Rabies: Questions and Answers Q&A information about the disease and

What causes ? is almost always fatal. Rabies occurs in more than Rabies is caused by a . The virus invades the 150 countries and territories and each year rabies and disrupts its functioning. kills more than 59,000 people around the world, mostly in and . How does rabies spread? Deaths from rabies are rare in the The is transmitted in the saliva of because of the wide availability of rabies and infected . People usually become infected rabies immune globulin with the virus by being bitten by an infected , but any contact with the saliva of an infected animal What should I do if a neighborhood bites (alive or dead) can potentially lead to if the my ? person has an opening in the skin or the saliva gets Rabies is not common in , , , and into their eyes, nose, or mouth. in the United States because most are You cannot get rabies from the blood, urine, or vaccinated against rabies. However, you should of a rabid animal, or from just touching or petting get medical attention for any . If the an animal. appeared healthy at the time your child was bitten, it can be confined for 10 days and observed; no anti- How long does it take to show signs of rabies af- rabies treatment need be given to your child. If the ter being exposed? pet appeared ill at the time it bit your child, it should be evaluated by a for signs of rabies. The of rabies is more variable Your physician will be able to give you more specific than with other . The incubation period advice for your situation. in is usually several weeks to months, but ranges from days to years. If rabies isn’t common in U.S. dogs and cats anymore, is there anything to worry about? What are the symptoms of rabies? Unfortunately, the rabies hosts have changed The rabies virus attacks the nervous system ( from domestic animals to wild ones. Before 1960, and ). The first symptoms of rabies are the majority of rabies cases in the United States similar to a flu-like illness—, , and involved domestic animals; now more than 90% of general discomfort. Within days, the disease can all animal cases reported to the Centers for Disease progress to symptoms such as , , Control and Prevention occur in . agitation, abnormal behavior, , and halluci- nations. What animals usually get infected with rabies? Once symptoms appear, the disease is almost Wild animals accounted for 92% of reported cases always fatal. Therefore, any person who has been bit- of rabies in 2015. were the most frequently ten, scratched, or somehow exposed to the saliva of reported rabid wildlife species (31% of all animal a potentially rabid animal should see a physician as cases during 2015), followed by (29%), soon as possible for postexposure treatment. (25%), (6%), cats (4%), (2%) How serious is rabies? and dogs (1%). While rabies is not commonly found in , Rabies is an extremely painful and deadly disease. , and , any can be infected As mentioned above, if prompt and appropriate by rabies. post-exposure treatment is not received, the disease continued on the next page ▶

Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4216.pdf • Item #P4216 (11/18) Rabies: Questions and Answers (continued) page 2 of 4

On a camping trip we woke up to find a in animal and the likelihood of rabies infection in that our tent. Should we have been concerned? species in that geographical location. Diagnosis is Yes. Because bats have small teeth and claws, it is easier if the animal involved is available for testing. possible to be bitten by a bat and not know it. There- If the biting animal is killed efforts should be made fore, if you find you’ve been sleeping in the same to preserve the head which will be tested for the room with a bat you should see a doctor as soon presence of rabies virus in a laboratory. as possible. This also applies if a bat is found in a room with a child or a mentally impaired or intoxi- What does postexposure treatment involve? cated person. In the United States, postexposure treatment con- The bat should be tested for rabies if possible. Call sists of one dose of immune globulin (a blood animal control or a wildlife conservation officer for product containing to rabies virus) and a help in capturing the bat if there is any question of series of rabies . More detailed informa- exposure. tion about the vaccine can be found on page 3. The good news is that if postexposure treatment is What should I do if I find a bat in my ? given correctly and in time, it is 100% effective in If you’re sure no family members or have possi- preventing rabies disease. bly been bitten by the bat, confine the bat to a room and leave one window open for the bat to exit. If the Can you get rabies from another person? bat doesn’t leave, call animal control for assistance This has only occurred in a small number of cases or for advice in safely capturing the bat. Bats that are after transplants (corneas, liver, kidneys) from an the easiest to approach and capture (unable to fly, infected person. Stricter guidelines for acceptance etc.) are the most likely to have rabies, so it is best of donor organs have been adopted as a result of to never handle any bat. these cases. In theory, infected humans could trans- mit rabies through a bite or other exposure, but no I’ve been bitten by a —what should I laboratory-confirmed cases of rabies occurring in do? this way have been reported. If you’ve been bitten or scratched by any animal, you How common is rabies in the United States? should In 2015, all 50 states and Puerto Rico reported 5,508 1. Clean the area immediately with soap and water cases of and 3 cases to for at least 5 minutes. CDC. The total number of reported cases decreased 2. See a health professional as soon as possible, by approximately 9.0% from those reported in 2014 ideally within 24–48 hours (6,033 rabid animals and 1 human case). In the last 100 years, the number of human deaths 3. Notify your state or local health department from rabies in the United States has fallen from 100 or more per year to an average of 2 or 3 per year. How is rabies diagnosed? This decline is due to both the improved control and Rabies can be very difficult to diagnose. Laboratory of domestic animals and to the develop- tests can find rabies virus in the saliva, skin, or brain ment of effective postexposure treatment and vac- tissue of a patient; unfortunately, this is not pos- cines. Although human deaths from rabies are now sible until late in the disease when it is too late for rare in the United States, an estimated 40,000 to treatment. Therefore, the physician or other health 50,000 people come in contact with potentially rabid professional will most likely make a diagnosis based animals and receive postexposure prophylaxis each on the details of contact with a potentially infected year.

continued on the next page ▶

Immunization Action Coalition • Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4216.pdf • Item #P4216 (11/18) Rabies: Questions and Answers (continued) page 3 of 4

How common is rabies in the world? What kind of vaccine is the ? The rabies virus can be found everywhere except Although the two brands of vaccine available in the in some countries and territories of the developed U.S. are prepared in different ways, both of them are world (e.g., Japan, New Zealand) and the developing made from inactivated, or killed, virus. Both types world (e.g., Barbados, Fiji, Maldives, and Seychelles) are considered equally safe and effective. The vac- and in parts of northern and southern continental cine is given in the as a series of 3–5 (e.g., Greece, Portugal, , Norway) shots. and America (e.g., Uruguay and Chile). In the United States, Western Europe, , and much Who should get this vaccine? of , rabies has been nearly eliminated Rabies vaccine is recommended for from domestic dogs, but still occurs in the wildlife • Persons in high-risk occupational groups, such population. as and their staff, animal handlers, Rabies is a big problem in Asia, Africa, and Central rabies researchers, and certain laboratory workers and South America. Each year rabies kills more than • Persons whose activities bring them in frequent 59,000 people and millions of animals worldwide. contact with rabies virus or potentially rabid bats, About 95% of human deaths occur in Asia and raccoons, skunks, cats, dogs, or other species at Africa. risk for having rabies Exposure to rabid dogs is the cause of over 90% of • International travelers who are likely to come in human rabies cases and over 99% of human deaths contact with animals in areas where dog rabies is from rabies worldwide. Although vaccination of common, especially if they will have limited access dogs and elimination of strays has been shown to to appropriate medical care effectively prevent most cases of human rabies, the cost of such a control program is beyond the reach Can the vaccine protect you if you’ve already of most developing countries. been exposed to rabies? Yes. The vaccine is only routinely recommended How can I help prevent rabies in my pet and for persons in groups at high-risk of exposure. Vac- myself? cinating the entire population against a rare disease • Vaccinate your pets (dogs, cats, ferrets) and live- they are unlikely to ever encounter isn’t practical, yet stock (, cattle, ) against rabies. Don’t anyone could have an unexpected encounter with a let your pets wander unsupervised. Spay or neuter bat or other potentially infected animal. Fortunately, your pets; pets that are fixed are less likely to leave because rabies usually has a long incubation period, home and become strays. the body has time to respond and develop antibod- • Contact animal control to remove stray animals or ies to a vaccine given after an exposure. animals acting sick or strange in your neighbor- hood. What does the postexposure treatment include? An exposed person who has never received any • Never touch or approach unfamiliar animals, rabies vaccine will first receive a dose of rabies domestic or wild. Don’t touch dead animals. immune globulin (a blood product that contains Teach your children the same. antibodies against rabies), which gives immedi- • Seal openings into your home (basement, porch, ate, short-term protection. This shot should be attic, and chimney openings) to prevent wild ani- given in or near the wound area. They should also mals from gaining entrance. be given a series of rabies vaccinations. The first • If you do get bitten by an animal, wash the wound dose should be given as soon as possible after the with soap and water for at least five minutes and exposure. Additional doses should be given on days then seek medical care. three, seven, and 14 after the first shot. These shots should be given in the deltoid muscle of the arm.

continued on the next page ▶

Immunization Action Coalition • Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4216.pdf • Item #P4216 (11/18) Rabies: Questions and Answers (continued) page 4 of 4

Children can also receive the shots in the muscle countries, especially in Asia and Africa. Not only is of the thigh. Properly administered postexposure dog rabies common there, but postexposure treat- treatment for rabies has never been known to ment for humans may be hard to obtain. If you are fail. Rabies vaccine should never be given in the traveling to a country where rabies is common, gluteal muscle. you should talk to your health care provider about the possibility of being protected against rabies The rabies vaccine is recommended for me before your trip. Vaccination may be recommended because I’m an animal control officer. How depending on your planned activities and length of does being treated after an exposure differ stay. Contact with all animals, including dogs and from getting vaccinated before an exposure? cats, should be avoided when traveling abroad. Treatment after an exposure in a previously Can a pregnant woman receive rabies vaccine unvaccinated person requires receiving a dose of rabies immune globulin and four (or five if the if exposed to rabies? person’s immune system is suppressed) doses Yes. No fetal abnormalities have been reported with of vaccine. Vaccination before exposure requires the rabies vaccine. She can even receive routine only three doses of vaccine and no immune glob- pre-exposure vaccination against rabies if her risk ulin. Booster doses of vaccine are recommended of exposure is high. for some persons at high risk of rabies exposure. Check with your health department. Who recommends this vaccine? The federal Advisory Committee on Immunization Is an immunized person totally protected if Practices (ACIP) of the Centers for Disease Control bitten by a rabid animal? and Prevention (CDC) formulate the recommenda- No. If bitten, a vaccinated person should receive tions for this vaccine. two more doses of rabies vaccine; one dose immediately and one three days later. What side effects have been reported with this vaccine? What’s the advantage of being immunized Most reactions to this vaccine are mild, such as against rabies if you still have to receive ad- soreness and redness at the injection site. Moder- ditional doses of vaccine if you’re exposed? ate problems, including hives, pain in the joints, Being vaccinated simplifies treatment by elimi- and fever, are possible in a small percentage of nating the need for rabies immune globulin patients (6%) given booster doses. and decreasing the number of doses of vaccine needed after an exposure. This is important Who should NOT receive the rabies vaccine? because many people at high risk may be work- The rabies vaccine is not recommended for routine ing in areas where they may not be able to get use in the general population. Anyone for whom immediate medical attention, or where immu- the vaccine is recommended should not receive a nizing products are not readily available. Being dose when they are moderately or severely ill. vaccinated might also provide protection against unknown exposures to rabies (e.g., from a bat Can the vaccine cause rabies? bite). No. Should I be concerned about rabies if I’m traveling outside the United States? Yes. Rabies is a big problem in many other

Immunization Action Coalition • Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4216.pdf • Item #P4216 (11/18)