What Is Rabies? Transmission, Symptoms and What to Do After a Possible Exposure

Created: 29.07.2024 · Last Updated: 17.08.2026 · Category: Infectious Diseases · Prepared by the Academic Hospital Web and Editorial Board.

What Is Rabies?

Rabies is a viral zoonotic disease transmitted from infected mammals to humans.

The virus travels through the nervous system and eventually affects the brain and spinal cord. Once clinical rabies symptoms develop, the disease is almost invariably fatal.

However, rabies can be prevented after an exposure through prompt wound care and appropriate post-exposure prophylaxis.

Do not wait for rabies symptoms to appear. Medical assessment should be obtained promptly after a potentially risky bite, scratch or saliva exposure.

How Is Rabies Transmitted?

Rabies is mainly transmitted through saliva from an infected mammal.

Potential routes include:

  • Bites from an infected animal
  • Scratches that break the skin
  • Saliva contacting broken skin or an open wound
  • Saliva contacting mucous membranes such as the eyes, mouth or nose
  • Certain direct exposures to bats

Worldwide, dogs account for the vast majority of human rabies infections.

Which Contacts Are Considered Rabies Exposures?

Exposure General WHO Approach
Category I
Touching or feeding animals, licking of intact skin		 Not considered a rabies exposure; PEP is generally not required when the skin is intact.
Category II
Nibbling of uncovered skin, minor scratches or abrasions without bleeding		 Wound care and rabies vaccination are considered.
Category III
Transdermal bites or scratches, saliva on broken skin or mucosa, certain direct bat exposures		 Wound care, vaccination and appropriate passive immunisation are considered.

The final decision depends on the animal species, type and location of exposure, local rabies epidemiology, whether the animal can be observed or tested and the person's previous rabies vaccination history.

What Should You Do After an Animal Bite or Scratch?

  1. Immediately wash and flush the wound thoroughly with soap and running water for at least 15 minutes.
  2. If available, an appropriate virucidal antiseptic such as povidone-iodine may be used.
  3. If saliva has contacted the eyes or another mucosal surface, rinse thoroughly with water.
  4. Seek medical assessment promptly.
  5. Tetanus protection and the risk of bacterial wound infection should also be assessed.

A small wound, a vaccinated-looking pet or a delay since the exposure should not be used as the sole reason to avoid medical assessment.

What Are the Symptoms of Rabies?

Early symptoms may include fever, headache, malaise and pain, tingling, burning or unusual sensations at the site of the bite or exposure.

As the infection progresses, neurological manifestations may include:

  • Agitation
  • Behavioural or mental-status changes
  • Difficulty swallowing
  • Hydrophobia caused by painful swallowing spasms
  • Excessive salivation
  • Seizures
  • Paralysis
  • Coma

Rabies does not always present with aggression. A paralytic form can occur in which progressive weakness and paralysis are prominent.

When Do Rabies Symptoms Appear?

The incubation period is commonly measured in weeks to months and is often around two to three months, although it can vary considerably.

The location and severity of the wound, amount of viral inoculum and proximity to highly innervated tissues can affect the incubation period.

A delay of days or weeks after an exposure does not automatically mean it is too late to seek care. People with an untreated potentially significant exposure should still obtain medical assessment.

How Is Rabies Diagnosed?

Clinical history, the circumstances of animal exposure and neurological findings are assessed together.

Laboratory confirmation of clinical rabies can involve multiple samples and techniques, including testing of saliva, cerebrospinal fluid and a skin biopsy from the nape of the neck.

Post-exposure prophylaxis decisions should not be delayed until clinical symptoms or a positive human laboratory test develop.

Can Rabies Be Prevented?

Yes. Prevention includes:

  • Vaccinating domestic animals
  • Avoiding unnecessary contact with stray or wild mammals
  • Teaching children safe behaviour around animals
  • Immediate wound washing after a possible exposure
  • Prompt medical risk assessment
  • Rabies vaccination and passive immunisation when indicated

What Is Rabies Post-exposure Prophylaxis?

Post-exposure prophylaxis (PEP) is preventive treatment given after a potential rabies exposure to stop the virus before it reaches the central nervous system.

It consists of:

  • Immediate wound care
  • Rabies vaccination when indicated
  • Rabies immunoglobulin or another appropriate passive immunisation product for selected high-risk exposures

The vaccination regimen can differ according to previous vaccination, immune status and the national protocol being followed.

When Is Rabies Immunoglobulin Used?

Rabies immunoglobulin provides immediate passive antibodies for selected severe exposures in people who have not previously received an appropriate rabies vaccination course.

Where indicated, as much as feasible is infiltrated in and around the wound.

Not every exposure requires rabies immunoglobulin, and management differs in people previously vaccinated against rabies.

What Does the 10-Day Animal Observation Period Mean?

A healthy dog or cat that has exposed a person can, in appropriate circumstances and under public-health or veterinary supervision, be observed for 10 days.

If the animal remains completely healthy during that period, it is considered not to have been infectious with rabies at the time of the exposure.

The 10-day observation period is not a reason for the exposed person to delay medical assessment. Decisions about observation and post-exposure treatment should be made by the relevant healthcare and veterinary/public-health authorities.

What About Bats and Wild Animals?

The standard 10-day observation period used for dogs and cats is not applied to bats and most wild animals.

A bite, scratch or other potentially significant direct exposure to a bat, fox or other wild mammal requires prompt medical risk assessment.

Bat bites can be very small and difficult to recognise, making the circumstances of the contact particularly important.

Who May Need Pre-exposure Rabies Vaccination?

Pre-exposure prophylaxis is not routinely required for the general population.

It may be considered for people with increased occupational or travel-related risk, including certain laboratory personnel, veterinary professionals, wildlife workers and selected travellers to high-risk areas where access to post-exposure care may be limited.

Pre-exposure vaccination does not eliminate the need for medical assessment and additional treatment after a genuine rabies exposure.

Do Not Delay After a Potential Rabies Exposure

After an animal bite, skin-breaking scratch or saliva exposure to broken skin or mucosa, wash the area thoroughly and seek medical assessment promptly.

Frequently Asked Questions

How is rabies transmitted?
Rabies is mainly transmitted when saliva from an infected mammal enters the body through a bite or skin-breaking scratch. Saliva contacting broken skin or the eyes, mouth or nose can also constitute an exposure.
What should I do first after a dog or cat bite?
Immediately wash and flush the wound with soap and running water for at least 15 minutes and seek medical assessment promptly. Rabies, tetanus and bacterial wound infection should be considered.
Is saliva on intact skin a rabies exposure?
Under the WHO exposure classification, touching an animal or a lick on intact skin is Category I and is not considered a rabies exposure. The situation is different when the skin is broken.
Should I wait for symptoms before receiving rabies vaccination?
No. Post-exposure prophylaxis is intended to prevent rabies before symptoms develop. Potentially significant exposures should be assessed promptly.
Is it too late if several days have passed since the bite?
Not necessarily. If a potentially significant exposure occurred and appropriate prophylaxis was not given, medical assessment should still be obtained. The passage of several days alone is not a reason to abandon evaluation.
Can a dog or cat be observed for 10 days?
A healthy dog or cat that can be reliably monitored may be observed for 10 days under appropriate authority supervision. The exposed person should still obtain medical assessment promptly rather than deciding independently to wait.
Is the same 10-day observation used after bat exposure?
No. The standard 10-day observation approach used for dogs and cats does not apply to bats and most wild animals. Potentially significant bat exposure requires prompt medical risk assessment.
Can rabies vaccination cure rabies after symptoms have started?
Rabies vaccination after exposure is used to prevent disease before symptoms develop. Once clinical rabies symptoms have begun, the disease is almost invariably fatal, making timely post-exposure prophylaxis critical.
Academic Hospital note: The appearance of the wound or the fact that an animal is a household pet is not sufficient to determine rabies risk. Wash the wound with soap and running water for at least 15 minutes and have the species, exposure type, animal health and vaccination status and your previous rabies vaccinations assessed together. You can book an appointment.

References

  1. Academic Hospital. Rabies: Transmission and Prevention
  2. World Health Organization. Rabies
  3. World Health Organization. Rabies Vaccinations and Immunization
  4. Centers for Disease Control and Prevention. Rabies Post-exposure Prophylaxis Guidance
  5. Centers for Disease Control and Prevention. Information for Veterinarians – Rabies