Rabies vaccine is unique in that it is most often used after exposure to the virus. The only people who typically get vaccinated as a preventive measure (before exposure) are those who are at high risk for exposure, such as laboratory workers, veterinarians, animal handlers, spelunkers (someone who explores caves), and travelers going to parts of the world where exposure to rabies is likely. People getting vaccinated as a preventive measure should get two doses of vaccine. The second should be given seven days after the first dose. Some people will also be recommended for antibody testing and possibly a booster dose.

Once someone has been exposed, their dosing will vary depending upon their vaccination history:

• For those who have been exposed to rabies without previous vaccination, the vaccine is given shortly after exposure to prevent the progressive, invariably fatal disease, rabies. In these situations, a total of four shots are given in the shoulder muscle of adults or the thigh of children. The first shot is given immediately after exposure to a rabid animal, then again three days later, seven days later, and 14 days later. The person should also receive another shot called rabies immune globulin (RIG).
• For those who have been exposed to rabies, but who were previously vaccinated with rabies vaccine, two shots should be given in the shoulder (adults) or thigh (children) muscle. The first shot should be given immediately after exposure. A second shot should be given three days later. These people do not need to get RIG.

The face of rabies

Edgar Allen Poe likely died from rabies, which has terrified mankind ever since it became obvious that the bite of a rabid animal led to an inevitable and horrible death. In the 1880s, Louis Pasteur first administered his experimental rabies vaccine to a 9-year-old boy named, Joseph Meister. Knowing the outcome without a vaccine, Meister’s mother insisted Pasteur try his vaccine on her son, even though Pasteur was hesitant to give an experimental vaccine to a child. Meister fully recovered after receiving multiple doses of the vaccine, and later went on to work at the Pasteur Institute in France. 

Fewer than 15 known cases of unvaccinated people surviving rabies once they developed symptoms of the disease have ever been documented.

The disease

What is rabies?

Rabies is a virus that attacks the brain and nervous system. It is transmitted by a bite from a rabid animal (meaning an animal infected with rabies virus). The incubation period of the virus, or the time it takes between exposure to the virus and the first symptoms of the disease, is quite long: on average, about two months. Because the virus has a long incubation period, the rabies vaccine works even if is given after exposure to the virus. However, once the symptoms start, the progression of the disease is relentless and unstoppable.

The first symptoms of rabies are fatigue, sore throat, chills, vomiting and headache. These symptoms get progressively worse a week later with disorientation, hallucinations, unusual behavior, hyperactivity and difficulty swallowing. The final stage of rabies includes paralysis, coma and, ultimately, death.

How do you catch rabies?

Rabies is contracted by exposure to the saliva of an infected animal. Any mammal can get rabies, but the most commonly infected animals in the United States are raccoons, skunks, bats and foxes. Rabies can be transmitted if a bite from an infected animal penetrates the skin. Rabies can also be transmitted if an infected animal licks an open wound, cut or scratch, or if the animal licks the mouth, nose or eyes. Simply petting a rabid animal will not transmit rabies.

If you or a family member is bitten by a rabid animal, you should thoroughly clean the wound and then call the local health department or a local infectious disease expert (in a hospital) to determine which animals in the region are likely to transmit rabies. But generally, in the United States, the following guidelines can serve as a good rule of thumb:

Rabies vaccine is not needed:

• If the animal (for example, dog or cat) lives in or has been hanging around the neighborhood, it can be observed for 10 days to see if it behaves normally.
• If, after 10 days, the animal does not show any signs of rabies, then no treatment is needed.
• Also, animals immunized with the rabies vaccine are unlikely to transmit rabies — all the more reason to make sure that your animals are immunized with rabies vaccine.

Mice, rats, squirrels, rabbits, birds and chipmunks generally do not carry rabies. There has been no record of reptiles, amphibians or fish ever becoming infected with or transmitting rabies.

Rabies vaccine is needed:

• If no one knows the animal and it cannot be observed, or in countries where rabid animals are prevalent, treatment should begin immediately.
• If, within the 10 days of observation, the animal shows any signs of rabies (such as bizarre or unusual behavior), then treatment should begin immediately.

Wild animals, such as raccoons, skunks, foxes, and bats may carry rabies. Unvaccinated companion animals, such as cats and dogs, may carry rabies.

How do you treat someone who is bitten by a potentially rabid animal?

Treatment of people bitten by an animal that might be rabid should include the following:

• Wash the wound carefully with soap and water.
• Administer rabies immune globulin (RIG),* a preparation of serum obtained from people who have high levels of rabies-specific antibodies in their blood. RIG should be injected in and around the wound to prevent attachment of rabies virus to the nervous system.
• Begin the series of shots of rabies vaccine immediately.*
• Call animal control authorities.

*Rabies immune globulin and the rabies vaccine are administered in local emergency departments.