Myths and Facts: Rabies

More than 55,000 people worldwide die of rabies each year, with 95 percent of the fatalities occurring in Asia and Africa.¹ Fortunately, due to improved control and vaccination of domestic animals, as well as the development of effective post-exposure treatment and vaccines, the number of rabies-related deaths in the United States has declined over the past century from 100 annually to just one or two each year.² But, while the rate of rabies deaths has dropped dramatically, the rate of rabies infection is no less of a concern. Thousands of people are still exposed to the rabies virus, and many of those people fail to seek medical attention, mainly because they are unaware of their exposure, but also because they are misinformed. Understanding the facts about how they can contract rabies and how to prevent infection is essential.

Myth: Rabies is not a major concern in the U.S.

Fact: Rabies has been reported in every state except Hawaii. In 2006, 49 states, the District of Columbia and Puerto Rico reported 6,940 cases of rabies in animals and three human cases to the Centers for Disease Control and Prevention. The total number of reported cases increased by 8.2 percent from those reported in 2005 (6,418 cases). Although human deaths from rabies are now rare in the U.S., every year approximately 40,000 persons receive postexposure treatment for rabies exposure.³

Myth: Rabies can only be transmitted by a rabid animal bite.

Fact: Rabies can be transmitted through a wound, scratch or other break in the skin if it comes in contact with the animal’s saliva.⁴ Very rarely, rabies has been transmitted without an actual bite.⁵

Myth: The only real threat of rabies comes from dogs and raccoons.

Fact: While dog bites continue to be a common cause of rabies in developing countries, wild animals are the most common cause of rabies in developed countries.¹ Domestic animals account for less than 10 percent of the reported rabies cases, with cats, cattle and dogs most often reported rabid.² However, there have been no reports of rabies caused by dog bites in the U.S. for many years due to widespread animal vaccination. What is more frequently reported now is rabies caused by bats and raccoons.⁵ Other wild animals that carry the rabies virus are wild foxes, skunks, jackals and wolves, although transmission from these animals is rare. In addition, livestock, horses and deer can become infected with rabies, and although they could transmit the virus to other animals or people, this rarely occurs.¹

Myth: Rabid animals will always froth at the mouth.

Fact: Although foaming at the mouth is a sign of rabies, it is also a symptom of more common ailments, including distemper, ticks, diabetes, liver failure, allergies and dehydration. And since it is not always characteristic of rabies, it should never be assumed that because an animal is not foaming at the mouth that it doesn’t have rabies.⁶

Myth: Rabid animals are afraid of the water.

Fact: Humans infected with rabies suffer painful muscle spasms while attempting to swallow, which can cause a fear of water. However, rabid animals are not afflicted with these spasms and, thus, can drink as much water as they want.⁴

Myth: After coming into contact with a suspected rabid animal, an individual should never try to capture it.

Fact: When humans are exposed to suspected rabid animals, attempts to identify, capture or humanely sacrifice the animal should be undertaken immediately. In addition, post-exposure treatment should begin right away and only be stopped if the animal is a dog or cat that remains healthy after 10 days. Animals that have been sacrificed or that have died should be tested for rabies.¹ Immunofluorescence microscopy, the most rapid and accurate test method, looks at the brain tissue after an animal is dead to diagnose rabies. A similar test checks for rabies in humans, using a piece of skin from the neck. And, doctors may also look for the rabies virus in humans in their saliva or spinal fluid.⁵

Myth: First aid won’t help a person who has been infected by a rabid animal.

Fact: Cleansing wounds and getting immunized against rabies immediately after contact with a suspected animal can prevent the onset of rabies in 100 percent of exposures. If individuals have merely touched or fed an animal they suspect of having rabies, but their skin is still intact, it is recommended they clean and disinfect the point of contact. Individuals who have minor scratches without bleeding from contact, licks on broken skin, bites or other contact that breaks the skin also should have an anti-rabies immunization. In addition, an anti-rabies immunoglobulin (a blood product that contains antibodies against rabies) should be given to those who have bites, scratches, licks on broken skin, other broken skin contact or even exposure to bats, as well as to those who have weaker immune systems.¹

Myth: Rabies is not necessarily fatal in humans.

Fact: Once symptoms of the disease develop, there is no cure. The virus infects the central nervous system, causing encephalopathy and, ultimately, death. Early symptoms are nonspecific, and consist of fever, headache and general malaise. As the disease progresses, neurological symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty swallowing and hydrophobia (fear of water). Death usually occurs within days of the onset of symptoms.²

Myth: Rabies is always fatal.

Fact: Rabies is fatal if not treated quickly. However, if treated with vaccinations within 24 to 48 hours,rabies is rarely fatal to humans or animals.⁶ In fact, vaccinations can prevent the onset of rabies in virtually 100 percent of exposures.¹ Currently, there are two rabies vaccines: Imovax, manufactured by Sanofi Pasteur; and Rabavert, manufactured by Novartis Vaccines. While these vaccines are prepared in different ways, both are made from inactivated virus, and both are considered equally safe and effective. Treatment with these vaccines is known as post-exposure prophylaxis (PEP). An exposed person who has never received any rabies vaccine will first receive a dose of rabies immune globulin, which gives immediate, short-term protection. This shot should be given in or near the wound area. Follow-up care includes a series of rabies vaccinations. The first dose should be given as soon as possible after the exposure,with additional doses administered on days three,seven and 14 after the first shot.Anyone who has previously been given the rabies vaccine should receive two more doses — one dose immediately and one three days later. These shots should be given in the deltoid muscle of the arm. However, children also can receive the shots in the muscle of the thigh.³

Myth: Rabies shots are extremely painful.

Fact: In the past, rabies treatment was extremely painful because it involved multiple nerve-tissue-based vaccinations into the abdomen with a large needle. Now, however, the procedure involves fewer injections with a much smaller needle into the deltoid muscle of the arm.⁷ The rabies vaccine today is no more painful than any other type of vaccination.