Rabies

Rabies has a feature that sets it apart from other infections: while there are no symptoms it can be prevented with almost complete reliability, and once symptoms appear there is no way to save the person. Between those two states lie weeks or months of margin, yet everything that decides the outcome happens right at the start — in the first hours after a bite, a scratch or contact with an animal's saliva. That is why this page is mostly about what to do straight away, and only briefly about how the illness itself unfolds.

The first minutes after a bite or scratch

The wound is the one place where the virus is still within reach and can be washed away. Mechanical flushing lowers the risk more than anything else you can do at home, and it should be done immediately, not after the journey to a clinic.

• Wash the wound with running water and soap for at least fifteen minutes. Fifteen means fifteen by the clock, not "until you get tired of it" — a quick rinse does not do the job. Do not spare the soap, run the water with some force, and if the wound is deep try to flush it right through.
• After that apply an antiseptic, alcohol-based or iodine-based.
• Do not cauterise the wound and do not try to open it up or squeeze it. It gains you nothing and damages the tissue further.
• Animal bites are usually not stitched straight away, or are closed with widely spaced sutures. Always tell the doctor the wound came from an animal — the whole approach depends on it.
• See a doctor the same day. Not tomorrow, not after the weekend.

An obvious bite is not the only thing that counts as contact. So does a scratch from claws or teeth, any break in the skin that an animal has licked, and saliva reaching your eyes, nose or mouth. Stroking an animal's fur, or saliva on unbroken skin, carries no risk.

While you are there the doctor will check two things people forget in the panic: whether a tetanus jab is due and whether antibiotics are needed. Bites to the hand and face, and deep punctures from a cat's teeth, become infected often, and that is a separate problem from rabies.

Why "let's watch the dog" is a bad plan

The commonest and costliest mistake is putting off the visit to see what happens to the animal and to yourself. Here is why that does not work.

The virus travels from the wound along the nerves towards the brain, and prevention works only while it has not arrived. The journey usually takes one to three months, but with bites to the face, neck or hand it can be far shorter. There is no way of knowing how much time you personally have, so that margin is not spent.

Watching the animal for ten days is a genuine veterinary procedure, but its purpose is different. It is not there to decide whether to start prevention — it is there to stop it: the course begins at once, and if after ten days the pet dog or cat is alive and well, the remaining doses are cancelled. Watching instead of starting is not watching, it is weeks thrown away.

Three more things tend to reassure people for no good reason. An animal is infectious for several days before it falls ill itself, so "it looked healthy" proves nothing. A stray dog or a fox is not something anyone can observe, and there is nowhere to do it. And an owner saying the dog is vaccinated is not a document — ask whether it is recorded in the animal's vaccination card and when.

Which animals carry it, and why bats are a case of their own

Rabies is not a dog disease alone, even though dogs account for the overwhelming majority of human deaths worldwide. The virus is carried by mammals of all sorts: cats, foxes, raccoon dogs, wolves, jackals, raccoons, mongooses, monkeys and livestock. Small rodents and hares practically never pass it to people, so a nip from a hamster or a field mouse does not belong in this story. In tourist areas monkeys deserve a line of their own: they snatch food from hands and scratch, and that contact is taken seriously.

Bats stand apart, and the rule for them is different. Their teeth are as fine as a needle: the bite may not hurt and may leave no mark on the skin at all. You cannot wait to see a visible wound here, because there may not be one even when contact has happened. So it is worth seeking advice if:

• you have handled a bat, lifted one off your clothing or waved one away from your face;
• you woke up in a room with a bat flying in it;
• a bat turned up in a room where a child was sleeping, or someone who cannot clearly describe what happened.

This matters all the more because in countries where land animals have been free of rabies for decades, bats are the only remaining source. The viruses they carry in Europe are close relatives of classical rabies, and the same vaccine protects against them.

How much risk there is where you are

The answer depends heavily on the country, which is the main reason not to be guided by somebody's account on the internet.

Most cases occur in Asia and Africa, where street and village dogs are the source; the risk remains appreciable in a number of Latin American countries. If you are travelling there, a dog bite is a reason to seek help on the spot, not once you are home.

In western and southern Europe there has been no rabies in land animals for decades: a dog or cat in Spain, Italy or Portugal is hardly ever the source, and only bats and the occasional illegally imported animal remain. The Spanish cities on the North African coast are a case apart, closer to the situation in the neighbouring country than to mainland Spain.

Eastern Europe looks different. In Ukraine and several nearby countries the virus persists in foxes and raccoon dogs, and from them it reaches village cats and dogs. That means a bite or scratch from a cat living in a yard is not a trifle but an ordinary reason to see a doctor the same day.

A word about children: they make up around half of those affected worldwide. They reach out to animals and then keep quiet about the bite for fear of being told off. If a child comes back with a scratch, ask directly and without reproach — far too much depends on whether they tell you.

What the doctor does: prevention after contact

The doctor first works out what kind of contact took place: whether an animal licked intact skin, whether there is a superficial scratch, or whether this was a deep bite or saliva on the mucous membranes. That determines whether prevention is needed at all, and how much of it.

From there, two components are possible.

• A course of vaccine. Several doses spread over two to four weeks. The exact number of doses and the days depend on the schedule used in the country and on whether you have been vaccinated against rabies before: for those already vaccinated the course is shorter. The dates matter, and a course that has been started should be finished.
• Rabies immunoglobulin. These are ready-made antibodies, infiltrated into the wound and around it so that they act on the spot while the vaccine has not yet taken effect. It is given once, and only to people not previously vaccinated, for deep or multiple bites and when saliva has reached the mucous membranes.

If the course was started abroad, bring home every piece of paper you were given: the doctor continues it rather than starting again. It is also worth knowing that pregnancy, breastfeeding, infancy and a weakened immune system are not obstacles to prevention. There are effectively no contraindications here, because on the other side of the scales sits a reliably fatal disease.

One last thing: if a week, a month or longer has passed since the bite and you never went anywhere, go now anyway. While there are no symptoms, it is never too late.

Vaccination before a trip: who it is worth it for

Vaccinating in advance is not for everyone going abroad, but for people in whom several conditions coincide: a long trip, remote places, difficulty reaching medical help quickly, and a way of travelling that brings you near animals — cycling, running, trekking, fieldwork. It is worth considering for children who will be away for a long stretch.

It helps to understand what it buys you. Being vaccinated beforehand does not excuse you from seeing a doctor after a bite: you will still need a course, only a shorter one. The decisive point is elsewhere — someone already vaccinated does not need immunoglobulin, and immunoglobulin is precisely what tends to be unobtainable in those remote places. That is the real argument.

The pre-travel course is several doses and takes time, so it is a conversation to have with a doctor at least a month before the flight, not the night before. People exposed through work — vets, staff in kennels and quarantine facilities, anyone handling bats or wildlife — are vaccinated regardless of travel, and their protection is checked periodically.

The symptoms: the point you must never reach

One to three months usually pass between the contact and the first signs; rarely a week, or conversely years. The onset is unremarkable: a temperature, feeling unwell, anxiety, poor sleep. The one early hint that points to rabies is itching, tingling or pain at the bite site, long since healed.

Then comes what makes the picture recognisable: intense agitation and fear, heavy salivation, a painful spasm in the throat when trying to swallow water and later at the mere sight of it or from a draught of air on the face. There is also a second, paralytic form in which muscle weakness builds instead of agitation; that one is recognised later and with more difficulty.

From that moment medicine cannot help: there is no treatment that works, and all that is left is easing the suffering. The end comes within a few days. We set this out not to frighten but to explain why there is so much insistence around a single bite: everything that could be done is done in the first twenty-four hours.

Online consultation

The question that genuinely torments people after an encounter with an animal is settled fastest at a distance: does this count as contact, and does anything need to be done. The doctor will go through where and how it happened, what the animal was and whether the skin was broken, and will tell you whether you need to go for prevention today or whether the alarm is unfounded. It is also a convenient way to plan a trip in advance and weigh up whether vaccination suits you, or to sort out a course begun in another country: how many doses are left and on which days.

It is worth being equally clear about what it does not replace. Nobody can wash the wound for you, and the vaccine and immunoglobulin are given only in person. If the contact happened today, start with fifteen minutes under the tap and with finding the nearest place that provides this care — let the conversation with a doctor run alongside that, not instead of it.

This material is for information only and does not replace medical advice.