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Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Watch Out for Rabies -- It Could Happen to You!

September 12, 2013

By Henry H. Bernstein D.O.

With summer just around the corner, you probably will find yourself spending more and more time outside, enjoying the warm weather. But you are not alone — animals also enjoy roaming around outside this time of year. So don't be surprised if you find yourself having close encounters with wild animals. Remember though, if you are not careful, these animals can spread diseases, such as rabies.

Rabies is a serious illness caused by a virus that attacks the brain and spinal cord (central nervous system). Rabies usually spreads through saliva, and people can get the virus when an infected animal bites or scratches them. Even though rabies is rare in the United States (only a few cases are reported each year), thousands of people throughout the world still die from rabies each year. Most of these deaths are in developing counties, where wild animals are not well controlled and rabies vaccine is not available.

Fortunately, the United States is able to spend several hundred million dollars each year on animal-control programs and rabies vaccinations for animals and people. Whereas dogs and other domestic animals used to be the primary carriers of rabies, they now account for less than 10% of the reported rabies cases (most of these are in cats, cattle, and dogs). Today, more than 90% of confirmed rabies cases in this country are found in wild animals. Most cases involve raccoons, skunks, bats and foxes. Although squirrels, mice, rabbits and other mammals can have rabies, they rarely do.

There is no way to know whether an animal is rabid just by looking at it. Only in the later stages of the disease do animals show the “classic” symptoms of rabies, such as being aggressive with foaming at the mouth, or wandering or stumbling around a neighborhood during the day. In fact, an animal could have the disease without showing any rabies symptoms. Therefore, the safest policy is to stay away from any wild animal. Watch wildlife from far away. Use binoculars to get a closer look. Remember that an animal usually does not attack if it is not provoked, so always staying away from them in the first place should prevent most attacks.

People usually get rabies through bites, but sometimes it can be transmitted through a scratch by an infected animal or infected fluid (such as saliva) that splashes in the eyes, mouth or nose. If you do get bitten, scratched, touched by any wild mammal, or even just find a bat in your home, you should immediately:

  • Clean any contact areas thoroughly with soap and water. Washing vigorously right away helps to get rid of the rabies virus before it has a chance to enter the body. Careful wound care alone may decrease the likelihood of rabies by up to 90%. Cleaning the site also kills other germs that may cause infection. 
  • Seek medical advice immediately. You may need antibiotics, a tetanus shot, rabies immunoglobulin (protective antibodies obtained from people who have already been immunized against the disease) or rabies vaccine. 
  • Check with your local police department or animal-control center to alert them about the possibility of a rabid wild animal in the area.

Physicians are extremely cautious when it comes to rabies because if it goes untreated, it almost always is fatal. If there is even the slightest possibility that you’ve been exposed to rabies, they’ll urge you to get the shots. You can get the shots up to one week after a bite, but the sooner the better.

The vaccine series is 100% effective in beating the infection, so it is very important to take the shots if you think that you could have been exposed to rabies.

Many people believe that the rabies shots are extremely painful, but that is no longer true. Recent advancements with this vaccine have made the shots much more manageable. Treatment for possible rabies exposure now requires five shots of the vaccine (in the upper arm, spread over one month) along with two shots of human rabies immunoglobulin on the first day, one where the bite or scratch occurred and the other in the buttocks.

People who have frequent contact with wild animals often get a full series of the rabies vaccine before any possible exposure. They also need to get booster shots and blood tests every six months to be sure that they are making enough rabies antibodies to be fully protected.

Rabies is a serious disease. To help prevent the spread of rabies, keep these tips from the U.S. Centers for Disease Control and Prevention (CDC) in mind:

Be a responsible pet owner:

  • Keep vaccinations up-to-date for all dogs, cats and ferrets. This keeps your pets from getting rabies, but also protects you if a rabid wild animal bites your pet. 
  • Always supervise your pets closely so they do not come in contact with wild animals. If a wild animal bites your pet, call a veterinarian immediately. 
  • Call your local animal-control agency to remove any stray animals from your neighborhood. They may be unvaccinated and could be infected by the disease. 
  • Spay or neuter your pets to help reduce the number of unwanted pets that may not be properly cared for or regularly vaccinated.

Avoid direct contact with unfamiliar animals:

  • Enjoy wild animals (raccoons, skunks, foxes) from afar. Do not handle, feed, or unintentionally attract wild animals with open garbage cans or litter. 
  • Never adopt wild animals or bring them into your home. Do not try to nurse sick animals to health. Call animal control or an animal-rescue agency for assistance. 
  • Teach children never to handle unfamiliar animals, wild or domestic, even if they appear friendly. "Love your own, leave other animals alone" is a good principle for children to learn. 
  • Keep bats out of your homes, churches, schools, or other areas where they might come in contact with people and pets. 
  • When traveling in foreign countries, avoid direct contact with wild animals and be especially careful around dogs. Dogs are the major source of rabies in many Asian, African and Latin American countries. Tens of thousands of people die of rabies each year. Before traveling abroad, consult with a health care professional, travel clinic, or your health department about the risk of exposure to rabies, need for pre-exposure prophylaxis (vaccines), and how you should handle an exposure if one happens.

For more information on rabies, go to the CDC website.

Henry H. Bernstein, D.O., is a senior lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and professor of pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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