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Questions
and Answers about Rabies
Updated July 2, 2004
Pets
- How
can I protect my pet from rabies?
- Why
does my pet need the rabies vaccine?
-
What happens if a neighborhood dog or cat bites me?
- What
happens if my pet (cat, dog, ferret) is bitten by a wild animal?
-
I am moving to a rabies-free country and want to take my pets with
me. Where can I get more information?
Human
rabies
- How do people get rabies?
-
Can I get rabies in any way other than an animal bite?
- How
soon after an exposure should I seek medical attention?
- What
medical attention do I need if I am exposed to rabies?
- Will the rabies vaccine
make me sick?
- What
if I cannot get rabies vaccine on the day I am supposed to get my
next dose?
-
Can rabies be transmitted from one person to another?
Wild
animals
- What
animals get rabies?
-
How can I find out what animals have rabies in my area?
- What
is the risk of rabies from squirrels, mice, rats, and other rodents?
Bats
and rabies
- Do bats get rabies?
- What
should I do if I come in contact with a bat?
-
What should I do if I find a bat in my home?
-
How can I tell if a bat has rabies?
Travel
- Should
I be concerned about rabies when I travel outside the United States?
- Should
I receive rabies preexposure prophylaxis before traveling to other
countries?
- If
I get preexposure vaccination before I travel, am I protected if
I am bitten?
-
I am moving to a rabies-free country and want to take my pets with
me. Where can I get more information?
Pets
1.
Q: How can I protect my pet from rabies?
A: There are several things you can do to protect your pet from rabies.
First, visit your veterinarian with your pet on a regular basis and keep
rabies vaccinations up-to-date for all cats, ferrets, and dogs. Second,
maintain control of your pets by keeping cats and ferrets indoors and
keeping dogs under direct supervision. Third, spay or neuter your pets
to help reduce the number of unwanted pets that may not be properly cared
for or vaccinated regularly. Lastly, call animal control to remove all
stray animals from your neighborhood since these animals may be unvaccinated
or ill.
2.
Q: Why does my pet need the rabies vaccine?
Although the majority of rabies cases occur in wildlife, most humans are
given rabies vaccine as a result of exposure to domestic animals. This
explains the tremendous cost of rabies prevention in domestic animals
in the United States. While wildlife are more likely to be rabid than
are domestic animals in the United States, the amount of human contact
with domestic animals greatly exceeds the amount of contact with wildlife.
Your pets and other domestic animals can be infected when they are bitten
by rabid wild animals. When "spillover" rabies occurs in domestic
animals, the risk to humans is increased. Pets are therefore vaccinated
by your veterinarian to prevent them from acquiring the disease from wildlife,
and thereby transmitting it to humans
3.
Q: What happens if a neighborhood dog or cat bites me?
A: You should seek medical evaluation for any animal bite. However, rabies
is uncommon in dogs, cats, and ferrets in the United States. Very few
bites by these animals carry a risk of rabies. If the cat (or dog or
ferret) appeared healthy at the time you were bitten, it can be confined
by its owner for 10 days and observed. No anti-rabies prophylaxis is
needed. No person in the United States has ever contracted rabies from
a dog, cat or ferret held in quarantine for 10 days.
If a dog,
cat, or ferret appeared ill at the time it bit you or becomes ill during
the 10 day quarantine, it should be evaluated by a veterinarian for signs
of rabies and you should seek medical advice about the need for anti-rabies
prophylaxis.
The quarantine
period is a precaution against the remote possibility that an animal may
appear healthy, but actually be sick with rabies. To understand this statement,
you have to understand a few things about the pathogenesis of rabies (the
way the rabies virus affects the animal it infects). From numerous studies
conducted on rabid dogs, cats, and ferrets, we know that rabies virus
inoculated into a muscle travels from the site of the inoculation to the
brain by moving within nerves. The animal does not appear ill during this
time, which is called the incubation period and which may last for weeks
to months. A bite by the animal during the incubation period does not
carry a risk of rabies because the virus is not in saliva. Only late in
the disease, after the virus has reached the brain and multiplied there
to cause an encephalitis (or inflammation of the brain), does the virus
move from the brain to the salivary glands and saliva. Also at this time,
after the virus has multiplied in the brain, almost all animals begin
to show the first signs of rabies. Most of these signs are obvious to
even an untrained observer, but within a short period of time, usually
within 3 to 5 days, the virus has caused enough damage to the brain that
the animal begins to show unmistakable signs of rabies. As an added precaution,
the quarantine period is lengthened to 10 days.
For
more information on recommendations about biting incidences, quarantine,
and postexposure prophylaxis (PEP), see: Compendium
of Animal Rabies Control, 2000 and Rabies
Prevention - United States, 1999 Recommendations of the Immunization Practices
Advisory Committee (ACIP).
For more
infromation on dog bites, please see the bibliography maintained by
th National Center for Injury Prevention and Control.
4.
Q: What happens if my pet (cat, dog, ferret) is bitten by a wild
animal?
A: Any animal bitten or scratched by either a wild, carnivorous mammal
or a bat that is not available for testing should be regarded as having
been exposed to rabies. Unvaccinated dogs, cats, and ferrets exposed
to a rabid animal should be euthanized immediately. If the owner is
unwilling to have this done, the animal should be placed in strict
isolation for 6 months and vaccinated 1 month before being released.
Animals with expired vaccinations need to be evaluated on a case-by-case
basis. Dogs and cats that are currently vaccinated are kept under
observation for 45 days.
For
information on rabies in domestic ferrets, see: Niezgoda, M., Briggs,
D. J., Shaddock, J., Dreesen, D. W., & Rupprecht, C. E. (1997).
Pathogenesis of experimentally induced rabies in domestic ferrets.
American Journal of Veterinary Research, 58(11), 1327-1331.
5.
Q: I am moving to a rabies-free country and want to take my pets
with me. Where can I get more information?
A: The details of regulation about importing pets into rabies-free
countries vary by country. Check with the embassy of your destination
country.
Human
Rabies
1. Q: How do people get rabies?
A: People usually get get rabies from the bite of a rabid animal. It
is also possible, but quite rare, that people may get rabies if infectious
material from a rabid animal, such as saliva, gets directly into their
eyes, nose, mouth, or a wound.
2.
Q: Can I get rabies in any way other than an animal bite?
A: Non-bite exposures to rabies are very rare. Scratches,
abrasions, open wounds, or mucous membranes contaminated with saliva
or other potentially infectious material (such as brain tissue) from
a rabid animal constitute non-bite exposures. Occasionally reports of
non-bite exposure are such that postexposure prophylaxis is given.
Inhalation
of aerosolized rabies virus is also a potential non-bite route of exposure,
but other than laboratory workers, most people are unlikely to encounter
an aerosol of rabies virus.
Other
contact, such as petting a rabid animal or contact with the blood, urine
or feces (e.g., guano) of a rabid animal, does not constitute an exposure
and is not an indication for prophylaxis.
3.
Q: How soon after an exposure should I seek medical attention?
A: Medical assistance should be obtained as soon as
possible after an exposure. There have been no vaccine failures in the
United States (i.e., someone developed rabies) when postexposure prophylaxis
(PEP) was given promptly and appropriately after an exposure.
4.
Q: What medical attention do I need if I am exposed to rabies?
A: One of the most effective methods to decrease the chances for infection
involves thorough washing of the wound with soap and water. Specific
medical attention for someone exposed to rabies is called postexposure
prophylaxis or PEP. In the United States, postexposure prophylaxis
consists of a regimen of one dose of immune globulin and five doses
of rabies vaccine over a 28-day period. Rabies immune globulin and
the first dose of rabies vaccine should be given by your health care
provider as soon as possible after exposure. Additional doses or rabies
vaccine should be given on days 3, 7, 14, and 28 after the first vaccination.
Current vaccines are relatively painless and are given in your arm,
like a flu or tetanus vaccine.
5.
Q: Will the rabies vaccine make me sick?
A: Adverse reactions to rabies vaccine and immune globulin
are not common. Newer vaccines in use today cause fewer adverse reactions
than previously available vaccines. Mild, local reactions to the rabies
vaccine, such as pain, redness, swelling, or itching at the injection
site, have been reported. Rarely, symptoms such as headache, nausea,
abdominal pain, muscle aches, and dizziness have been reported. Local
pain and low-grade fever may follow injection of rabies immune globulin.
6.
Q: What if I cannot get rabies vaccine on the day I am supposed
to get my next dose?
A: Consult with your doctor or state or local public
health officials for recommended times if there is going to be a change
in the recommended schedule of shots. Rabies prevention is a serious
matter and changes should not be made in the schedule of doses.
7.
Q: Can rabies be transmitted from one person to another?
A: The
only well-documented documented cases of rabies caused by human-to-human
transmission occurred among 8 recipients of transplanted corneas, and
recently among three recipients of solid organs (see MMWR
article).
Guidelines for acceptance of suitable cornea
and organ donations,
as well as the rarity of human rabies in the United States, reduce
this risk. In addition to transmission from cornea and organ transplants,
bite and non-bite exposures inflicted by infected humans could theoretically
transmit rabies, but no such cases have been documented. Casual contact,
such as touching a person with rabies or contact with non-infectious
fluid or tissue (urine, blood, feces) does not constitute an exposure
and does not require postexposure prophylaxis. In addition, contact with someone who is receiving
rabies vaccination does not constitute rabies exposure and does not require
postexposure prophylaxis.
For
more information on person-to-person transmission of rabies, see: Fekadu,
M., Endeshaw, T., Alemu, W., Bogale, Y., Teshager, T., & Olson, J.
G. (1996). Possible human-to-human transmission of rabies in Ethiopia.
Ethiopia Medical Journal, 34, 123-127.
Wild
Animals
1.
Q: What animals get rabies?
A: Any mammal can get rabies. The most common wild
reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes.
Domestic mammals can also get rabies. Cats, cattle, and dogs are the
most frequently reported rabid domestic animals in the United States.
2.
Q: How can I find out what animals have rabies in my area?
A: Each state collects specific information about rabies,
and is the best source for information on rabies in your area. In addition,
the CDC publishes rabies surveillance data every year for the United
States. The report, entitled Rabies
Surveillance in the United States, contains information about the
number of cases of rabies reported to CDC during the year, the animals
reported rabid, maps showing where cases were reported for wild and
domestic animals, and distribution maps showing outbreaks of rabies
associated with specific animals. A summary of the report can be found
in the Epidemiology section of this
web site.
3.
Q: What is the risk of rabies from squirrels, mice, rats, and other
rodents?
A: Small rodents (such as squirrels, rats, mice, hamsters,
guinea pigs, gerbils, and chipmunks, ) and lagomorphs (such as rabbits
and hares) are almost never found to be infected with rabies and have
not been known to cause rabies among humans in the United States. Bites
by these animals are usually not considered a risk of rabies unless
the animal was sick or behaving in any unusual manner and rabies is
widespread in your area. However, from 1985 through 1994, woodchucks
accounted for 86% of the 368 cases of rabies among rodents reported
to CDC. Woodchucks or groundhogs
(Marmota monax) are the only rodents that may be frequently
submitted to state health department because of a suspicion of rabies.
In all cases involving rodents, the state or local health department
should be consulted before a decision is made to initiate postexposure
prophylaxis (PEP).
For
more information about rabies in rodents and lagomorphs, see: Childs,
J. E., Colby, L., Krebs, J. W., Strine, T., Feller, M., Noah, D., Drenzek,
C., Smith, J.S., & Rupprecht, C. E. (1997). Surveillance and
spatiotemporal associations of rabies in rodents and lagomorphs in the
United States, 1985-1994. Journal of Wildlife Diseases, 33(1),
20-27.
Bats
and Rabies
1. Q: Do bats get rabies?
A: Yes. Bats are mammals and are susceptible to rabies,
but most do not have the disease. You cannot tell if a bat has rabies
just by looking at it; rabies can be confirmed only by having the animal
tested in a laboratory. To minimize the risk for rabies, it is best
never to handle any bat.
2.
Q: What should I do if I come in contact with a bat?
A: If you are bitten by a bat -- or if infectious material
(such as saliva) from a bat gets into your eyes, nose, mouth, or a wound
-- wash the affected area thoroughly and get medical attention immediately.
Whenever possible, the bat should be captured and sent to a laboratory
for rabies testing.
People
usually know when they have been bitten by a bat. However, because bats
have small teeth which may leave marks that are not easily seen, there
are situations in which you should seek medical advice even in the absence
of an obvious bite wound. For example, if you awaken and find a bat in
your room, see a bat in the room of an unattended child, or see a bat
near a mentally impaired or intoxicated person, seek medical advice and
have the bat tested.
People
cannot get rabies just from seeing a bat in an attic, in a cave, or at
a distance. In addition, people cannot get rabies from having contact
with bat guano (feces), blood, or urine, or from touching a bat on its
fur (even though bats should never be handled!).
3.
Q: What should I do if I find a bat in my home?
A: If you see a bat in your home and you are sure no
human or pet exposure has occurred, confine the bat to a room by closing
all doors and windows leading out of the room except those to the outside.
The bat will probably leave soon. If not, it can be caught, as described
below, and released outdoors away from people and pets.
However,
if there is any question of exposure, leave the bat alone and call animal
control or a wildlife conservation agency for assistance. If professional
assistance is unavailable, use precautions to capture the bat safely,
as described below.
What
you will need:
leather work gloves (put them on)
small box or coffee can
piece of cardboard
tape
When the bat lands, approach it slowly and place a box or coffee can over
it. Slide the cardboard under the container to trap the bat inside. Tape
the cardboard to the container securely. Contact your health department
or animal control authority to make arrangements for rabies testing.
4.
Q: How can I tell if a bat has rabies?
A: Rabies can be confirmed only in a laboratory. However,
any bat that is active by day, is found in a place where bats are not
usually seen (for example in rooms in your home or on the lawn), or
is unable to fly, is far more likely than others to be rabid. Such bats
are often the most easily approached. Therefore, it is best never to
handle any bat.
Travel
1.
Q: Should I be concerned about rabies when I travel outside the United
States?
A: Yes. Rabies and the rabies-like viruses can occur
in animals anywhere in the world. In most countries, the risk of rabies
in an encounter with an animal and the precautions necessary to prevent
rabies are the same as they are in the United States. When traveling,
it is always prudent to avoid approaching any wild or domestic animal.
The
developing countries in Africa, Asia, and Latin America have additional
problems in that dog rabies is common there and preventive treatment for
human rabies may be difficult to obtain. The importance of rabid dogs
in these countries, where tens of thousands of people die of the disease
each year, cannot be overstated. Unlike programs in developed countries,
dog rabies vaccination programs in developing countries have not always
been successful. Rates of postexposure prophylaxis in some developing
countries are about 10 times higher than in the United States, and rates
of human rabies are sometimes100 times higher. Before traveling abroad,
consult a health care provider, travel clinic, or health department about
your risk of exposure to rabies and how to handle an exposure should it
arise.
2.
Q: Should I receive rabies preexposure vaccination before traveling
to other countries?
A: In most countries, the risk of rabies and the precautions
for preventing
rabies are the same as they are in the United States. However, in some
developing countries in Africa, Asia, and Latin America, dog rabies
may be common and preventive treatment for rabies may be difficult to
obtain. If you are traveling to a rabies-endemic country, you should
consult your health care provider about the possibility of receiving
preexposure vaccination
against rabies. Preexposure vaccination is suggested if:
-
Your
planned activity will bring you into contact with wild or domestic
animals (for example, biologists, veterinarians, or agriculture specialists
working with animals).
-
You
will be visiting remote areas where medical care is difficult to obtain
or may be delayed (for example, hiking through remote villages where
dogs are common).
-
Your
stay is longer than 1 month in an area where dog rabies is common
(the longer you stay, the greater the chance of an encounter with
an animal).
3.
Q: If I get preexposure vaccination before I travel, am I protected
if I am bitten?
A: No. Preexposure prophylaxis is given for several
reasons. First, although preexposure vaccination does not eliminate
the need for additional therapy after a rabies exposure, it simplifies
therapy by eliminating the need for human rabies immune globulin (HRIG)
and decreasing the number of doses needed a point of particular
importance for persons at high risk of being exposed to rabies in areas
where immunizing products may not be readily available. Second, it may
protect persons whose postexposure therapy might be delayed. Finally,
it may provide partial protection to persons with inapparent exposures
to rabies.
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