Rabies
Signs and Symptoms of Rabies
Rabies is a very serious infection of the nervous system that is caused by a virus. Rabies is usually transmitted by an animal bite, and humans who develop a rabies infection often have a history of being bitten by an animal in the 1 to 2 months before their rabies symptoms begin. Rabies starts with a PRODROMAL PERIOD (premonitory symptoms indicating the beginning of a disease) that usually lasts for 1 to 4 days. Symptoms during this prodromal period include: fever, headache, malaise (a generally ill feeling), muscle aches, loss of appetite, nausea, vomiting, sore throat, cough, and fatigue. There may also be a tingling or twitching sensation around the area of the animal bite. This is the one most specific symptom of rabies at this stage of the rabies infection. After the prodromal period, a second stage begins with symptoms that look like those of an encephalitis (inflammation of the brain). There may be fever as high as 105 degrees F (40.6 degrees C) with any of the following symptoms: irritability, excessive movements or agitation, confusion, hallucinations, aggressiveness, bizarre or abnormal thoughts, muscle spasms, abnormal postures, seizure (convulsions), weakness or paralysis (person cannot move some part of the body), extreme sensitivity to bright lights, sounds, or touch, increased production of saliva or tears. Also, there may be inability to speak as the vocal cords become paralyzed.

The last stages of rabies produce symptoms that reflect the infection’s destruction of many important areas of the nervous system. There may be double vision, problems in moving facial muscles, abnormal movements of the diaphragm and muscles that control breathing, and difficulty swallowing. It is the difficulty in swallowing – combined with increased production of saliva – that leads to the “Foaming at the mouth” usually associated with a rabies infection. Finally, the person with a rabies infection can slip into a coma and stop breathing. Without life support measures, death usually follows within 4 to 20 days after symptoms of rabies begin.
Description
Rabies is an infection of the nervous system that is caused by the rabies virus. The rabies virus is carried in the saliva of infected animals and is usually transmitted to humans though an animal bite. In rarer cases, the virus may also spread to humans when an infected animal’s saliva touches someone’s mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or contacts an area of broken skin – a cut, scratch, bruise, or open wound. Not all animals are equally likely to carry the rabies virus. In the United States, the most common carriers of rabies are bats, raccoons, skunks, and foxes, with a few cases also reported in wolves, coyotes, bobcats, and ferrets. Animals that are not usually expected to carry rabies include small rodents (hamsters, squirrels, chipmunks, mice), rabbits, and hares. Twenty–one of the 36 human rabies cases in the United States from 1980 to 1997 have been linked to bats. Most other countries cite dogs as the major source of rabies among humans.
Once the rabies virus enters the human body through an animal bite, it probably begins multiplying in the surrounding muscle. This is why part of the first doses of anti–rabies medicine (rabies immune globulin given to prevent infection after an animal bite) is usually injected right into the area around the animal bite. Eventually the rabies virus travels up a nearby nerve from the bite area to the brain. Once it reaches the brain, the rabies virus infects many important brain areas and finally causes death.
Prevention of Rabies
Rabies can be prevented by a series of vaccine injections, such as Rab Avert. In humans, this vaccine is routinely given to persons who have jobs or lifestyles that carry an increased risk for rabies, including: veterinarians, animal handlers, cave explorers, and certain laboratory workers. You should ask your family doctor about receiving a vaccination before traveling to a high–risk rabies area, such as Asia, the Indian Subcontinent, or Africa. Once a human has been bitten by an infected animal, rabies can be prevented by a series of injections of HUMAN DIPLOID CELL VACCINE and HUMAN RABIES IMMUNE GLOBULIN. Not all animal bites carry the same risk of rabies, and the decision whether to begin the series of prophylactic (disease–preventing) injections is usually made by a doctor who follows the guidelines of local health authorities. Because cats, dogs, and ferrets can also be infected by rabies, one of the most important ways of preventing rabies in humans is by vaccinating the pets that share our homes. It is also wise to report any stray animals to your local health authorities or animal–control officer. Also, remind your children that animals can be “Strangers,” too, and that they should never touch or feed stray cats or dogs wandering in the neighborhood or elsewhere. If you suspect that your child has been in contact with an unknown cat, dog, bat, or other animal, contact your child’s doctor immediately.


Incubation of Rabies
Incubation of Rabies
The incubation period for rabies can be from 10 days to 1 year, but it is usually 1 to 2 months.
Duration
After symptoms of rabies begin, chances of survival are poor. Without life support, death may occur within 4 to 20 days.

Contagiousness
Rabies is a contagious infection caused by a virus. It is spread in the saliva of infected animals and usually infects humans through an animal bite or scratch. Rarely, humans can also catch rabies when their mucous membranes (moist skin surfaces, like gums or inner eyelids) or an area of broken skin (cut or scrape) touches saliva from an infected animal.

Home Treatment for Rabies
If your child is bitten by an animal, wash the bite area with soap and water for 10 minutes and cover the bite with a clean bandage. Call your doctor or a nearby hospital’s emergency room and ask for advice. Also call local animal–control authorities to help find the animal which caused the bite – the animal may need to be detained and observed for signs of rabies. If your child has been recently bitten by an animal and has any of the symptoms of rabies, she must be seen by a doctor immediately. Anyone with a rabies infection must be treated in a hospital.

Professional Treatment for Rabies
If your child is bitten by an animal, her doctor will clean the wound thoroughly and check that her tetanus immunizations are up–to–date. Your child may need a tetanus booster. Your child’s doctor may decide to begin treating your child to prevent rabies. This decision is usually based on the circumstances of the bite (provoked or unprovoked), the type of animal (species, wild or domestic), animal’s health history (vaccinated or not), and the recommendations of local health authorities. Rabies prevention no longer means a series of painful injections in the abdomen. If your child’s doctor decides to begin the anti–rabies immunization, it will involve a series of intramuscular (into a muscle) injections of human diploid cell vaccine and human rabies immune globulin. Part of rabies human immunoglobulin is usually injected near the bite area. Persons who already show signs and symptoms of rabies infection absolutely need to be treated in a hospital. There they will have tests to check for rabies infection. If they do have rabies, they will need specialized life–support equipment to help them survive.

When To Call Your Pediatrician
Call your child’s doctor immediately if your child has any of the signs and symptoms of rabies, especially if the child has recently been bitten by an animal. Call your child’s doctor whenever your child is bitten by an animal. If your child has been exposed to an animal that might have rabies, but the child is too young to be able to describe the extent of their contact with that animal, call your child’s doctor to ask advice. Also, if your child has been exposed to bats, even without being bitten, call your child’s doctor. Your child should receive rabies treatment to prevent infection. You should also call your child’s doctor if you are planning to travel abroad and might come into contact with animals that are infected with rabies, particularly if you are traveling to an area where you might not have access to health care.