What is Rabies — Risks, Symptoms & What To Do After a Bite?

Rabies is almost always fatal once symptoms appear, but 100% preventable with prompt post-exposure prophylaxis (PEP). Learn risks, symptoms, prevention, and urgent steps after exposure.

Infectious Diseases

Rabies — Risks, Symptoms & What To Do After a Bite

2025-09-19

Intro

Rabies is a viral disease that attacks the brain and spinal cord. Once symptoms appear, it is nearly always fatal — but it is 100% preventable with prompt vaccination after exposure.

While rabies is rare in the United States, it causes an estimated 60,000 deaths worldwide each year, mainly in Africa and Asia. Bats are the leading source of human rabies in the U.S., while dogs account for most deaths globally.

Key Points

Cause: Rabies virus (Lyssavirus, family Rhabdoviridae).
Transmission: Saliva from infected animals via bites; also scratches or saliva contacting eyes, mouth, or broken skin.
Reservoirs: Globally dogs; in the U.S., bats; also raccoons, foxes, skunks, coyotes.
Fatality: Nearly 100% once symptoms start — prevention with PEP is critical.
PEP basics: Immediate wound cleaning → rabies immune globulin (if never vaccinated) → vaccine series.

Transmission & Risk

Animals: Dogs (global), bats (U.S.), raccoons, foxes, skunks, coyotes.
Higher risk groups: Travelers to endemic regions, veterinarians, animal control/wildlife workers, lab staff handling the virus, cavers/spelunkers, and young children in dog-rabies regions.

Symptoms

Incubation (weeks–months): Usually no symptoms.
Early: Fever, headache, malaise, tingling/prickling or pain at the bite site.
Progressive: Agitation, confusion, hallucinations, aggressive behavior; hydrophobia and excessive saliva are classic.
Outcome: Rapid progression to coma and death within days to weeks.

Post-Exposure Prophylaxis (PEP)

Not previously vaccinated

RIG: Infiltrate around/into the wound on Day 0 (as much as anatomically feasible).
Vaccine: Days 0, 3, 7, 14. (Immunocompromised: add Day 28.)

Previously vaccinated (PrEP or prior full PEP)

No RIG.
Vaccine: Days 0 and 3.

Start PEP as soon as possible. Don’t delay for animal testing unless public health authorities confirm it’s safe.

Which Exposures Need PEP?

Bites/scratches that break the skin.
Saliva contacting eyes, mouth, or broken skin.
Bat scenarios where a bite cannot be ruled out.
Usually not PEP: Touching/feeding animals without a bite/scratch; contact with blood/urine/feces/fur alone.

Monitoring Animals (When Feasible)

Healthy dogs/cats/ferrets may be observed for 10 days; if they remain healthy, transmission is unlikely.
Wildlife (bats, raccoons, foxes, skunks; stray dogs in high-risk areas) should be considered rabid until proven otherwise — do not delay PEP.

Travel Risks & Pre-Exposure Vaccine (PrEP)

Higher risk regions: Many parts of Asia, Africa, Latin America (dog rabies).
Consider PrEP (2 doses, 7 days apart) if you’ll be in rural/remote areas, around animals, or far from reliable medical care.
Know access points for rabies vaccine and RIG at your destination.

Prevention

Keep pets up to date on rabies vaccination.
Avoid contact with stray animals and wildlife; teach children not to touch unfamiliar animals.
Bat-proof sleeping areas (screens, seal gaps, chimneys).
Travelers: don’t feed or pet animals; carry a small first-aid kit for immediate wound care.

Safety & Side Effects

Rabies vaccines are safe in adults, children, and during pregnancy.
Common effects: sore arm, mild fever.
RIG may cause local discomfort but is essential for the unvaccinated.

FAQ

Do small scratches need PEP?
Yes—if they break the skin, especially with high-risk species or in endemic areas.

What if I started PEP abroad?
Bring documentation and complete the schedule at home without restarting.

What if RIG isn’t available on Day 0?
Begin vaccine immediately; RIG can be administered up to Day 7 after the first dose.

Can rabies be cured after symptoms start?
No. Prevention with timely PEP is the only reliable protection.