Rabies is a virus that infects the nervous system, usually through the infected saliva of a rabid animal. When a rabid animal bites or scratches you, the rabies virus will be transmitted through the saliva into the wound, where it will travel up the nervous system towards the brain. If the rabies virus is able to infect the brain, it is almost always fatal. Because of how dangerous the rabies virus is, it is important to get the proper pre-exposure treatment if you are travelling to a country with a risk of rabies, and prompt post-exposure treatment if you have been potentially exposed to rabies.
What is pre-exposure rabies treatment?
The rabies vaccine is an effective way to protect yourself from the rabies virus. Rabies vaccines are ‘inactivated vaccines’, which means that they don’t contain any trace of the live rabies virus. This allows patients to develop resistance, and eventually immunity, to rabies without being put at risk of a full infection. This vaccine is given as an injection straight into the muscle, usually in the upper arm.
Travellers who are visiting countries where there is a risk of rabies are typically advised to get a full course of the vaccine before departing. Health workers that could be exposed to the virus in their line of work, such as vets or other animal handlers, may also be advised to get vaccinated against rabies to minimise the risk of infection.
How do I treat an animal bite?
Rabies is typically spread to humans through bites or scratches from an infected animal, so the first thing to do if you have been bitten or scratched is to take care of the wound. Even if an animal doesn’t have the rabies virus, there will be hundreds of millions of bacteria present in their saliva that can infect the wound. Treating the wound as soon as possible reduces the risk of an infection from both the rabies virus and from possible bacterial infections.
Stop the bleeding – animal bites and scratches, especially caused by an aggressive, rabid animal, can be quite deep and cause a lot of bleeding. To staunch the bleeding, cover the wound with a clean cloth or a gauze and apply pressure until the bleeding stops.
Clean the wound – after stopping the bleeding, you should wash out the wound with soap and water. The World Health Organisation recommends that the wound should be thoroughly washed for around 15 minutes to make sure it is as clean as possible. This will get rid of most of the infectious material that can get into the wound, such as dirt or saliva. According to the CDC, washing the wound is one of the most effective ways to lower the chance of a rabies infection.
Disinfect – the next stage of the cleaning process is to use an iodine or alcohol-based disinfectant to kill off any substances that could still be present in the wound. If you do not have any at hand, most first aid kits will contain some kind of antiseptic, usually a cream or spray, that can be applied to the wound to help reduce the chance of infection.
Bandage – the final step is to wrap up the wound with a sterile bandage to protect it from further contamination.
Seek medical attention – a rabies infection is almost always fatal in humans once the symptoms appear, so it is important to make sure you seek medical advice as soon as possible after being bitten or scratched so you can get the proper post-exposure treatment.
For more specific information on how to treat animal bites, click here.
What is post-exposure rabies treatment?
There is no cure once you have been infected by the rabies virus, and the chance of surviving rabies is incredibly low. If you start to develop the symptoms of rabies, treatment is shifted towards making you as comfortable as possible rather than trying to treat the infection.
However, if you receive appropriate treatment before the rabies virus is able to infect the brain, then the symptoms of rabies can be prevented. This is called post-exposure treatment, or PET. Post-exposure rabies treatment consists of additional doses of the rabies vaccine, and in some cases a human rabies immunoglobulin (HRIG) shot may be required.
Human rabies immunoglobulin (HRIG) – human rabies immunoglobulin is a medication that is made from human blood that has high levels of antibodies against the rabies virus. The HRIG shot gives your immune system a boost to help you effectively fight off a potential rabies infection before symptoms can develop. HRIG is typically only needed if you are immunosuppressed, or didn’t get vaccinated against rabies prior to exposure.
Your risk of developing rabies will be assessed by a medical professional, which will determine the post-exposure treatment that is required.
This risk assessment is a traffic-light system based on the following factors:
- the type of animal that may have exposed you to the virus
- the country or region where you encountered the animal
- if you were vaccinated against rabies prior to exposure
Green – if you were not in direct contact with the saliva of an animal, or were exposed to saliva in a country with no risk of rabies, then typically you will not require any rabies-specific treatment.
Amber – if you were exposed to animal saliva in a country where there was a low risk of rabies, or had minimal contact in a country with a high risk of rabies, then you are considered to be at risk of developing rabies and will receive post-exposure rabies treatment. This will typically just be additional doses the rabies vaccine if you were already fully or partially immunised, and a HRIG shot if you have a weakened immune system.
Red – if you had direct exposure to animal saliva in a country with a high risk of rabies, then you are considered to be at a high-risk of developing rabies and will be given immediate post-exposure treatment. If you were fully immunised prior to exposure then you’ll only need additional shots of the rabies vaccine. If you were not fully immunised, or if you have a weakened immune system, then you may be given the HRIG shot as well.