Rabies

What is rabies?

Rabies is a disease that is caused by a germ called a virus. The rabies virus affects the body's central nervous system. The central nervous system is made up of the brain, spinal cord, and nerves. The rabies virus most often spreads through the bite of an animal. Animals that may spread rabies include dogs, coyotes, cats, raccoons, foxes, skunks, and bats. Rabies occurs when the virus enters the skin and goes to the muscles or nerves. The virus may then go to the brain or other body parts by traveling through the nerves.

What causes rabies?

Rabies is most often caused by contact with the saliva of a rabid animal, usually through a bite wound. If saliva or other tissues of a rabid animal enter a person's open wound, abrasion, eyes, or mouth, rabies may occur.

What puts me at risk of getting rabies?

Rabies can affect anyone of any age. The following factors may place you at a higher risk of getting this disease:

• Being bitten on the head, face, neck, or hands, getting bitten many times, or having deep bite wounds. In the case of a bat bite, even a small bite can increase your risk of rabies.
  
  
• Having a weak immune system. The immune system is the part of your body that fights infection. Taking medicine such as steroids, or having HIV can weaken a person's immune system.
  
  
• Traveling to places where rabies is commonly found.
  
  
• Work that includes handling the virus or working with animals. These jobs may include laboratory workers, veterinarians, forest rangers, and animal control and wildlife workers.

What are the signs and symptoms of rabies?

Signs and symptoms of rabies may appear weeks, months, or even years after the infection. They are usually divided into early and late signs and symptoms.

• Early: During the early stages of rabies, you may feel like you have the flu. You may have one or more of the following signs and symptoms for up to ten days:
  
  
  • Weakness, fever, headache, and irritability (being easily angered).
    
    
  • Loss of appetite, nausea (upset stomach), and vomiting (throwing up).
    
    
  • Pain, numbness, or a burning or tingling feeling at the bite site, which may slowly spread to other areas.
    
    
  • Severe itching at the bite site. Scratching often leads to large areas of scratches or breaks in the skin.
  
  
• Late: Over time, rabies may cause symptoms that show that the brain may be affected. Symptoms may include any of the following:
  
  
  • Confusion (cannot think clearly) or insomnia (trouble falling or staying asleep).
    
    
  • Dizziness, seeing double, or seeing something that is not really there.
    
    
  • Restlessness and hyperactivity, which is increased by thirst, fear, light, or noise. Anxiety and panic attacks may also happen.
    
    
  • Seizures (convulsions) or twitching.
    
    
  • Slurred speech, drooling, swallowing problems, and a fear of water.
    
    
  • Tiredness, muscle cramps, trouble moving, or severe (very bad) weakness. Weakness may be seen only on one side of the body or face.

How is rabies diagnosed?

Your caregiver will take a detailed health history from you. This includes information on medicines taken, vaccinations (shots) received, and past travels or activities. He will ask you if you have been in contact with an animal or another person who has rabies. If you were bitten, your caregiver may ask whether something was done to cause the animal to attack. This can help caregivers learn if rabies may have caused the animal to bite you. The animal that bit you will be watched, and it may need to be killed so that further tests can be done. The brain tissue of a dead animal may show whether the animal had rabies. Testing the animal will help caregivers select the right tests and treatment for you.

• Tests: You may have any of the following tests to help caregivers look for a rabies infection:
  
  
  • Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. These tests will look for antibodies to the rabies virus. Antibodies are substances that the immune system makes to protect the body from outside invaders. Blood tests give your caregivers more information about your health condition. You may need to have blood drawn more than once.
    
    
  • Biopsy: Your caregiver may do a skin biopsy. A biopsy is done by removing a small piece of tissue and then sending it to the lab for tests. A skin sample is usually taken from the back of the neck. A biopsy can help caregivers learn the cause of your symptoms.
    
    
  • Cultures: This is a test that is done to learn about the germ that is causing your illness. Samples of your saliva, tears, or fluid around the brain and spinal cord may be collected and tested.
    
    
  • Lumbar puncture: A lumbar puncture, or spinal tap, may be done to check the fluid around your brain and spinal cord for the rabies virus.
    
    
  • MRI: This scan uses powerful magnets and a computer to take pictures of your brain. It will also take pictures of the blood vessels and structures in your head. You may be given dye, also called contrast, before the test. Tell caregivers if you are allergic to dye, iodine, or seafood. Remove all jewelry, and tell caregivers if you have any metal in or on your body. Metal can cause serious injury. Tell caregivers if you cannot lie still or are anxious or afraid of closed spaces.
  
  

How is rabies treated?

Stopping and preventing the virus from spreading inside the body is the main goal of treatment. Treating rabies as soon as possible may prevent more serious problems and increase the chance of recovery. Treatment may include the following:

• Cleaning the bite wound: Clean the bite wound with povidone-iodine solution mixed with water, or with soap and water. Doing this right after being bitten decreases the chance of getting a wound infection, and can decrease the risk of getting rabies. Caregivers may need to close the wound using stitches.
  
  
• Vaccine: A rabies vaccine (shot) is given to help your body make antibodies to fight the virus and help prevent rabies. The vaccine may be given if caregivers know that you will be exposed to rabies (preexposure). It also can be given when caregivers learn that you have been exposed to rabies (postexposure).
  
  
  • If you have been exposed to the rabies virus and you have not been given the vaccine in the past, you will be given four different doses. These will be given on four different days within a 1-month period. You will also be given a shot of rabies immune globulin.
    
    
  • If you have been given the rabies vaccine in the past and have now been exposed to the virus, you will receive two doses, given three days apart.
    
    
  • If you are at risk of being exposed to rabies, you will be given three doses on three different days. These are given within a 1-month period.
  
  
• Rabies immune globulin medicine: If you have been exposed to rabies, you may be given rabies immune globulin to attack the virus. This medicine will also help your immune system fight the infection. If you have been given the rabies vaccine in the past, you will not be given this medicine.
  
  
• Td vaccine: This vaccine is a booster shot used to help prevent diphtheria and tetanus. The Td booster may be given to adolescents and adults every 10 years or for certain wounds and injuries.

Once rabies has progressed, treatment is aimed at relieving symptoms. Some people may be placed in the Intensive Care Unit (ICU). Caregivers may treat you with supportive measures to relieve your signs and symptoms. You may need the following supportive measures:

• Aiding devices: These may include respirators and oxygen to help with your breathing.
  
  
• Medicine: Medicines may be given to calm and relax, ease pain, headaches, and fever, or to control seizures.

What are the risks of having or treating rabies?

• Rabies vaccinations (shots) may cause headaches, muscle aches, or fever. The area where the shot was given may be painful, red, swollen, or itchy. You may get rabies even after you have the rabies shot. Immune globulin medicine can cause pain and a fever. Bite wounds can damage nerves and tendons in the body. Bite wounds can also cause an infection in the area of the wound, or in the bloodstream.
  
  
• Without early treatment, rabies damages the brain and other organs. You may have brain swelling, seizures (convulsions), and paralysis (being unable to move). Rabies that is not treated causes death in almost everyone. Talk to your caregiver if you are worried or have questions about rabies, or your medicine or care.

How can rabies be prevented?

• Get vaccinated (shots) against rabies to prevent infection. This may be needed if your work puts you at risk of getting rabies. You may also get shots if you plan to travel to places where the chance of getting rabies is high. If you are going to travel, visit your caregiver 3 to 4 weeks before you leave. You may need to get a booster shot after some time. Ask your caregiver for more information on rabies shots.
  
  
• Avoid contact with bats or going to places where they are likely to be found. Avoid contact with wild animals. Do not try to take them home with you. Do not approach any tame or wild animal that you have not seen before.
  
  
• Get medical care if you get bitten by a wild animal or a bat, even if the wound is very small. Talk with your caregiver if you wake up and find a bat in the room, even if you think you have not been bitten.
  
  
• Cover windows and other openings in your home with screens. This may help keep bats from getting into your house.
  
  
• Get your pet vaccinated against rabies.

What should I do if an animal bites me?

• Clean the bite wound. Clean the bite wound well, using soap and water, or povidone-iodine solution mixed with water. Doing this right after being bitten decreases the chance of getting a wound infection, and can decrease the risk of getting rabies.
  
  
• Cover the wound with a clean bandage.
  
  
• See your caregiver right away. Caregivers may need to treat the wound and close it using stitches. You may need to take medicine, such as antibiotics, to help fight or treat infection.

Where can I find more information?

Accepting that you have a rabies infection may be hard. You and those close to you may feel scared, sad, or angry. These are normal feelings. Contact the following for more information about rabies and its prevention:

• Centers for Disease Control and Prevention (CDC)
  1600 Clifton Road
  Atlanta , GA 30333
  Phone: 1- 800 - 232-4636
  Web Address: http://www.cdc.gov/
  

• National Institute of Allergy and Infectious Diseases
  NIAID Office of Communications & Government Relations
  6610 Rockledge Drive, MSC 6612
  Bethesda , MD 20892-6612
  Phone: 1- 301 - 496-5717
  Phone: 1- 866 - 284-4107
  Web Address: www3.niaid.nih.gov
  

When should I call my caregiver?

Call caregivers if:

• You have a fever.
  
  
• After taking a new kind of medicine, you get a rash, or your skin becomes itchy, red, and swollen.
  
  
• After treatment, you have pain, itching, and other symptoms that are getting worse over time.
  
  
• Your symptoms, such as nausea, vomiting, or headaches, do not get better after treatment.
  
  
• You have questions or concerns about rabies and rabies treatment.

When should I seek immediate help?

Call 911 or seek care immediately if:

• You may have been, or you have been exposed to rabies.
  
  
• You have been bitten by an animal.
  
  
• After exposure to rabies, you have trouble swallowing, slurred speech, double vision, or you see things that are not really there. You may also begin twitching, have muscle cramps, or have a seizure.
  
  
• After exposure to rabies, you feel weak, tired, dizzy, confused, restless, or anxious.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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