When many people think of rabies, ideas from popular culture may dominate: Stephen King’s murderous Saint Bernard, Cujo, or the tragically ill Old Yeller. In the books and films, both dogs were bitten by rabid animals and became aggressive and attacked people (or tried to, in the latter case). Or, perhaps you think of a snarling wild animal—maybe a coyote or raccoon—foaming at the mouth.
I’d guess that, day to day, most people don’t really think about rabies in any serious way. It’s one of those rare illnesses that the average person doesn’t worry too much about affecting them. And that’s fair, given that rabies deaths are not common in the U.S. Globally, rabies causes about 59,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC), most of them due to bites from rabid dogs. In the U.S., there have been 23 rabies deaths accounted for between 2008 and 2017, per the CDC—and eight of those deaths were due to bites that occurred in other countries.
But it’s possible for a person to contract rabies without realizing it, and this has happened more than once in the U.S. in the last couple of years. And before you know it, you have nonspecific symptoms that you can’t seem to explain, and rabies may not be the first cause considered.
That’s the biggest problem with rabies infection—because once symptoms start, the disease is nearly always fatal.
This past November, a 55-year-old Utah resident died after he contracted rabies from a bat, even though he reportedly didn’t know he had been bitten. He developed back pain in October, according to news reports and a fundraising page set up by the family, which worsened and eventually was accompanied by other symptoms like muscle tremors and speech issues. On October 25th, he fell into a coma from which he never awoke; his cause of death was rabies infection. It was the first rabies death in Utah since 1944.
This followed the death of a 6-year-old boy in January of last year, who died from rabies from a sick bat that his dad discovered, which reportedly scratched or bit the boy. Per a local outlet that covered the boy’s death, the family said they didn’t know that bats could transmit rabies.
Tragic situations like this are rare. But it’s worth understanding how humans can contract rabies so you can protect yourself.
So what is rabies exactly? Put simply, it’s a virus that affects the nervous system and leads to disease in the brain. Rabies affects mammals and is generally transmitted via the bite or scratch of an animal carrying the virus. When a person contracts rabies, they may first experience symptoms that are flu-like, including nausea, fever, headache, and vomiting. As it progresses, other symptoms may present, such as hallucinations or partial paralysis, the Mayo Clinic explains.
During a typical bite, the virus gets introduced into the muscle, where it will reproduce and then enter the nerves, eventually leading to the brain, Rodney Rohde, Ph.D., M.S., professor of clinical laboratory science at Texas State University and author of a forthcoming book on rabies, tells SELF. This is part of the reason the time between rabies exposure and the development of symptoms is so variable: A bite in the ankle could take months to travel to the brain, while a bite on the arm or shoulder has a much shorter journey. Eventually the virus also ends up in the saliva, through which it can be transmitted to others.
In the U.S., domestic animal bites, like from a pet dog or cat, are actually rarely the cause of rabies. In fact, the vast majority of reported cases of rabies in the U.S. are from wild animals, primarily bats, but also raccoons, skunks, and foxes, according to the CDC.
You’d probably notice and remember if you were bitten or scratched by, say, a raccoon. But bats in particular can be problematic because you don’t always realize you’ve been bitten by one even if you’re aware that you interacted with it (for instance, if you removed one from your attic).
“Bats create an interesting dilemma because of their incisors and their teeth being so small,” Rohde says. “Even if you knew you had been bitten by a bat and if you asked a physician or someone who was trying to find [the bite], it is really difficult to do so.” The skulls of some bats are smaller than the first knuckle of your fingers; an incisor may be as small as 2 millimeters in length, and the bite about the size of a needle prick.
Some animals can get aggressive when infected with rabies, but that’s not always the case.
A rabid coyote that attacked a North Carolina man last April had been reportedly aggressive and ferocious, as was a stray cat that was thought to have rabies after it was aggressive and pounced on a 3-year-old girl last summer, also in North Carolina.
But with bats who are ill with rabies, for example, while they do behave strangely, it’s often in ways that allow humans to interact with them. They may be awake during the daytime, or on the ground instead of flying. Rohde points out that about 10 percent of “downed” bats, meaning they are unable to fly properly, are rabid. “So about a one in 10 chance, which isn’t great odds if you’re picking things up,” Rohde says.
Unfortunately, there are no good tests for rabies in animals, other than observing them for a period to see if they exhibit classically rabid behavior (which you can’t do if the animal is wild and can’t be tracked down). Diagnosis is done after death, by testing the brain.
If caught in time, rabies can be treated with vaccination.
Rabies post-exposure prophylaxis is generally recommended for individuals who have a possible exposure to the virus.
This regimen involves a dose of rabies immune globulin, which gives some immediate protection, followed by a series of four rabies vaccines (administered in the arm, just like other vaccines) to allow the body to mount its own immune response. The injections are given at “day zero, then three more on day three, seven, and 14,” Rhode says.
The combination of immune globulin and the vaccines will stop the growth of the virus in the body, preventing further disease development. “That’s proven effective; I don’t know of any vaccine failures that I’ve read about in my lifetime,” Rohde adds. But again, once rabies infection has taken hold, it’s almost always deadly and vaccination will no longer help.
People who are at a high risk of rabies exposure (think: veterinarians, animal lab workers or handlers, or people traveling to parts of the world where rabies is more prevalent, who may be around animals) may be offered rabies vaccines as a preventive measure. If they work with animals regularly, they will have to stay up to date on their vaccinations with guidance from a doctor.
The easiest way to avoid rabies is to avoid the animals who carry it, Rohde notes.
This includes avoiding bats or other wildlife that appear to be acting strangely, as well as keeping your pets up to date on their rabies vaccines.
You can ask your veterinarian about how often your cat or dog needs to be vaccinated. Luckily, rabies in domestic cats and dogs in the U.S. is uncommon thanks to our pet vaccination rates; this has, in turn, led to a very low rate of human rabies in the country, with just one to three rabies deaths per year, according to the CDC.
Also, keep an eye on your pets if they go outdoors. Dogs or cats that spend any time outdoors could be in contact with sick wildlife, and if the owner isn’t watching them, even a quick exposure could spread rabies. “If they’re out there and they run across a skunk and fight through a fence, or get bitten by a skunk or a fox, or pick up a bat—cats love to play with sick bats—then suddenly they’ve been exposed and you don’t know,” Rohde explains.
You also have to be on alert while traveling abroad: Tourists visiting areas where rabies is common are also susceptible; a Virginia woman died in 2017 after reportedly being bitten on the hand by a puppy that was thought to have rabies at a yoga retreat in India.
If you suspect you may have been exposed, seek treatment immediately.
This is crucial, even if you’re not totally sure that you were dealing with a rabid animal. Thoroughly washing an animal bite may help to kill some virus if rabies is present, but it’s not enough to prevent infection.
There’s also no great way to tell whether an animal that bit you had rabies, especially if it was wild and can’t be located, so you’re better off checking in with a doctor ASAP. You may be vaccinated just to be safe, depending on the situation. (If you were bitten or scratched by a domestic animal that is available to be examined, and experts deem its behavior normal and are confident it was not rabid, you may not need rabies treatment.)
With bat exposure in particular, most experts say to err on the side of caution, even if you’re not 100 percent certain you’ve been bitten. Rohde gives this hypothetical of a possible, but unconfirmed, exposure: “For example, a child wakes up in the morning and tells someone that he thought there was a bird or something flying around the room. [Even] if you’re not sure, and the window or a screen was open, someone might recommend that vaccine series,” he describes.
Ultimately, when it comes to rabies, there is no cure. So an ounce of prevention—by avoiding sick animals and being proactive immediately if you suspect any amount of exposure—is the best, and only, option.