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Hydrophobia

Rabies is a very serious viral infection that targets the brain and nervous system. It is spread to humans through the saliva of infected animals.

Rabies is a very serious viral infection that targets the brain and nervous system. You can catch rabies if you are bitten by an infected animal and haven't been vaccinated.

It's almost always fatal once symptoms develop, but can be prevented if treatment is given promptly after exposure.

In the UK, rabies is not found in the animal population (with the exception of bats) and infections are almost always picked up during travel abroad.

When to seek medical help

Seek immediate medical advice if you're worried that you or your child may have been bitten, scratched or licked by an animal while abroad, or if you're bitten or scratched by a bat in any country, including the UK.

Although rabies is unlikely, you should also seek immediate medical help if you're bitten or scratched by a pet that has travelled abroad and has an uncertain vaccination history.

If you've been bitten or scratched, you should:

  • wash the wound thoroughly with soap and water under a running tap for 15 minutes
  • apply antiseptic or alcohol to clean the wound
  • leave the wound open
  • go to the nearest hospital or medical centre and explain that you've been bitten

If the incident happens abroad, you should seek local medical help and not wait until you have returned to the UK.

How rabies spreads

Rabies can be spread to humans from infected animals through a bite, scratch or lick to broken skin, the mouth or the eye. You may also be at risk if an animal spits in your face. In very rare cases, rabies can be spread during an organ transplant.

Once it enters the body, the rabies virus multiplies before spreading into nerve endings. It then travels to the spinal cord and brain (the central nervous system). Once the virus is in the central nervous system, it multiplies rapidly and spreads to the salivary glands, lungs, kidneys and other organs.

Animals that carry rabies

All mammals, including monkeys, can carry the rabies virus, but the following species are more commonly infected:

  • dogs
  • bats
  • raccoons
  • foxes
  • jackals
  • cats
  • mongooses

What are the symptoms?

It can take a while for symptoms to develop, but when they do the condition is almost always fatal.

Symptoms in humans can include:

  • a high temperature (fever)
  • an irrational fear of water (hydrophobia)
  • sensitivity to light (photophobia)
  • fear of drafts of air (aerophobia)
  • confusion or aggressive behaviour

Read more about the symptoms of rabies.

Treating rabies

If you have been exposed (bitten, scratched or licked) by an animal that might have rabies, you'll need to seek medical advice to determine whether you need to have a course of treatment to prevent rabies. This is known as post-exposure treatment.

It's important this is done before you develop symptoms. Once symptoms develop, the infection cannot be treated and it's almost always fatal.

Post-exposure treatment (preventing rabies)

Post-exposure treatment usually involves administering a course of the rabies vaccine, with or without rabies immunoglobulin, in an attempt to prevent the infection spreading to the brain and nervous system. If started promptly, post-exposure treatment is very effective.

However, if rabies infection reaches a stage where it causes symptoms, it's almost always fatal. In these cases, treatment will usually focus on making you as comfortable as possible.

Rabies can only be diagnosed once you have developed the disease and get symptoms. Various tests, including a skin biopsy, saliva tests or blood tests, can be used to make the diagnosis.

Read more about treating rabies.

Vaccination

A number of vaccines can be used to prevent a rabies infection developing. Routine (pre-exposure) vaccination is usually only recommended if you regularly work with potentially infected animals or are travelling to a part of the world known to have high levels of rabies and limited medical care.

A course of rabies vaccine can also prevent rabies from developing after a potential exposure, provided it is started promptly. Before you travel, you should seek advice about whether you need a rabies vaccination. For more information, visit the National Travel Health Network and Centre (NaTHNaC) website.

Read more about the rabies vaccination.

Avoiding rabies

When travelling in countries that aren't rabies-free, avoid contact with animals and educate your children about the dangers of petting them.

Examine your children regularly for cuts and scratches after contact with any animal and ask how they got them. Make sure they know that being bitten or licked by an animal may be dangerous and they need to tell you about it.

It's rare for bat rabies viruses to infect other animals, and the risk of human infection is thought to be low. Nevertheless, if you find an injured bat or a bat that needs to be moved, don't touch it. Call the Bat Conservation Trust helpline on 0345 1300 228 for advice.

Quarantine and the Pet Travel Scheme (PETS)

To keep countries rabies-free, it's important there are strict public health measures to control stray animals such as foxes.

The movement of potentially infected animals across borders into uninfected regions is controlled by strictly enforcing quarantine regulations. Animals that don't have a licence shouldn't be brought into the UK.

The Pet Travel Scheme is a system that allows pet dogs, cats and ferrets from certain countries to enter the UK without going into quarantine as long as they have been vaccinated. It also means people in the UK can take their dogs, cats and ferrets to other European Union (EU) countries and return with them to the UK.

More information can be found on the GOV.UK website.

How common is human rabies?

There are an estimated 60,000 deaths from human rabies each year worldwide. Most cases occur in the developing world, particularly in Africa and Asia.

As a result of strict UK quarantine laws regarding transporting animals, as well as the introduction of the Pet Travel Scheme, the UK has been rabies-free since the beginning of the 20th century, with the exception of a rabies-like virus in a single species of bat.

There have been no cases of human rabies acquired in the UK since 1902, apart from a case of rabies acquired in a bat-handler from an infected bat in 2002. The last recorded case of rabies in the UK was in 2012. The patient, who died, contracted the disease after being bitten by a dog in India.

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Hydrophobia

The initial symptoms of rabies are mild, but they can quickly become serious.

The initial symptoms of rabies are mild, but they quickly become serious.

The incubation period

The incubation period is the time it takes for symptoms to develop after a person is infected with the virus. The incubation period for rabies is usually two to 12 weeks, although it can be as short as four days. It is unusual for the incubation period to last for more than a year.

The closer the site of infection is to your brain, the shorter the incubation period. For example, a bite to your face, head or neck will have a shorter incubation period than a bite to your arm or leg.

The length of the incubation period is important as it's the only period in which treatment can be successful.

Initial symptoms

The initial symptoms of rabies are often vague and it can be easy to mistake them for other, less serious, types of infection. They include:

  • fever
  • headache
  • feeling generally unwell
  • feeling scared or anxious

Around half of people also experience pain and a tingling sensation at the infection site.

Advanced symptoms

Initial symptoms of rabies last for two to 10 days before more severe symptoms start to develop. These typically include aggressive behaviour, hallucinations, agitation and producing lots of saliva. 

When to seek medical advice

If you're in a part of the world known to be affected by rabies, always seek medical advice as soon as possible if you're bitten or scratched by an animal, particularly a dog. You can also catch rabies if you have an open wound that is licked by an infected animal.

In the UK, rabies is only found in bats. However, always seek medical attention if you're bitten by a bat or if you think someone in your care who is unable to report a bite may have been bitten (for example, if you find a bat in a young child's room).

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Hydrophobia

Treatment for rabies will depend on whether you have started to show signs or symptoms.

If you have been exposed (bitten, scratched or licked) by an animal that might have rabies, you'll need to seek medical advice to determine whether you need to have a course of treatment to prevent rabies.

This is called post-exposure treatment. It can usually prevent a rabies infection from becoming established and producing symptoms.

Post-exposure treatment

Post-exposure treatment involves three stages:

  • cleaning the wound
  • administering rabies immunoglobulin (a special preparation of antibodies)
  • administering a course of the rabies vaccine

Cleaning the wound

Immediately after being bitten, you should:

  • wash the wound thoroughly under a running tap
  • use antiseptic or alcohol to clean the wound and apply ethanol, tincture or aqueous solution of iodine, if available
  • leave the wound open – use a simple dressing, but don't try to stitch it as this could expose your nerve endings to the rabies virus
  • go to the nearest hospital or medical centre and explain you've been bitten

If you think your eye may have been infected with the saliva of an animal, wash it thoroughly with clean water and seek medical help.

Rabies immunoglobulin

If you've been in a high-risk situation, you may also be given an injection of rabies immunoglobulin as well as the rabies vaccination. This helps protect you against the virus while your body is developing antibodies after vaccination.

The immunoglobulin works by providing ready-made antibodies designed to neutralise the rabies virus and prevent it spreading. Apart from some temporary soreness at the injection site, rabies immunoglobulin doesn't usually cause any side effects.

Vaccination

The rabies vaccine should be given in every case of suspected exposure to rabies. The length of your vaccination course will depend on whether you have previously been vaccinated.

You should receive five doses of the vaccine if you've never been vaccinated. The first dose is given at the beginning of the treatment, followed by four further doses, which are given three, seven, 14 and 30 days after the start of treatment.

If you've previously been vaccinated, you should receive two doses of the vaccine. The first dose is given at the start of your treatment, followed by a second dose three to seven days later. The doses are given by injection into the shoulder muscle.

A common side effect of the rabies vaccine is redness, swelling and pain at the injection site, which occurs 24 to 48 hours after the injection has been given.

Choice of vaccine

Worldwide, there are three types of rabies vaccine:

  • human diploid cell vaccine (HDCV), which is created by using samples of human cells
  • purified chick embryo cell rabies vaccine (PCEC), which is created by using samples of chicken embryos 
  • nerve tissue vaccine, which is created by using samples of nerves taken from animal brains

The World Health Organization (WHO) only recommends purified cell culture or embryonated egg-based vaccines (CCEEVs), which include HDCV or PCEC, should be used. This is because there are safety concerns over the nerve tissue vaccine.

Researchers found this type of vaccine has a 1 in 650 chance of causing serious complications that can result in permanent disability, such as muscle paralysis. Despite this, it should be taken if it is the only vaccine available.

A small number of countries have not followed the WHO recommendations and may still use the nerve tissue vaccine. They include Ecuador, Peru, Myanmar (Burma) and Pakistan.

Supportive treatment

Once a person develops symptoms, the disease is usually fatal. Treatment involves keeping the person comfortable and treating complications.

To date, there have been no reported cases of human-to-human transmission of rabies. However, it's theoretically possible, so anyone who has been in close contact with someone who has a rabies infection may be advised to have post-exposure treatment as a precaution.

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Hydrophobia

A vaccination that offers protection against rabies is recommended for people who are felt to be at risk.

A vaccination offering protection against rabies is recommended for people who are felt to be at risk.

Who should be vaccinated?

In the UK, the rabies vaccination is offered to:

  • laboratory workers who may be required to handle samples of the rabies virus
  • people handling bats
  • people working abroad in close contact with animals, such as vets or animal handlers at zoos

It is also recommended for:

  • people travelling to an area for one month or more where rabies is common in animals and there is no access to prompt and safe medical care
  • people travelling to an area where rabies is common and taking part in activities that expose them to rabies, such as trekking in a jungle

The GOV.UK website provides a detailed list of countries that have rabies in domestic animals or wildlife.

The vaccine

Two rabies vaccines are available in the UK. Vaccination usually requires a course of three doses for protection. The second dose is given seven days after the first. The third dose is given 21 or 28 days after the first, depending on which vaccine is used.

The injections aren't painful and are given into your upper arm. There are usually no serious side effects. Vaccination should be completed before your departure to allow your body time to develop full immunity.

Bat handlers who regularly handle bats are entitled to a free pre-exposure vaccine on the NHS  your GP will order this from Public Health England. For other groups, the vaccine is not available on the NHS and should be obtained through their employer's occupational health department.

If you need to pay for the vaccination privately, you can either visit your GP surgery or a travel clinic. The price for the complete course of three doses ranges from £120 to £170.

As a general rule, pregnant women are usually advised to avoid rabies vaccinations. The vaccine is usually only recommended if the potential risk of exposure to rabies is thought to be high and there is limited access to medical care.

Further doses

For people who continue to be at risk of rabies exposure (because of their job, for example), further doses of the vaccine are needed to maintain immunity.

In these cases, a single reinforcing dose of vaccine should be given one year after the first course is completed. Further doses should be given at three- to five-year intervals after that.

Side effects

After having the rabies vaccine, some people experience temporary soreness, redness and swelling at the injection site for 24 to 48 hours after the vaccination. In rare cases, some people may also experience:

  • a mild fever
  • headache
  • muscle aches
  • vomiting
  • a rash

Severe reactions are very rare.

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