Robert Wood Johnson University Hospital



Centers for Disease Control  recommendation for travelers

Rabies vaccination is not a requirement for entry into any country. However, a pre-exposure immunization may be recommended for persons traveling to developing countries of Africa, Asia, and Central and South American, where rabies is not well controlled.

What are the dangers of animal bites?

Animal bites and scratches, even when they are minor, can become infected and spread bacteria to other parts of the body. Whether the bite is from a family pet or an animal in the wild, scratches and bites can carry disease. Cat scratches, for examples, even from a kitten can carry "cat scratch disease," a bacterial infection. Other animals can transmit rabies and tetanus. Bites that break the skin are even more likely to become infected.

What is the immediate care for animal bites?

What is rabies?

Rabies is a widespread, viral infection of warm-blooded animals. Caused by a virus in the Rhabdoviridae family, it attacks the nervous system and, once symptoms develop, it is 100 percent fatal in animals.

In North America, rabies occurs primarily in skunks, raccoons, foxes, coyotes, and bats. In some areas, these wild animals infect domestic cats, dogs, and livestock. In the United States, cats are more likely than dogs to be rabid.

Individual states maintain information about animals that may carry rabies. it is best to check for region specific information if you are unsure about a specific animal and have been bitten.

In the mid-Atlantic states, where rabies is increasing in raccoons, woodchucks (groundhogs) can be rabid.

Travelers to developing countries, where vaccination of domestic animals is not routine, should talk with their health care provider about getting the rabies vaccine before traveling.

How does rabies occur?

The rabies virus enters the body through a cut or scratch, or through mucous membranes (such as the lining of the mouth and eyes), and travels to the central nervous system. Once the infection is established in the brain, the virus travels down the nerves from the brain and multiplies in different organs.

The salivary glands are most important in the spread of rabies from one animal to another. When an infected animal bites another animal, the rabies virus is transmitted through the infected animal's saliva. Scratches by claws of rabid animals are also dangerous because these animals lick their claws.

What are the symptoms of rabies?

The incubation in humans from the time of exposure to the onset of illness can range anywhere from five days to more than a year, although the average incubation period is about two months.

Rabies: Stage 1

Rabies: Stage 2

  • Initial period of vague symptoms, lasting two to 10 days
  • Vague symptoms may include:
    • Fever
    • Headache
    • Malaise
    • Decreased appetite
    • Vomiting
  • Pain, itching or numbness and tingling at the site of the wound
  • Patients often develop difficulty in swallowing (sometimes referred to as "foaming at the mouth") due to the inability to swallow saliva. Even the sight of water may terrify the patient.
  • Some patients become agitated and disoriented, while others become paralyzed.
  • Immediate death, or coma resulting in death from other complications, may result.

How is rabies diagnosed?

In animals, the direct fluorescent antibody test (dFA) performed on brain tissue is most frequently used to diagnose rabies. Within a few hours, diagnostic laboratories can determine whether an animal is rabid and provide this information to medical professionals. These results may save a patient from unnecessary physical and psychological trauma if the animal is not rabid.

In humans, a battery of tests is necessary to confirm or rule out rabies, as no single test can be used to rule out the disease with certainty. Tests are performed on samples of serum, saliva, spinal fluid, and skin biopsies taken from the nape of the neck.

What is the treatment for rabies?

Unfortunately, there is no known, effective treatment for rabies once symptoms of the illness have developed. However, there are effective vaccines (HDCV, PCEC) that provide immunity to rabies when administered soon after an exposure, or for protection before an exposure occurs (for persons such as veterinarians and animal handlers).

How can animal bites and rabies be prevented?

If I am bitten by a wild or domestic animal, what should I tell my health care provider?

If you or someone you know is bitten by an animal, remember these facts to report to your health care provider:


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