Overview
Rabies is a virus that attacks the brain and nerves. It lives in the saliva of an infected animal and reaches people through a bite, a scratch, or a lick on broken skin.
No animal is born with rabies and animals do not carry it by default: an animal has to catch the virus, almost always from another infected animal's bite. In India dogs cause most human rabies. Once symptoms appear the disease is almost always fatal, so the hours after a bite decide everything.
Symptoms
Symptoms usually start two to three months after the bite, though the gap can be a week or a year. Early signs are fever, headache, and pain or tingling at the healed bite.
Later there is agitation and confusion, drooling, fear of water and of moving air, or instead weakness and paralysis spreading from the wound.
An animal may be infected if its behaviour changes suddenly: unusual aggression, or unusual tameness. Drooling, trouble swallowing and weak legs are other signs. An infected dog or cat can spread the virus shortly before it looks ill.
When to see a doctor
Do not wait to see whether the animal falls ill. Treatment works best early, and it is never refused to someone who comes late.
Causes
Rabies is caused by a virus that travels along the nerves to the brain. It is in the saliva of an infected animal and gets in through:
- A bite that breaks the skin
- A scratch or graze, including one that does not bleed
- A lick on broken skin, or on the eyes, nose or mouth
Risk factors
- Living or working where street dogs are common
- Children, whose small bites and scratches often go unreported
- Work with animals, such as veterinary staff and animal handlers
- Pets whose yearly rabies vaccination has lapsed
Complications
Once symptoms begin the illness moves quickly and is almost always fatal, usually within days. Care at that stage is aimed at comfort.
Animal bites also cause wound infection and tetanus, and can damage tendons and nerves.
Prevention
- Having every bite, scratch or lick on broken skin assessed the same day
- Keeping pet dogs and cats vaccinated against rabies every year
- Teaching children to stay away from street animals and to report any bite
- Not handling sick, injured or unusually tame animals
Diagnosis
Treatment does not wait for a test. The doctor grades the exposure, from touching or feeding an animal, through minor scratches without bleeding, to deeper bites and licks on broken skin. That grade decides the treatment.
Where the dog or cat is known and can be kept safely, it may be watched for 10 days.
Treatment
Wash the wound with soap and plenty of running water for about 15 minutes, then apply an antiseptic such as povidone iodine. Do not apply chilli, turmeric, oil, lime, salt, mud or herbs. Stitching is avoided or delayed, because closing a wound early can trap the virus.
Most exposures then need a course of anti-rabies over about a month, given either into the skin of the upper arm across four visits or into the muscle across five. For deeper wounds, rabies is placed into and around the wound as well.
A tetanus injection and may also be needed. The course must be finished on the dates given.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Street dogs are dangerous because dogs are born with rabies in them, but our own pet dog is safe.”What is true?
Fact
Neither half of that is right. No animal is born with rabies: a dog, cat or other mammal has to catch the virus from another infected animal, so most animals around us are not infected. A pet can be infected too, and India's national guidance is that treatment is started whatever the biting animal's vaccination status, because a vaccination record is not proof that the animal was protected.
Myth“It was only a small scratch and it hardly bled, so there is nothing to do.”What is true?
Fact
Minor scratches and grazes that do not bleed are still counted as an exposure in WHO and Indian national guidance, and they are treated with thorough wound washing and a course of vaccine. A lick on broken skin counts too. A wound does not have to look serious to matter.
Myth“Putting chilli, turmeric, oil or lime on the bite draws the poison out.”What is true?
Fact
India's national rabies guidelines say plainly that these give no advantage and are damaging. They irritate the wound, which may open more ways for the virus to reach the nerves, and they give a false sense that something has been done. Washing with soap and running water is what actually helps.
Myth“Rabies treatment is 14 painful injections in the stomach.”What is true?
Fact
That was the old nerve tissue vaccine, which India phased out from December 2004. Modern cell culture vaccines are a short course of small injections, usually into the skin or muscle of the upper arm, spread over about a month. The doctor will explain the exact dates.
Myth“The dog that bit me is still alive after 10 days, so I never needed the injections.”What is true?
Fact
The 10-day watch applies only to dogs and cats, and Indian guidance is that treatment starts immediately, not after the wait. If the animal is well at 10 days the doctor may be able to adjust the remaining doses, depending on which schedule is being used. It does not mean the first doses were wasted, because there is no way to know on day one whether the animal was infected.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
The dog that bit me is our family pet and it has had its injections. Do I still need treatment?
See a doctor the same day. India's national guidance is that treatment after exposure is started whatever the biting animal's vaccination status, because a vaccination record does not prove that the animal is protected. Animal vaccines can fail if a dose was stored badly, given wrongly, or given to an animal that was already unwell.
I was bitten weeks ago and did nothing. Is it too late now?
Go to a doctor now. Because the virus can take weeks or months to reach the brain, someone who comes late is assessed and treated as though the bite had just happened. Treatment is not refused because of the delay, and the wound is still washed even if it has healed over.
Can the vaccine be given during pregnancy?
Yes. Pregnancy, breastfeeding, infancy, older age and other illnesses are not reasons to hold back rabies treatment, because the disease is almost always fatal and the treatment is life saving. Tell the doctor about a pregnancy and about any medicines being taken, as some medicines affect which route of injection is chosen.
Can rabies pass from one person to another?
Not in everyday contact. Spread between people has not been documented other than in a few cases through transplanted cornea or organ tissue. People who have been in close contact with the saliva of someone with rabies may still be offered treatment as a precaution.
