Rabies is a viral disease usually transmitted to humans by a bite from an infected animal. The disease leads to death if treatment is not started before the onset of severe symptoms.

What is rabies?

The rabies virus is one from the genus Lyssavirus. Once the virus has entered the body, it travels quickly along the nerves to the central nervous system, causing acute inflammation of the brain. It then spreads into the organs of the body; the saliva glands receive high concentrations of the virus, causing further transmission into the body. Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is effectively untreatable and usually fatal within days. Rabies kills around 55,000 people a year, mostly in Asia and Africa.

Causes

Worldwide, the vast majority of human rabies cases (approximately 97%) come from dog bites, but other animals such as infected bats, monkeys, raccoons, foxes, skunks, cattle, mongoose or cats present the greatest risk to humans. Rabies may also spread through exposure to infected domestic farm animals, groundhogs, weasels and other wild carnivores. Rodents (e.g. mice and squirrels) are seldom infected.

Symptoms

The incubation period of rabies is normally two to 12 weeks, but it can take as long as two years for the first symptoms to show.

At first the symptoms will be like those of the flu (fever, headache and general weakness or discomfort), but soon thereafter the infected person will experience slight or partial paralysis and suffer from confusion, anxiety, insomnia, distress, hydrophobia (fear of water), paranoia, terror, hallucination and eventually delirium and coma.

Typical symptoms during the later stages of the illness is the production of large quantities of saliva and tears coupled with an inability to speak or swallow.

Death usually follows two to ten days after the first symptoms.

What to do if bitten

The virus is present in the nerves and saliva of a rabid animal. Humans usually become infected when bitten by an animal with rabies, but this is not the only method as any contact that transfers the virus to humans may cause the infection. Rabid animals usually display exceptionally aggressive or uncharacteristic behaviour and may attack without provocation. Any biting animal suspected of being rabid should be immediately killed humanely and taken along to the hospital, clinic or doctor for laboratory examination to confirm or refute rabies infection.

The WHO recommends the following immediate first-aid procedures:

    • “Immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, [alcohol], povidone iodine or other substances of proven lethal effect on rabies virus. If soap or an antiviral agent is not available, the wound should be thoroughly and extensively washed with water… Exposed mucous membranes such as the eyes, nose or mouth should be flushed thoroughly with water.”
    • It is imperative that the sufferer be taken to a hospital, clinic or doctor immediately for proper treatment (see below).

Treatment

Apart from the first-aid treatment mentioned above, medical treatment should be started as early as possible after exposure. Treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, generally within ten days of infection. Usually sufferers receive a dosage of human rabies immunoglobulin and four doses of rabies vaccine over a fourteen day period.

Further, specialised treatment of the wound(s) will take place and other treatments, such as the administration of antibiotics and medicines to prevent tetanus, will be applied as appropriate for other bite wounds.

Prevention

Preventative vaccines are recommended for anyone who is at continual, frequent or increased risk of exposure to the rabies virus due to the area where they live or their occupation. Travellers spending a lot of time outdoors and children living in rural high-risk areas are particularly at risk.

These vaccines have been given to millions of people worldwide and in Asia and Africa they prevent approximately 272 000 deaths each year.

Vaccines for domestic dogs and cats are also available and recommended.

World Rabies Day, on 28 September every year, helps to promote information on and awareness of the prevention and elimination of the disease.

Our Employee Wellbeing Programme (EAP) is available 24 hours a day if you want to know more about rabies.