Rabies is a severe neurological infectious disease caused by the rabies virus, with a nearly 100% fatality rate. The virus is primarily transmitted through the saliva of infected animals, most commonly via bites or scratches. Once the virus enters the human body, it travels along the nervous system to the brain, ultimately causing encephalitis or meningitis, which can be fatal.
Globally, approximately 59,000 people die from rabies each year, with the vast majority of cases occurring in Asia and Africa. Although rabies is almost universally fatal once symptoms appear, timely post-exposure prophylaxis can effectively prevent the virus from causing infection. Therefore, understanding the transmission routes, symptoms, and prevention methods of rabies is crucial for public health.
The rabies virus (Rabies virus) belongs to the RNA virus family and circulates mainly among mammals such as dogs, cats, foxes, and bats. The virus exists in the saliva and nervous tissue of infected animals. When humans are bitten, scratched, or come into contact with saliva on wounds or mucous membranes of these animals, the virus can invade the body. After entering the body, the virus slowly travels along nerve axons toward the central nervous system, a process known as incubation. The incubation period typically lasts 1 to 3 months but can be as short as a few days or as long as several years.
Risk factors include:
The symptoms of rabies can be divided into three stages based on disease progression:
This stage lasts from 2 to 10 days. Patients may experience flu-like symptoms such as fever, headache, fatigue, and may have abnormal tingling or itching at the wound site. Some patients may also have heightened sensitivity to light, sound, or wind.
Symptoms during this stage include:
In the final stage, patients enter coma, and paralysis of respiratory muscles leads to respiratory failure. Nearly all cases result in death within 7 to 10 days. Currently, there is no effective treatment, and the mortality rate after symptom onset approaches 100%.
Diagnosing rabies requires a combination of clinical presentation, exposure history, and laboratory tests. Doctors will inquire about animal contact history, including the type of animal, wound location, and whether the animal exhibited abnormal behavior. Laboratory diagnostic methods include:
In suspected cases, even without laboratory evidence, if the patient has a high-risk exposure history, doctors will immediately initiate prophylactic treatment, as waiting for diagnostic results may miss the optimal treatment window.
High-risk groups (such as veterinarians, laboratory personnel) should receive rabies vaccination. The vaccination schedule typically involves three doses, which induce antibody production providing protection for several years. For unvaccinated individuals exposed to potential rabies, post-exposure prophylaxis (PEP) should be administered immediately.
Post-exposure management includes four key steps:
The core of rabies prevention is to block the transmission chain of the virus. Key measures include:
In endemic areas, it is recommended that high-risk groups receive pre-exposure vaccination. Travel medicine centers advise vaccination before traveling to high-risk regions, which can shorten the post-exposure treatment process. New cell-culture vaccines (such as PUR® vaccine) have a more convenient schedule and cause less injection site pain.
If any of the following occur, seek medical attention immediately:
Even if the wound appears minor (such as a light bite from a bat), an assessment is necessary to determine if vaccination is needed. Doctors will evaluate the risk level based on WHO’s “Four-Level Exposure Assessment System” and decide whether to implement full post-exposure prophylaxis. Timely medical intervention is the only effective prevention. Delaying treatment significantly increases infection risk, as once the virus reaches the brain, it becomes untreatable. Even in resource-limited areas, immediate post-exposure management can save lives.
Even if more than 24 hours have passed since the bite, immediate medical evaluation is necessary to assess whether vaccination is needed. Once the rabies virus enters the nervous system, the fatality rate is nearly 100%. However, if vaccination and immune globulin are administered before symptoms appear, it may still effectively prevent infection. Therefore, regardless of how long ago the bite occurred, it is crucial to seek prompt medical assessment of the risk.
Can rabies vaccine be administered simultaneously with other vaccines?Generally, rabies vaccine can be given with other vaccines at the same time, but injection sites should be separate. If there are special health conditions (such as immunodeficiency) or concurrent vaccination with other specific vaccines (such as tetanus), consult a physician beforehand to avoid potential immune interference or adverse reactions.
If a pet cat or dog that appears healthy bites, do I still need to treat the wound?Yes. Even if the animal looks healthy, if it has been in contact with suspected rabid animals or sources of unknown origin, it should be considered high risk. Immediate thorough cleaning of the wound with soap and water for 15 minutes is recommended, followed by prompt medical evaluation. Regular vaccination of pet dogs and cats is essential, but wounds should be observed for 10 days to confirm whether the animal is carrying the virus.
If a person experiences fever or redness/swelling after rabies vaccination, should the subsequent doses be stopped?Mild fever or redness/swelling at the injection site are common side effects and usually do not require stopping vaccination. Taking antipyretics can help alleviate discomfort. If severe allergic reactions such as anaphylactic shock or widespread rash occur, discontinue and seek medical attention immediately. Completing the full vaccination course is essential to ensure adequate protection; do not stop treatment due to mild adverse effects.
If someone has previously completed rabies vaccination and is bitten again, is the full dose necessary?If previously vaccinated completely, only two doses of accelerated vaccination (on days 0 and 3) are usually needed after re-exposure, along with monitoring the animal for rabies. However, in high-risk exposures (such as head wounds or in rabies-endemic regions), the doctor may adjust the vaccination plan according to the situation, following professional advice.
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