While the chances of being exposed to rabies in the United States is low, it does happen. The Center for Disease Control and Prevention estimates between 30,000 and 60,000 people are treated annually for possible rabies exposure.
What Should You Do?
Don’t delay! The CDC recommends you
-
- Consider any exposure a medical urgency
- Immediately wash the wound with soap and water.
- Call a medical doctor. If not available call urgent care.1
Medical doctors will then decide, often consulting with local health department officials, on the treatment.
For more help, see the CDC website on rabies:
How Have Rabies Treatments Changed?
In researching and planning these rabies blogs, I asked colleagues about rabies treatments. Most reported similar horror stories to those I’d heard as a youth. Growing up in Eastern Kansas in the 1960s, I heard stories about the painful rabies treatment. It consisted of using large needles to inject the vaccine into the stomach (the abdominal area) over several weeks. This story persists to this day.
In a 2012 Atlantic magazine article, writer Larry Madoff reported on rabies. He told the story of his dad being bitten by a rabid dog as a youth in the 1930s. His dad had to endure the “Pasteur Treatment,” which consisted of 25 injections of a crudely purified vaccine into the abdomen. On the first day of this treatment, patients received three injections in the abdominal wall and one injection daily in the same area for the next three weeks. Madoff reported his father recalled the treatment as more horrible than his dog bite.2
The “Pasteur Treatment” is no longer used in the United States. Today, medical doctors use two rabies vaccination protocols—pre-exposure and post-exposure protocols.
The CDC reports that pre-exposure vaccinations are for high-risk individuals. High-risk individuals include those who handle animals regularly (veterinarians, animal handlers, laboratory workers) who might be exposed to rabid animals or work with infected nerve or brain tissue.3 These people take the rabies pre-exposure protocol vaccine sequence before they might be exposed to rabies. The sequence consists of an injection on day one, and then injections on days seven, and 21 or 28, depending on the current medical protocol. The series builds antibodies against rabies, should these people be exposed to rabies.
Depending on their potential exposure to rabies virus, high-risk individuals should be tested for rabies antibodies every six months to two years. If antibodies are not high enough, they receive one dose of rabies vaccine to boost the rabies antibodies. If they are exposed to rabies, they receive additional vaccinations.
For people who have been bitten or scratched by a rabid (or possibly rabid) animal or may have been exposed to rabies in other ways, the CDC recommends Post-exposure Prophylaxis (PEP).
The CDC reports that PEP treatment begins with immediately cleaning any suspicious wounds with soap and water. The next step is irrigating (flushing) the wounds with a solution to kills the virus (in medical terms a virucidal agent), such as povidone-iodine.3
Patients next receive a shot of human rabies immune globulin in the area of the bite, scratch, or injury. Then, four shots of a rabies vaccine are administered over the course of two weeks. CDC reports the first dose should be given as soon as possible after exposure to rabies. The usual procedure is rabies vaccine shots on day one, three, seven, and 14. Adults receive the shots in their upper arm, and children receive shots in the thigh. CDC reports the shots are relatively painless. 3
The scientific explanation of how the vaccine works is complex, so think of it in this way. It takes time for the rabies virus to multiply and move through the nervous system to the brain. By giving the rabies vaccine early, the vaccine stimulates the human body’s immune system to start producing rabies antibodies. Those antibodies can then destroy or fight the rabies virus as it starts multiplying. By producing enough antibodies and doing so quickly enough, the immune system fights the rabies virus to stop the disease.
As pointed out in my earlier blog, the CDC reports one to three human rabies deaths are reported in the United States annually.
Between 2008 and 2017, the CDC reported 15 cases of people infected with rabies in the United States. Of these, 13 people died. Ten people were infected (either bites or contact) by bats, two were infected by raccoons, and one was infected by a kidney transplant. An eight-year-old girl and a 17-year-old boy survived rabies following experimental medical treatments. 4 An additional eight people were infected (usually by dog bites) outside of the United States, returned to the United States, and then died.
Notes & Resources
1 Centers for Disease Control and Prevention. (2018). When should I seek medical attention?
Fact Sheet. Centers for Disease Control
and Prevention. Retrieved from https://www.cdc.gov/rabies/exposure/ 9
January 2019.
Centers for Disease Control and Prevention. (2018). What care will I receive? Fact Sheet. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/rabies/medical_care 23 December 2018.
Centers for Disease Control and Prevention. (2018). Rabies website home page provides links to a detailed and worthy presentation of rabies topics. Retrieved from https://www.cdc.gov/rabies 24 December 2018.
2 Madoff, Larry. January 3, 2012. Health: The State of Rabies: Treating a Disease
That Often Leads to Death. The Atlantic.
Retrieved from https://www.theatlantic.com/health/archive/2012/01/the-state-of-rabies-treating-a-disease-that-often-leads-to-death/250749/ 24 December
2018.
3 Centers for Disease Control and Prevention. (2018). Preexposure Vaccinations. Rabies Vaccine. Websites, Retrieved from
https://www.cdc.gov/rabies/medical_care/ https://www.cdc.gov/rabies/medical_care/vaccine.html https://www.cdc.gov/rabies/medical_care/ 16 December 2018.
4 Centers for Disease Control and Prevention. (2019). Human Rabies. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html 9 January 2019.
Past Blogs
Blog # 1. A Closer Look at Rabies.
Blog # 2. Do You Have A Rabid Animal in Your Yard?
Blog # 3 How to Protect Yourself and Your Children from Rabies.