as scheduled. During this time, you can live normally, but you should watch for any signs of infection or unusual symptoms and contact your doctor if you feel unwell. If you develop any neurological symptoms, seek emergency help immediately.

Lifestyle tips

• Avoid contact with wild or stray animals, especially when travelling.
• Make sure your pets are vaccinated against rabies and keep up with their booster injections.
• If you travel frequently, talk to your doctor about pre-exposure vaccination.

Diet and exercise

There are no specific dietary or exercise requirements following a rabies exposure. Eat a balanced diet and get plenty of rest to help your immune system. If you feel anxious, gentle activities like walking can help you relax.

Mental health and emotional wellbeing

Being bitten by an animal can be frightening, and the fear of rabies can cause anxiety and stress. It is normal to worry. Completing your treatment and staying in touch with your doctor can ease your mind. If anxiety is affecting your daily life, speak to your GP or a mental health professional.

Prevention

Yes, rabies can be prevented. The best way is to avoid bites and scratches from wild or stray animals and to make sure pets are vaccinated. If you are exposed, getting post-exposure prophylaxis quickly and completing the course stops the virus from causing disease.

Vaccines

There are safe and effective vaccinations for rabies. They are recommended for people at high risk, such as travellers to countries where rabies is common, and people who work with animals. Pre-exposure vaccination means you need fewer injections after a bite, but it does not replace the need to seek urgent medical care and wound cleaning after any potential exposure.

Complications

If left untreated

• Inflammation of the brain (encephalitis), which can cause confusion, seizures, and personality changes
• Severe muscle spasms, difficulty swallowing, and breathing failure
• Coma and death — rabies is nearly always fatal once symptoms appear

Long-term outlook

The outlook depends on getting medical help immediately after exposure. If you receive post-exposure prophylaxis promptly and complete the course, rabies is almost completely preventable and survival is the norm. Even in the very rare cases where symptoms develop, a small number of people have survived, but the chance is extremely low. The best hope is to act fast and never delay seeking care after an animal bite.

Find support

International organisations

• World Health Organization (WHO) ↗

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