Rabies

What is rabies?
Rabies is a viral infection of the nervous system that can infect almost all mammals, including humans. Foxes, dogs, raccoons, bats and skunks can all act as reservoirs for rabies. Worldwide, the principal hosts for rabies are the domestic dog, and bats, particularly insect eating bats. Once infected, the virus becomes concentrated in an infected animal's saliva and is passed on through the animal's bite. It can also be passed on by contact of infected saliva through scratches, licks on broken skin and mucous membranes. It is one of the oldest recognised diseases in man. Rabies is a notifiable disease in Ireland.

How does rabies make you ill?
After being bitten by an infected animal, the disease usually incubates for about 3 to 8 weeks, but can be very variable. The virus multiplies in the initial wound and spreads through the nerves to the spinal cord and brain. When the virus reaches the brain, it rapidly multiplies and passes to the salivary glands. After this time early symptoms of malaise, fever, or headache followed by anxiety, convulsions and paralysis appear. Due to spasm of throat muscles, an affected person may find it difficult to swallow even water (hydrophobia). Not everyone who is bitten by a rabid animal will develop the disease. By the time symptoms develop, the disease has become very advanced and it is almost always fatal.  

Can rabies be treated?
There is a vaccine against rabies, licensed for use in Ireland, that is very effective at preventing the disease. The vaccine works by stimulating the body's defences to produce antibodies that will neutralise the rabies virus. When someone is strongly suspected of having been bitten by a rabid animal, specific antibody (called immunoglobulin or Ig) is also given at the same time as the vaccine, regardless of whether the person has been immunised in the past. This gives a booster dose of antibody that provides a very high dose of antibodies to combat the rabies vaccine. The earlier the vaccine and immunoglobulin are given, the better are the chances of survival. If given within hours of a bite recovery is generally 100%. Once symptoms of encephalitis appear (confusion, paralysis, coma), the disease is almost invariably fatal. 

Where is rabies found?
Rabies is found in Asia, Africa, and Central and South America, but it also can be found in northern Europe. In developed countries such as the United States very few people die of rabies, despite the disease being quite common among animals there. 

According to the World Health Organization, rabies is estimated to cause 59,000 human deaths annually in over 150 countries, with 95% of cases occurring in Africa and Asia. At least 30 countries, including Ireland, are officially rabies-free, usually because of strict regulations about animal movement. There has not been a case of rabies in animals in Ireland since 1902.  

How likely are you to catch rabies?
Rabies is very hard to contract. A deep bite from a rabid animal is the most likely way in which it can be passed on. Although possible, the likelihood of contracting rabies from licks of a rabid animal or from touching a rabid animal is tiny. 

Are bats a risk?
A tiny proportion of bats in Europe carry bat rabies (caused by European Bat Lyssavirus - very similar to normal or sylvatic rabies). Bats carrying rabies have been identified in the UK and there is at least one instance of a British bat handler dying of rabies following a bat bite. As bat populations are potentially quite mobile, the supposition must be that bats carrying rabies can fly to Ireland and so, given the seriousness of rabies, the assumption must be that any bat in Ireland (most especially a species known as Daubenton's bat) poses a risk of rabies. Accordingly, if a person is bitten by a bat in Ireland, they will be offered rabies preventive treatment, on the very slender possibility that they may have been exposed to the virus. However, it must be remembered that the likelihood of a member of the general public contracting rabies from a bat is extremely small; and it would only be in the circumstance where a bat were to bite a person that the disease could be spread.  

Bats are a protected and valuable species. It is important that members of the public should not approach a bat they come across. If a bat is seen during the day or allows a person to approach them, they are unwell and should not be approached. Bats should only ever be approached and handled by those trained and qualified to do so. By avoiding bats, members of the general public will have a risk of developing rabies that is very close to zero. 

What can be done if one is bitten by a rabid animal?
If bitten, and treated straightaway, the risk of dying is tiny. The wound should be cleaned thoroughly with soap and water. The person should then seek immediate medical attention. Vaccination and, occasionally if medically indicated, immunoglobulin are given. This would be particularly important for bites acquired outside the UK and Ireland.  

How to reduce your risk of rabies

Avoiding animal bites

Contact with wild or domestic animals (including bats) during travel should be avoided. Travellers should:
• not approach animals
• not attempt to pick up an unusually tame animal or one that appears to be unwell
• not attract stray animals by offering food or by being careless with litter
• be aware that certain activities may attract dogs (e.g. running, cycling)

Pre-exposure vaccines
If your doctor considers you might be at risk of rabies (i.e. travelling to the interior of remote tropical and temperate areas, far from medical services) then a course of pre-exposure vaccines (vaccines given before there is any contact with animals) are recommended.

A record of vaccination should be carried and shown to those providing emergency treatment following a worrisome bite. If the bite is bad enough, a person may also need post exposure prophylaxis as well but this is always a medical decision.

If a person is bitten then post exposure treatment (PET) in the form of an immunoglobulin that destroys the rabies can be given. It is only effective if given very shortly after the bite has occurred.

Action following a possible rabies exposure:

Following a bite from a dog suspected as being rabid: aid following a possible rabies exposure:

• Urgent action is required; treatment should be begin as soon as possible after the exposure
• Immediately wash the wound thoroughly under running water for several minutes and wash with detergent or soap
• Apply disinfectant to the wound such as 40-70 percent alcohol or iodine solution
• Apply a simple dressing to the wound
• Seek immediate medical advice about the need for PET and possible antibiotics to prevent wound infection
• Animal saliva in the eyes, mouth and nose should be washed thoroughly with water
• Tetanus vaccine may be necessary if the traveller is not up-to-date as animal bites may be considered tetanus-prone wounds.

Who should be immunised against rabies? 
Various groups of people should be immunised against rabies. Groups for whom vaccination should be considered include: anyone who travels to remote places where medical treatment may not be available; people who handle bats; anyone whose work involves working with imported animals; health and laboratory workers who work with the virus. The vaccine comes in three doses, and should be boosted every two or three years. It is a very safe vaccine with few side effects and is virtually 100 per cent effective. 

Where can I get further information on rabies?

European Centre for Disease Prevention and Control 

World Health Organization 

Centers for Disease Control and Prevention 

Last reviewed: 14th November 2018