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Rabies 101

Rabies is a virus that causes neurologic encephalitis and is almost 100% fatal.  Since 2000, 31 cases of human rabies have been reported in the United States.  Seven of them were acquired from exposure abroad (Phillippines, Ghana, El Salvador, Haiti, Mexico and India).  Rabies is mainly contracted from an animal bite or saliva from an infected animal.  The most common animals are dogs, bats, coyotes, raccoons and skunks.  The average incubation period between exposure and illness is 2-7 weeks but symptoms can first occur after 3 months.

If  Doctors don't suspect rabies, it can be difficult to diagnose at first and once symptoms occur it is 100% fatal.  Symptoms may include anxiety, loss of feeling in an area of the body and loss of muscle function.  Fever is low grade and the patient is restless.  As the infection develops,  drooling, difficulty swallowing and convulsions occur.  Hydrophobia (aversion to water) is common.  Death occurs as quickly as one week.

The only treatment for rabies is postexposure prophylaxis (PEP) administered if there is expected exposure and before symptoms begin.  Family members who are in close contact with or exposed to saliva from a suspected infected person also undergo PEP.  This consists of one dose of Rabies immune globulin, followed by four more injections over a two week period.

It is important for travelers to be aware of rabies.  Although rare in the United States, 55,000 people die of rabies around the world every year.   Rabies is found on every continent except Antartica. For travelers going to endemic areas where PEP is not available and there is limited access to medical care, pre-exposure vaccination is available.   This consists of three injections and if all three cannot be received the traveler should not start them.  If all three doses are not given, the traveler will not be considered vaccinated and any exposure will require PEP.

Most developing countries do not have PEP and any bite or exposure may require immediate travel to an area where it is available.

The old form of rabies vaccine was manufactured from viruses grown in animal brains and some of these vaccines are still in use in developing countries.  Travelers who are offered a large injection daily for 14-21 days into the abdomen should refuse these vaccines and travel to another country where immune globulin is available.

The best prevention is understanding that rabies is out there and stray animals should be avoided.  Any bite or scratch that occurs in a rabies endemic area should be grounds for seeking post exposure rabies immunoprophylaxis.

Comments

KM said…
Thanks for this great information. I had wondered about getting the vaccine when I went to Haiti last month, but didn't think there was enough time that was needed.
Anonymous said…
From this article it is difficult to understand what your chances are if you haven't been immunized, are bitten and immediately seek treatment after a bite.
Toni Brayer, MD said…
Anon: The odds of getting rabies are highly dependent upon the circumstances. If you are traveling or have encountered a wild animal that bites, you need to go to an emergency department/clinic right away. The odds of rabies are quite low but it is so serious that any unknown animal bite must be followed up.
Anonymous said…
Thanks Dr. Brayer for your comment.

I travel to developing countries intermittently and see myself doing this for the rest of my life. I travel enough so that I want to be aware of rabies but not enough that I want to be re-vaccinated again and again over my lifetime since it only lasts 1-2 years.

So my question is - isn't it also a good strategy to simply be vigilant - if I am bitten, see a doctor immediately, most probably start treatment immediately, and I will most probably be fine in the end?
All really helpful, very informative. Keep up the good work.
Toni Brayer, MD said…
Anon: Yes, I agree completely. Nothing to fear in travel!
Unknown said…
Thank you Dr. Brayer. I am a seventh grade student doing a class project on rabies and your site has helped me a great deal and I thank you.
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