In humans, rabies is an extremely painful and deadly viral disease that infects the central nervous system. The virus is transmitted in the saliva of infected animals. Left untreated, rabies virus travels from the site of infection (usually the bite wound) to the brain and spinal cord. Once clinical signs of rabies appear, the disease is almost always fatal. In the United States at the turn of the century, approximately 100 rabies deaths occurred annually in humans. Since the 1940's when animal vaccination programs began (commonly for dogs and cats), numbers of cases dropped dramatically. Also, highly effective modern rabies vaccinations and post-exposure prophylaxis (PEP) have been developed for humans. The biggest threat of exposure to rabies today in the U.S. is through interactions with infected wildlife, as many dogs are vaccinated. Contact with potentially infected wildlife has resulted in the PEP vaccine being administered to approximately 40,000 people in the U.S. each year. Vaccine development and advanced medical care has reduced the number of human rabies cases in the U.S. to an average of 1 to 3 people annually, and a lucky few with clinical cases have been able to survive. The Centers for Disease Control (CDC) reports that only 3 people in the U.S. have ever been documented to survive clinical rabies infections. These recent cases benefited from rabies prophylaxis and improved modern day supportive medical care. Even though rabies vaccines have been around for a long time (Louis Pasteur developed the first one in 1885), rabies eradication has not been achieved because the virus is maintained in many large and varied populations of animals worldwide.
In California, rabies is endemic throughout the entire state. It is also highly endemic in the U.S. This means it can be found almost anywhere that host or reservoir animals live. The only state in the U.S. that is rabies free is Hawaii. Bats, skunks, foxes, raccoons and coyotes are common wild animals that carry and spread rabies. In California, most cases of rabies occur in bats. Each year in California, rabies is detected in approximately 200 wild animals. Fortunately, human rabies cases are rare in California, with only 15 cases occurring since 1980.
Worldwide, human rabies cases are still common in developing countries in Asia, Africa and Latin America, where large numbers of stray dogs are the major transmitters. The Asian continent accounts for more that 95% of all human rabies cases worldwide with about 35,000 deaths per year. Approximately 59,000 people die from rabies worldwide each year (that is nearly one death every 9 minutes), with many victims being under the age of 15. The World Health Organizaion (WHO) is promoting a campaign called the "Global elimination of dog-mediated human rabies - The Time is Now", which hopes to increase public health resources and vaccination efforts. The CDC promotes "World Rabies Day", which encourages rabies awareness and education. In many developing countries, costs of these programs make them difficult to implement, as it would involve the vaccination and revaccination of millions of animals each year. Progress is being made however, by slowly improving access to preventative treatment, diagnostic facilities and effective rabies control programs.
People get rabies because they come into contact with animals with rabies that are shedding the virus in their saliva. If saliva from an infected animal gets into a break in a person's skin or on mucous membranes such as eyes, mouth or nose, that person might become infected. In studies of human rabies cases acquired from bats in caves, it has been hypothesized that an airborne mechanism could be responsible for transmission. The incubation period of rabies is more variable than most other infections. In humans, it is usually several weeks to months before symptoms begin to appear, but can range from days to years. The first symptoms of rabies are flu-like, with fever, headache and general discomfort. Within days, symptoms may include anxiety, confusion, agitation, abnormal behavior, pain, insomnia, hallucinations, paralysis, abnormal secretion of saliva, difficulty in swallowing and delirium. Death usually occurs within several days after the onset of symptoms.
Rabies can be prevented by avoiding contact with unfamiliar animals. If you are bitten by a potentially rabid animal, immediately wash the area with soap and water and seek medical attention. Immediate and thorough washing of the bite wound, hands, etc. can be life saving. Local animal control should be contacted so they can quarantine or send out the animal for rabies testing if necessary. Your health care provider is the only one who can determine the proper treatment for you based on your incident specific circumstances. Factors involved in your doctor's decision will include: the type of animal involved, whether the attack was provoked or unprovoked, any vaccination status available on the animal, and whether the animal can be quarantined or tested for rabies. The important step you must take is that you must seek medical attention.
To reduce the risk of contracting rabies:
- Keep vaccinations up to date for your dogs, cats, and other susceptible pets.
- All dogs in California are required by law to be vaccinated against rabies.
- Call your local animal control agency to remove stray animals.
- Never adopt or bring wild or stray animals into your home, keep pets away from wild or unfamiliar animals.
- Prevent bats from from entering living quarters or occupied spaces in houses, churches, schools, etc.
- Enjoy wild animals from a distance.