Rabies: Recognize Exposure and Act Fast

Rabies is a nearly 100% fatal viral disease once symptoms begin—but it is preventable after exposure with prompt wound care, vaccine, and, for high‑risk exposures, rabies immunoglobulin (RIG). Dogs are the most common source globally, but cats, bats, and other mammals can transmit the virus.

How Rabies Spreads

• Source of infection: infected mammals (especially dogs; also cats, bats, raccoons, foxes). Human‑to‑human transmission is exceedingly rare.
• Route: virus in saliva enters through bites, scratches that break skin, or contact with mucous membranes (eyes, mouth). Intact skin contact does not transmit rabies.
• Susceptibility: all unvaccinated people are susceptible; risk is higher for veterinarians, animal handlers, and travelers to endemic areas.

Immediate First Aid After a Bite or Scratch

• Wash the wound immediately with soap and running water for at least 15 minutes; flush thoroughly. If available, apply povidone‑iodine or another virucidal antiseptic after washing.
• Do not delay medical evaluation. Avoid tight bandaging and primary closure unless directed by a clinician.
• Record the animal’s species, behavior, health status, and availability for testing/observation.

Classifying Exposures (guides treatment)

• Category I: touching/feeding animals, licks on intact skin → no PEP if reliable history and skin intact.
• Category II: minor scratches/abrasions without bleeding, nibbling of uncovered skin → vaccine.
• Category III: single or multiple transdermal bites/scratches, contamination of mucosa or broken skin with saliva, bat exposures → vaccine + RIG.

Post‑Exposure Prophylaxis (PEP)

• Vaccine (unvaccinated persons):
• Intramuscular regimen (common): doses on days 0, 3, 7, and 14. Some programs add day 28 for immunocompromised individuals.
• Intradermal regimens are used in some settings; follow local public health guidance.
• Rabies immunoglobulin (RIG) for Category III exposures (and some severe Category II per policy):
• Infiltrate as much of the calculated dose as anatomically feasible into and around all wounds after thorough washing. Inject any remaining volume intramuscularly at a site distant from vaccine.
• Use human RIG 20 IU/kg (or equine RIG 40 IU/kg where used). Do not mix in the same syringe or site as vaccine.
• RIG is given once, ideally with the first vaccine dose (day 0), up to 7 days after starting vaccine if initially unavailable.
• Previously vaccinated persons (documented pre‑ or post‑exposure series): no RIG; give 2 vaccine doses on days 0 and 3.

Special situations

• Bites to the head/face/hands or deep, multiple wounds: urgent evaluation; prioritize RIG infiltration.
• Immunocompromised: use full IM schedule and consider serologic confirmation of response.
• Pregnancy and childhood: PEP is safe and indicated when exposed.

Animal Assessment and Public Health Steps

• Healthy dogs/cats/ferrets that bite humans may be observed for 10 days when feasible under public health direction; illness or death warrants testing and continuation of PEP.
• Wild or unavailable animals: treat as rabid exposure unless proven otherwise.
• Coordinate with local health authorities for testing and vaccination guidance.

Symptoms and When to Seek Emergency Care

• Early: fever, tingling/paresthesia at bite site, anxiety.
• Progressive neurologic signs: agitation, hydrophobia/aerophobia, confusion, excessive salivation, difficulty swallowing, or paralysis.
• Any exposure with neurological symptoms is a medical emergency—seek immediate care.

Prevention

• Vaccinate pets; follow leashing and animal control laws.
• Avoid contact with stray animals and wildlife; do not handle bats.
• Travelers to endemic regions and high‑risk workers may benefit from pre‑exposure vaccination (two doses on days 0 and 7 per recent guidance; follow local policy).
• Educate children to report animal bites promptly.

This article is for general education and does not replace professional medical care. After any bite or scratch from a mammal in a rabies‑endemic area—or uncertain exposure to a bat—wash immediately and seek medical evaluation without delay. Public health guidance varies; follow local recommendations.