Rabies

About rabies

Rabies causes inflammation of your brain and spinal cord. Unless treated before the symptoms develop, it's almost always fatal. Up to 55,000 people die from rabies each year – most of these deaths occur in developing countries, such as Africa, Asia and South America.

You can catch rabies through a bite from an infected animal. Since the early 1900s, the rabies virus has been wiped out among wild animals in the UK. Under UK law, most mammals brought into the country that are capable of carrying the rabies virus are required to stay in quarantine for a period of six months before being released. This is to prevent the spread of the virus.

Rabies is very rare in the UK. Most people diagnosed with rabies in the UK have got it abroad, usually through dog bites.

Symptoms of rabies

The time it takes for symptoms to appear after you become infected with the rabies virus is known as the incubation period. This period is usually between one and three months. However, it can range from under a week to over one year. The incubation period is shorter if you get bitten on your face, rather than on one of your extremities such as your hands or feet.

The symptoms of rabies, to begin with, include having a flu-like illness with fever and headache, followed by itching, pain or pins and needles close to the bite. Rabies can then develop in one of two ways depending on whether the virus enters your brain or spinal cord. Symptoms of rabies usually last between two and 10 days.

Furious rabies

This develops when the virus causes inflammation of your brain (encephalitis). Most people get this type. Symptoms of furious rabies can include:

  • feeling restless or agitated
  • feeling confused and hallucinating (seeing or hearing things that aren't really there)
  • being hyperactive
  • having strange thoughts and behaving out of character
  • being very sensitive to light, noise and touch
  • having difficulty sleeping (insomnia)
  • foaming at the mouth (because of increased salivation)
  • being unable to swallow water

Within a few days, your breathing will slow down and your heart will beat irregularly, eventually leading to heart failure, coma and death.

Paralytic or ‘dumb’ rabies

This develops when the virus causes inflammation of your spinal cord. Your muscles gradually become paralysed, starting near to the bite and then spreading to other areas of your body. Within a few weeks, the paralysis will cause heart failure and death.

Causes of rabies

The rabies virus belongs to a group of viruses called Lyssavirus and is found in the saliva of infected animals. You can get the virus if you’re bitten or scratched by an infected animal. You can also get it if the infected animal licks you and its saliva comes into contact with cuts, areas of eczema on your skin, or the mucous membranes of your eyes or mouth. Rabies is most commonly passed on from infected dogs, but you can also get it from cats, raccoons, bats, foxes and skunks.

Once inside your body, the virus enters your nervous system and gradually travels towards your brain and spinal cord.

Diagnosis of rabies

Although rabies is very rare in the UK, if you've been bitten by an animal, particularly a wild dog or bat, you must seek urgent medical attention. Your doctor will examine you and ask about the type of animal that has bitten you. He or she may also ask you about the animal’s general behaviour at the time – particularly if you have been bitten abroad. You should tell him or her if you have had the rabies vaccine.

If your doctor suspects you could have come into contact with rabies, you will be given the rabies vaccine and anti-rabies antibodies (rabies immune globulin) to prevent the condition developing.

If you have the symptoms of rabies, your doctor may take saliva, blood or tissue samples to confirm you have rabies.

Treatment of rabies

If you have been bitten by an animal that has rabies and seek help quickly (within days of exposure), it's possible to prevent the condition developing with a course of vaccines (see Prevention of rabies). If you have already developed some of the symptoms, you should seek medical help even though there isn't a cure. Your doctor may be able to give you a sedative and some painkillers to help ease the symptoms, though the condition is always fatal.

Prevention of rabies

There is no cure for rabies, so it’s important to take preventive measures. Things you can to do to reduce your risk of rabies include the following.

  • Don’t approach wild animals.
  • Don’t attempt to pick up stray cats or dogs – even if they look friendly.
  • Don’t attract stray animals by offering food or by being careless with litter.
  • If you're travelling to an area where rabies is common, especially if you will be travelling in rural areas that are far away from towns and cities, get vaccinated beforehand (see Pre-exposure to rabies).
  • If you’re bitten by a wild animal, seek urgent medical help (see Post-exposure to rabies).

Pre-exposure to rabies

If you're travelling to an area where rabies is common, especially if you will be away from towns and cities for an extended period, you must have a pre-exposure rabies vaccine. You will be given three injections. After the first, you will have the second a week later and the third after a further three weeks (or after a further two weeks if there isn't enough time before you travel). After this, you will need a reinforcing dose a year later and a top-up every two to five years, depending on how at risk you are of getting rabies.

Having the rabies vaccine doesn't mean you're immune to the disease. However, in the event that you get bitten, it may give you more time to seek medical treatment before the symptoms develop.

See your GP or visit a travel advice centre for more information.

Post-exposure to rabies

If you have been bitten by an animal that may have rabies, you should clean the wound with soap and water immediately. You should then disinfect the area with alcohol or iodine solution and seek help from a medical professional.

Your doctor will give you a course of five rabies vaccines. After the initial dose (day one), you will need four further doses on day three, seven, 14 and 28 after the first vaccine. If you have recently had a course of rabies vaccines before exposure, you may only need to have two more doses, three days apart.

Your doctor may also give you antibiotics to prevent infection and a dose of rabies immunoglobulin, depending on the type of animal you have been bitten by. The aim of the rabies immunoglobulin is to give you antibodies to fight the rabies virus while your body produces its own. For this reason, the rabies immunoglobulin is only given at the same time as your first dose of the rabies vaccine after exposure.

Who should have the rabies vaccine?

Answer

Anyone who comes into regular contact with imported animals, or who lives or travels in a country where rabies is common, especially in rural areas, should have the vaccine.

Explanation

If your job requires you to handle animals from other countries, you will need to have the rabies vaccine. This may be the case, for example, if you work at an animal quarantine centre, a zoo, port or research centre.

If you're planning on moving to and settling in a country where rabies is common, for example, in India, Thailand or Turkey, you may need to have the rabies vaccine. You may also need to have it if you're travelling for more than one month in an area that doesn't have reliable medical services.

See your GP or travel advice centre for more information about the rabies vaccine.

Are there any side-effects of the rabies vaccine?

Answer

Most people who have the rabies vaccine don't have any side-effects. Severe reactions are very rare.

Explanation

Apart from having some pain, inflammation and redness where the needle containing the rabies vaccine was put into your skin, it's unlikely that you will have any other side-effects. The most common side-effects include fever, headache, tiredness and irritability. Severe reactions to the vaccine (hypersensitivity) are very rare but require urgent medical help. Symptoms of such a reaction include:

  • difficulty breathing
  • severe and sudden swelling in your skin, especially around your eyes, neck and mouth
  • a rash on your skin with dark red, raised, itchy bumps (commonly known as hives)

Although not necessarily caused by a reaction to the rabies vaccine, you should seek urgent medical attention if you have these symptoms. 

How do I know if an animal has rabies?

Answer

As in humans, the symptoms of rabies in animals vary considerably.

Explanation

Some of the symptoms of rabies are difficult to spot in wild animals. For example, a wild animal is usually nervous or aggressive if you approach it. You may not notice any signs of foaming at the mouth unless you get close to the animal. If the disease causes paralysis – this too may be difficult to spot – the animal could be dragging its limbs, or sitting still for any number of reasons. And it will be difficult for you to tell if the animal is having problems with swallowing or drinking unless you try to feed it.

The best advice is to not approach or handle wild animals, especially if you're travelling abroad.