Rabies is a
viral disease
A viral disease (or viral infection) occurs when an organism's body is invaded by pathogenic viruses, and infectious virus particles (virions) attach to and enter susceptible cells.
Examples include the common cold, gastroenteritis, COVID-19, ...
that causes
encephalitis
Encephalitis is inflammation of the Human brain, brain. The severity can be variable with symptoms including reduction or alteration in consciousness, aphasia, headache, fever, confusion, a stiff neck, and vomiting. Complications may include se ...
in humans and other
mammals
A mammal () is a vertebrate animal of the class Mammalia (). Mammals are characterised by the presence of milk-producing mammary glands for feeding their young, a broad neocortex region of the brain, fur or hair, and three middle e ...
.
It was historically referred to as hydrophobia ("fear of water") because its victims panic when offered liquids to drink. Early symptoms can include fever and abnormal sensations at the site of exposure.
These symptoms are followed by one or more of the following symptoms: nausea, vomiting, violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and
loss of consciousness
Unconsciousness is a state in which a living individual exhibits a complete, or near-complete, inability to maintain an awareness of self and environment or to respond to any human or environmental stimulus. Unconsciousness may occur as the re ...
.
Once symptoms appear, the result is virtually always death.
The time period between contracting the disease and the start of symptoms is usually one to three months but can vary from less than one week to more than one year.
The time depends on the distance the virus must travel along
peripheral nerves
The peripheral nervous system (PNS) is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside the brain a ...
to reach the
central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
.
Rabies is caused by
lyssavirus
''Lyssavirus'' (from the Greek ''lyssa'' "rage, fury, rabies" and the Latin '' vīrus'') is a genus of RNA viruses in the family ''Rhabdoviridae'', order '' Mononegavirales''. Mammals, including humans, can serve as natural hosts. The genus ...
es, including the
rabies virus
Rabies virus (''Lyssavirus rabies'') is a neurotropic virus that causes rabies in animals, including humans. It can cause violence, hydrophobia, and fever. Rabies transmission can also occur through the saliva of animals and less commonly throu ...
and
Australian bat lyssavirus
Australian bat lyssavirus (ABLV) is a enzootic virus closely related to the rabies virus. It was first identified in a 5-month-old juvenile black flying fox (''Pteropus alecto'') collected near Ballina, New South Wales, Ballina in northern New ...
.
It is spread when an infected animal bites or scratches a human or other animals.
Saliva from an infected animal can also transmit rabies if the saliva comes into contact with the eyes, mouth, or nose.
Globally, dogs are the most common animal involved.
In countries where dogs commonly have the disease, more than 99% of rabies cases in humans are the direct result of
dog bites
A dog bite is a bite upon a person or other animal by a dog. More than one successive bite is often called a dog attack, although dog attacks can include knock-downs and scratches. Though some dog bites do not result in injury, they can resul ...
.
In the
Americas
The Americas, sometimes collectively called America, are a landmass comprising the totality of North America and South America.''Webster's New World College Dictionary'', 2010 by Wiley Publishing, Inc., Cleveland, Ohio. When viewed as a sing ...
,
bat
Bats are flying mammals of the order Chiroptera (). With their forelimbs adapted as wings, they are the only mammals capable of true and sustained flight. Bats are more agile in flight than most birds, flying with their very long spread-out ...
bites are the most common source of rabies infections in humans, and less than 5% of cases are from dogs.
Rodent
Rodents (from Latin , 'to gnaw') are mammals of the Order (biology), order Rodentia ( ), which are characterized by a single pair of continuously growing incisors in each of the upper and Mandible, lower jaws. About 40% of all mammal specie ...
s are very rarely infected with rabies.
The disease can be diagnosed only after the start of symptoms.
Animal control and vaccination programs have decreased the risk of rabies from dogs in a number of regions of the world.
Immunizing people before they are exposed is recommended for those at high risk, including those who work with bats or who spend prolonged periods in areas of the world where rabies is common.
In people who have been exposed to rabies, the
rabies vaccine
The rabies vaccine is a vaccine used to prevent rabies. There are several rabies vaccines available that are both safe and effective. Vaccinations must be administered prior to rabies virus exposure or within the Latent period (epidemiology), l ...
and sometimes
rabies immunoglobulin
Rabies, a viral zoonotic neglected tropical disease, poses a severe public health threat in over 150 countries and territories, primarily in Asia and Africa. Each year, this disease results in tens of thousands of fatalities, with children unde ...
are effective in preventing the disease if the person receives the treatment before the start of rabies symptoms.
Washing bites and scratches for 15 minutes with soap and water,
povidone-iodine
Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may ...
, or detergent may reduce the number of viral particles and may be somewhat effective at preventing transmission.
, only fourteen people were documented to have survived a rabies infection after showing symptoms.
However, research conducted in 2010 among a population of people in
Peru
Peru, officially the Republic of Peru, is a country in western South America. It is bordered in the north by Ecuador and Colombia, in the east by Brazil, in the southeast by Bolivia, in the south by Chile, and in the south and west by the Pac ...
with a self-reported history of one or more bites from
vampire bat
Vampire bats, members of the subfamily Desmodontinae, are Phyllostomidae, leaf-nosed bats currently found in Central and South America. Their food source is the blood of other animals, a dietary trait called hematophagy. Three extant bat species ...
s (commonly infected with rabies), found that out of 73 individuals reporting previous bat bites, seven people had rabies virus-neutralizing
antibodies
An antibody (Ab) or immunoglobulin (Ig) is a large, Y-shaped protein belonging to the immunoglobulin superfamily which is used by the immune system to identify and neutralize antigens such as bacteria and viruses, including those that caus ...
(rVNA). Since only one member of this group reported prior vaccination for rabies, the findings of the research suggest previously undocumented cases of infection and viral replication followed by an abortive infection. This could indicate that people may have an exposure to the virus without treatment and develop natural antibodies as a result.
Rabies causes about 59,000 deaths worldwide per year,
about 40% of which are in children under the age of 15. More than 95% of human deaths from rabies occur in Africa and Asia.
Rabies is present in more than 150 countries and on all continents but Antarctica.
More than 3 billion people live in regions of the world where rabies occurs.
A number of countries, including Australia and Japan, as well as much of Western Europe, do not have rabies among dogs.
Many Pacific islands do not have rabies at all.
It is classified as a
neglected tropical disease
Neglected tropical diseases (NTDs) are a diverse group of tropical infections that are common in low-income populations in developing regions of Africa, Asia, and the Americas. They are caused by a variety of pathogens, such as viruses, bacteri ...
.
The global cost of rabies is estimated to be around US$8.6 billion per year including lost lives and livelihoods, medical care and associated costs, as well as uncalculated
psychological trauma
Psychological trauma (also known as mental trauma, psychiatric trauma, emotional damage, or psychotrauma) is an emotional response caused by severe distressing events, such as Major trauma, bodily injury, Sexual assault, sexual violence, or ot ...
.
Etymology
The name rabies is derived from the
Latin
Latin ( or ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken by the Latins (Italic tribe), Latins in Latium (now known as Lazio), the lower Tiber area aroun ...
''rabies'', meaning "madness".
The Greeks derived the word ''lyssa'', from ''lud'' or "violent"; this root is used in the genus name of the rabies virus, ''Lyssavirus''.
Signs and symptoms

The
period
Period may refer to:
Common uses
* Period (punctuation)
* Era, a length or span of time
*Menstruation, commonly referred to as a "period"
Arts, entertainment, and media
* Period (music), a concept in musical composition
* Periodic sentence (o ...
between infection and the first
symptoms
Signs and symptoms are diagnostic indications of an illness, injury, or condition.
Signs are objective and externally observable; symptoms are a person's reported subjective experiences.
A sign for example may be a higher or lower temperature ...
(incubation period) is typically one to three months in humans.
This period may be as short as four days or longer than six years, depending on the location and severity of the wound and the amount of virus introduced.
Initial symptoms of rabies are often nonspecific, such as fever and headache.
As rabies progresses and causes
inflammation of the brain and meninges, symptoms can include slight or partial
paralysis
Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...
,
anxiety
Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
,
insomnia
Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...
,
confusion
In psychology, confusion is the quality or emotional state of being bewildered or unclear. The term "acute mental confusion" ,
agitation, abnormal behavior,
paranoia
Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety, suspicion, or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of co ...
,
terror, and
hallucination
A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming ( REM sleep), which does not involve wakefulness; pse ...
s.
The person may also have fear of water.
The symptoms eventually progress to
delirium
Delirium (formerly acute confusional state, an ambiguous term that is now discouraged) is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or ...
and
coma
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to Nociception, respond normally to Pain, painful stimuli, light, or sound, lacks a normal Circadian rhythm, sleep-wake cycle and does not initiate ...
.
Death
Death is the end of life; the irreversible cessation of all biological functions that sustain a living organism. Death eventually and inevitably occurs in all organisms. The remains of a former organism normally begin to decompose sh ...
usually occurs two to ten days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care.
Rabies has also occasionally been referred to as hydrophobia ("fear of water") throughout its history. It refers to a set of symptoms in the later stages of an infection in which the person has difficulty swallowing, shows panic when presented with liquids to drink, and cannot quench their thirst. Saliva production is greatly increased, and attempts to drink, or even the intention or suggestion of drinking, may cause excruciatingly painful spasms of the muscles in the throat and
larynx
The larynx (), commonly called the voice box, is an organ (anatomy), organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal ...
. Since the infected individual cannot swallow saliva and water, the virus has a much higher chance of being transmitted, because it multiplies and accumulates in the
salivary gland
The salivary glands in many vertebrates including mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands ( parotid, submandibular, and sublingual), as well as hundreds of min ...
s and is transmitted through biting.
Hydrophobia is commonly associated with furious rabies, which affects 80% of rabies-infected people. This form of rabies causes irrational aggression in the host, which aids in the spreading of the virus through animal bites; a "foaming at the mouth" effect, caused by the accumulation of saliva, is also commonly associated with rabies in the public perception and in popular culture. The remaining 20% may experience a paralytic form of rabies that is marked by muscle
weakness
Weakness is a symptom of many different medical conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, ...
, loss of sensation, and
paralysis
Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...
; this form of rabies does not usually cause fear of water.
Cause
File:Rabies Virus.jpg, Rendering of the rabies virus
File:Electron microscope image of rabies virus.jpg, An electron microscope image of the rabies virus
File:Rabies Virus EM PHIL 1876.JPG, TEM micrograph
A micrograph is an image, captured photographically or digitally, taken through a microscope or similar device to show a magnify, magnified image of an object. This is opposed to a macrograph or photomacrograph, an image which is also taken ...
with numerous rabies virion
A virion (plural, ''viria'' or ''virions'') is an inert virus particle capable of invading a Cell (biology), cell. Upon entering the cell, the virion disassembles and the genetic material from the virus takes control of the cell infrastructure, t ...
s (small, dark grey, rodlike particles) and Negri bodies
Negri bodies are eosinophilic, sharply outlined, pathognomonic inclusion bodies (2–10 μm in diameter) found in the cytoplasm of certain nerve cells containing the virus of rabies, especially in pyramidal cells within Ammon's horn of t ...
(the larger pathognomonic
Pathognomonic (synonym ''pathognomic'') is a term, often used in medicine, that means "characteristic for a particular disease". A pathognomonic sign is a particular sign whose presence means that a particular disease is present beyond any doubt. ...
cellular inclusions of rabies infection)
Rabies is caused by a number of
lyssavirus
''Lyssavirus'' (from the Greek ''lyssa'' "rage, fury, rabies" and the Latin '' vīrus'') is a genus of RNA viruses in the family ''Rhabdoviridae'', order '' Mononegavirales''. Mammals, including humans, can serve as natural hosts. The genus ...
es including the
rabies virus
Rabies virus (''Lyssavirus rabies'') is a neurotropic virus that causes rabies in animals, including humans. It can cause violence, hydrophobia, and fever. Rabies transmission can also occur through the saliva of animals and less commonly throu ...
and
Australian bat lyssavirus
Australian bat lyssavirus (ABLV) is a enzootic virus closely related to the rabies virus. It was first identified in a 5-month-old juvenile black flying fox (''Pteropus alecto'') collected near Ballina, New South Wales, Ballina in northern New ...
.
Duvenhage lyssavirus may cause a rabies-like infection.
The rabies virus is the
type species
In International_Code_of_Zoological_Nomenclature, zoological nomenclature, a type species (''species typica'') is the species name with which the name of a genus or subgenus is considered to be permanently taxonomically associated, i.e., the spe ...
of the ''
Lyssavirus
''Lyssavirus'' (from the Greek ''lyssa'' "rage, fury, rabies" and the Latin '' vīrus'') is a genus of RNA viruses in the family ''Rhabdoviridae'', order '' Mononegavirales''. Mammals, including humans, can serve as natural hosts. The genus ...
''
genus
Genus (; : genera ) is a taxonomic rank above species and below family (taxonomy), family as used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruses. In bino ...
, in the family''
Rhabdoviridae
''Rhabdoviridae'' is a family of negative-strand RNA viruses in the order ''Mononegavirales''. Vertebrates (including mammals and humans), invertebrates, plants, fungi and protozoans serve as natural hosts. Diseases associated with member virus ...
'', order ''
Mononegavirales
''Mononegavirales'' is an order of negative-strand RNA viruses which have nonsegmented genomes. Some members that cause human disease in this order include Ebola virus, human respiratory syncytial virus, measles virus, mumps virus, Nipah viru ...
''. Lyssavirions have helical symmetry, with a length of about 180
nm and a cross-section of about 75 nm.
These virions are
enveloped and have a single-stranded
RNA
Ribonucleic acid (RNA) is a polymeric molecule that is essential for most biological functions, either by performing the function itself (non-coding RNA) or by forming a template for the production of proteins (messenger RNA). RNA and deoxyrib ...
genome with
negative sense. The genetic information is packed as a
ribonucleoprotein
Nucleoproteins are proteins conjugated with nucleic acids (either DNA or RNA). Typical nucleoproteins include ribosomes, nucleosomes and viral nucleocapsid proteins.
Structures
Nucleoproteins tend to be positively charged, facilitating inter ...
complex in which RNA is tightly bound by the viral nucleoprotein. The
RNA genome of the virus encodes five genes whose order is highly conserved: nucleoprotein (N), phosphoprotein (P), matrix protein (M), glycoprotein (G), and the viral RNA polymerase (L).
To enter cells, trimeric spikes on the exterior of the membrane of the virus interact with a specific cell receptor, the most likely one being the
acetylcholine
Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Par ...
receptor. The cellular membrane pinches in a procession known as
pinocytosis
In cellular biology, pinocytosis, otherwise known as fluid endocytosis and bulk-phase pinocytosis, is a mode of endocytosis in which small molecules dissolved in extracellular fluid are brought into the cell through an invagination of the cell me ...
and allows entry of the virus into the cell by way of an
endosome
Endosomes are a collection of intracellular sorting organelles in eukaryotic cells. They are parts of the endocytic membrane transport pathway originating from the trans Golgi network. Molecules or ligands internalized from the plasma membra ...
. The virus then uses the acidic environment, which is necessary, of that endosome and binds to its membrane simultaneously, releasing its five proteins and single-strand RNA into the cytoplasm.
Once within a muscle or nerve cell, the virus undergoes replication. The L protein then transcribes five mRNA strands and a positive strand of RNA all from the original negative strand RNA using free nucleotides in the cytoplasm. These five mRNA strands are then translated into their corresponding proteins (P, L, N, G and M proteins) at free ribosomes in the cytoplasm. Some proteins require post-translational modifications. For example, the G protein travels through the rough
endoplasmic reticulum
The endoplasmic reticulum (ER) is a part of a transportation system of the eukaryote, eukaryotic cell, and has many other important functions such as protein folding. The word endoplasmic means "within the cytoplasm", and reticulum is Latin for ...
, where it undergoes further folding, and is then transported to the
Golgi apparatus
The Golgi apparatus (), also known as the Golgi complex, Golgi body, or simply the Golgi, is an organelle found in most eukaryotic Cell (biology), cells. Part of the endomembrane system in the cytoplasm, it protein targeting, packages proteins ...
, where a sugar group is added to it (
glycosylation
Glycosylation is the reaction in which a carbohydrate (or ' glycan'), i.e. a glycosyl donor, is attached to a hydroxyl or other functional group of another molecule (a glycosyl acceptor) in order to form a glycoconjugate. In biology (but not ...
).
When there are enough viral proteins, the viral polymerase will begin to synthesize new negative strands of RNA from the template of the positive-strand RNA. These negative strands will then form complexes with the N, P, L and M proteins and then travel to the inner membrane of the cell, where a G protein has embedded itself in the membrane. The G protein then coils around the N-P-L-M complex of proteins taking some of the host cell membrane with it, which will form the new outer envelope of the virus particle. The virus then buds from the cell.
From the point of entry, the virus is
neurotropic, traveling along the neural pathways into the
central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
. The virus usually first infects muscle cells close to the site of infection, where they are able to replicate without being 'noticed' by the host's immune system. Once enough virus has been replicated, they begin to bind to
acetylcholine receptor
An acetylcholine receptor (abbreviated AChR) or a cholinergic receptor is an integral membrane protein that responds to the binding of acetylcholine, a neurotransmitter.
Classification
Like other transmembrane receptors, acetylcholine receptor ...
s at the neuromuscular junction. The virus then travels through the nerve cell axon via
retrograde transport
Axonal transport, also called axoplasmic transport or axoplasmic flow, is a cellular process responsible for movement of mitochondria, lipids, synaptic vesicles, proteins, and other organelles to and from a neuron's cell body, through the cytoplasm ...
, as its
P protein interacts with
dynein
Dyneins are a family of cytoskeletal motor proteins (though they are actually protein complexes) that move along microtubules in cells. They convert the chemical energy stored in ATP to mechanical work. Dynein transports various cellular cargo ...
, a protein present in the cytoplasm of nerve cells. Once the virus reaches the cell body it travels rapidly to the
central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
(CNS), replicating in motor neurons and eventually reaching the brain.
After the brain is infected, the virus travels centrifugally to the peripheral and autonomic nervous systems, eventually migrating to the salivary glands, where it is ready to be transmitted to the next host.
Transmission

All
warm-blooded
Warm-blooded is a term referring to animal species whose bodies maintain a temperature higher than that of their environment. In particular, homeothermic species (including birds and mammals) maintain a stable body temperature by regulating ...
species, including humans, may become infected with the rabies virus and develop symptoms.
Bird
Birds are a group of warm-blooded vertebrates constituting the class (biology), class Aves (), characterised by feathers, toothless beaked jaws, the Oviparity, laying of Eggshell, hard-shelled eggs, a high Metabolism, metabolic rate, a fou ...
s were first artificially infected with rabies in 1884; however, infected birds are largely, if not wholly, asymptomatic, and recover.
Other bird species have been known to develop rabies
antibodies
An antibody (Ab) or immunoglobulin (Ig) is a large, Y-shaped protein belonging to the immunoglobulin superfamily which is used by the immune system to identify and neutralize antigens such as bacteria and viruses, including those that caus ...
, a sign of infection, after feeding on rabies-infected mammals.
The virus has also adapted to grow in cells of
cold-blooded vertebrates. Most animals can be infected by the virus and can transmit the disease to humans. Worldwide, about 99% of human rabies cases come from
dog
The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the gray wolf. Also called the domestic dog, it was selectively bred from a population of wolves during the Late Pleistocene by hunter-gatherers. ...
s. Other sources of rabies in humans include
bat
Bats are flying mammals of the order Chiroptera (). With their forelimbs adapted as wings, they are the only mammals capable of true and sustained flight. Bats are more agile in flight than most birds, flying with their very long spread-out ...
s,
monkey
Monkey is a common name that may refer to most mammals of the infraorder Simiiformes, also known as simians. Traditionally, all animals in the group now known as simians are counted as monkeys except the apes. Thus monkeys, in that sense, co ...
s,
raccoon
The raccoon ( or , ''Procyon lotor''), sometimes called the North American, northern or common raccoon (also spelled racoon) to distinguish it from Procyonina, other species of raccoon, is a mammal native to North America. It is the largest ...
s,
fox
Foxes are small-to-medium-sized omnivorous mammals belonging to several genera of the family Canidae. They have a flattened skull; upright, triangular ears; a pointed, slightly upturned snout; and a long, bushy tail ("brush").
Twelve species ...
es,
skunk
Skunks are mammals in the family Mephitidae. They are known for their ability to spray a liquid with a strong, unpleasant scent from their anal glands. Different species of skunk vary in appearance from black-and-white to brown, cream or gi ...
s,
cattle
Cattle (''Bos taurus'') are large, domesticated, bovid ungulates widely kept as livestock. They are prominent modern members of the subfamily Bovinae and the most widespread species of the genus '' Bos''. Mature female cattle are calle ...
,
wolves
The wolf (''Canis lupus''; : wolves), also known as the grey wolf or gray wolf, is a canine native to Eurasia and North America. More than thirty subspecies of ''Canis lupus'' have been recognized, including the dog and dingo, though gr ...
,
coyotes
The coyote (''Canis latrans''), also known as the American jackal, prairie wolf, or brush wolf, is a species of canine native to North America. It is smaller than its close relative, the gray wolf, and slightly smaller than the closely relat ...
,
cat
The cat (''Felis catus''), also referred to as the domestic cat or house cat, is a small domesticated carnivorous mammal. It is the only domesticated species of the family Felidae. Advances in archaeology and genetics have shown that the ...
s, and
mongoose
A mongoose is a small terrestrial carnivorous mammal belonging to the family Herpestidae. This family has two subfamilies, the Herpestinae and the Mungotinae. The Herpestinae comprises 23 living species that are native to southern Europe, A ...
s (normally either the small Asian mongoose or the yellow mongoose).
Rabies may also spread through exposure to infected
bears
Bears are carnivoran mammals of the family Ursidae (). They are classified as caniforms, or doglike carnivorans. Although only eight species of bears are extant, they are widespread, appearing in a wide variety of habitats throughout most o ...
,
domestic farm animals,
groundhog
The groundhog (''Marmota monax''), also known as the woodchuck, is a rodent of the family Sciuridae, belonging to the group of large ground squirrels known as marmots.
A lowland creature of North America, it is found through much of the Easte ...
s,
weasel
Weasels are mammals of the genus ''Mustela'' of the family Mustelidae. The genus ''Mustela'' includes the least weasels, polecats, stoats, ferrets, and European mink. Members of this genus are small, active predators, with long and slend ...
s, and other
wild carnivorans. However,
lagomorphs
The lagomorphs () are the members of the taxonomic order Lagomorpha, of which there are two living families: the Leporidae (rabbits and hares) and the Ochotonidae (pikas). There are 110 recent species of lagomorph, of which 109 species in twelve ...
, such as
hare
Hares and jackrabbits are mammals belonging to the genus ''Lepus''. They are herbivores and live Solitary animal, solitarily or in pairs. They nest in slight depressions called forms, and their young are precociality, able to fend for themselves ...
s and
rabbit
Rabbits are small mammals in the family Leporidae (which also includes the hares), which is in the order Lagomorpha (which also includes pikas). They are familiar throughout the world as a small herbivore, a prey animal, a domesticated ...
s, and small
rodent
Rodents (from Latin , 'to gnaw') are mammals of the Order (biology), order Rodentia ( ), which are characterized by a single pair of continuously growing incisors in each of the upper and Mandible, lower jaws. About 40% of all mammal specie ...
s, such as
chipmunk
Chipmunks are small, striped rodents of subtribe Tamiina. Chipmunks are found in North America, with the exception of the Siberian chipmunk which is found primarily in Asia.
Taxonomy and systematics
Chipmunks are classified as four genera: '' ...
s,
gerbil
The Mongolian gerbil or Mongolian jird (''Meriones unguiculatus'') is a rodent belonging to the subfamily Gerbillinae. Their body size is typically , with a tail, and body weight , with adult males larger than females. The animal is used in s ...
s,
guinea pig
The guinea pig or domestic guinea pig (''Cavia porcellus''), also known as the cavy or domestic cavy ( ), is a species of rodent belonging to the genus ''Cavia'', family Caviidae. Animal fancy, Breeders tend to use the name "cavy" for the ani ...
s,
hamster
Hamsters are rodents (order Rodentia) belonging to the subfamily Cricetinae, which contains 19 species classified in seven genera. They have become established as popular small pets. The best-known species of hamster is the golden or Syrian ...
s,
mice
A mouse (: mice) is a small rodent. Characteristically, mice are known to have a pointed snout, small rounded ears, a body-length scaly tail, and a high breeding rate. The best known mouse species is the common house mouse (''Mus musculus' ...
,
rat
Rats are various medium-sized, long-tailed rodents. Species of rats are found throughout the order Rodentia, but stereotypical rats are found in the genus ''Rattus''. Other rat genera include '' Neotoma'' (pack rats), '' Bandicota'' (bandicoo ...
s, and
squirrel
Squirrels are members of the family Sciuridae (), a family that includes small or medium-sized rodents. The squirrel family includes tree squirrels, ground squirrels (including chipmunks and prairie dogs, among others), and flying squirrel ...
s, are almost never found to be infected with rabies and are not known to transmit rabies to humans. Bites from mice, rats, or squirrels rarely require rabies prevention because these rodents are typically killed by any encounter with a larger, rabid animal, and would, therefore, not be carriers. The
Virginia opossum
The Virginia opossum (''Didelphis virginiana''), also known as the North American opossum, is a member of the opossum family found from southern Canada to northern Costa Rica, making it the northernmost marsupial in the world and the only marsup ...
(a marsupial, unlike the other mammals named in this paragraph, which are all
eutherians/
placental
Placental mammals (infraclass Placentalia ) are one of the three extant subdivisions of the class Mammalia, the other two being Monotremata and Marsupialia. Placentalia contains the vast majority of extant mammals, which are partly distinguished ...
), has a lower internal body temperature than the rabies virus prefers and therefore is resistant but not immune to rabies.
Marsupials
Marsupials are a diverse group of mammals belonging to the infraclass Marsupialia. They are natively found in Australasia, Wallacea, and the Americas. One of marsupials' unique features is their reproductive strategy: the young are born in a ...
, along with
monotremes
Monotremes () are mammals of the order Monotremata. They are the only group of living mammals that lay eggs, rather than bearing live young. The extant monotreme species are the platypus and the four species of echidnas. Monotremes are typified ...
(
platypuses
The platypus (''Ornithorhynchus anatinus''), sometimes referred to as the duck-billed platypus, is a semiaquatic, egg-laying mammal endemic to eastern Australia, including Tasmania. The platypus is the sole living representative or monotypi ...
and
echidnas
Echidnas (), sometimes known as spiny anteaters, are quill-covered monotremes (egg-laying mammals) belonging to the family Tachyglossidae , living in Australia and New Guinea. The four extant species of echidnas and the platypus are the only l ...
), typically have lower body temperatures than similarly sized
eutherians. In 2024, reports emerged that rabies is spreading in South African
Cape fur seal
The brown fur seal (''Arctocephalus pusillus''), also known as the Cape fur seal, and Afro-Australian fur seal, is a species of fur seal.
Description
The brown fur seal is the largest and most robust member of the fur seals. It has a large an ...
s, possibly making it the first outbreak documented in
marine mammal
Marine mammals are mammals that rely on marine ecosystems for their existence. They include animals such as cetaceans, pinnipeds, sirenians, sea otters and polar bears. They are an informal group, unified only by their reliance on marine enviro ...
s.
The virus is usually present in the nerves and
saliva
Saliva (commonly referred as spit or drool) is an extracellular fluid produced and secreted by salivary glands in the mouth. In humans, saliva is around 99% water, plus electrolytes, mucus, white blood cells, epithelial cells (from which ...
of a symptomatic rabid animal. The route of
infection
An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...
is usually, but not always, by a bite. In many cases, the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwise uncharacteristic behavior. This is an example of a viral pathogen
modifying the behavior of its host to facilitate its transmission to other hosts. After a typical human infection by bite, the virus enters the
peripheral nervous system
The peripheral nervous system (PNS) is one of two components that make up the nervous system of Bilateria, bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside t ...
. It then travels retrograde along the
efferent nerve
A motor nerve, or efferent nerve, is a nerve that contains exclusively efferent nerve fibers and transmits motor signals from the central nervous system (CNS) to the effector organs (muscles and glands), as opposed to sensory nerves, which transf ...
s toward the
central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
. During this phase, the virus cannot be easily detected within the host, and vaccination may still confer cell-mediated immunity to prevent symptomatic rabies. When the virus reaches the
brain
The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
, it rapidly causes
encephalitis
Encephalitis is inflammation of the Human brain, brain. The severity can be variable with symptoms including reduction or alteration in consciousness, aphasia, headache, fever, confusion, a stiff neck, and vomiting. Complications may include se ...
, the prodromal phase, which is the beginning of the symptoms. Once the patient becomes symptomatic, treatment is almost never effective and mortality is over 99%. Rabies may also inflame the
spinal cord
The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...
, producing
transverse myelitis
Transverse myelitis (TM) is a rare neurological condition wherein the spinal cord is Inflammation, inflamed. The adjective ''wikt:transverse#Adjective, transverse'' implies that the spinal inflammation (myelitis) extends horizontally throughout ...
.
Although it is theoretically possible for rabies-infected humans to transmit it to others by biting or otherwise, no such cases have ever been documented, because infected humans are usually hospitalized and necessary precautions taken. Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue (urine, blood, feces), does not constitute an exposure and does not require post-exposure prophylaxis. But as the virus is present in sperm and vaginal secretions, it might be possible for rabies to spread through sex. There are only a small number of recorded cases of human-to-human transmission of rabies, and all occurred through
organ transplant
Organ transplantation is a medical procedure in which an organ (anatomy), organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or org ...
s, most frequently with
corneal transplantation
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty a ...
, from infected donors.
Diagnosis
Rabies can be difficult to diagnose because, in the early stages, it is easily confused with other diseases or even with a simple aggressive temperament.
The
reference method for diagnosing rabies is the fluorescent antibody test (FAT), an
immunohistochemistry
Immunohistochemistry is a form of immunostaining. It involves the process of selectively identifying antigens in cells and tissue, by exploiting the principle of Antibody, antibodies binding specifically to antigens in biological tissues. Alber ...
procedure, which is recommended by the
World Health Organization
The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO). The FAT relies on the ability of a detector molecule (usually fluorescein isothiocyanate) coupled with a rabies-specific antibody, forming a conjugate, to bind to and allow the visualisation of rabies antigen using fluorescent microscopy techniques. Microscopic analysis of samples is the only direct method that allows for the identification of rabies virus-specific antigen in a short time and at a reduced cost, irrespective of geographical origin and status of the host. It has to be regarded as the first step in diagnostic procedures for all laboratories. Autolysed samples can, however, reduce the sensitivity and specificity of the FAT.
The
RT PCR assays proved to be a sensitive and specific tool for routine diagnostic purposes, particularly in decomposed samples
or archival specimens.
The diagnosis can be reliably made from brain samples taken after death. The diagnosis can also be made from saliva, urine, and cerebrospinal fluid samples, but this is not as
sensitive or reliable as brain samples.
Cerebral inclusion bodies called
Negri bodies
Negri bodies are eosinophilic, sharply outlined, pathognomonic inclusion bodies (2–10 μm in diameter) found in the cytoplasm of certain nerve cells containing the virus of rabies, especially in pyramidal cells within Ammon's horn of t ...
are 100% diagnostic for rabies infection but are found in only about 80% of cases.
If possible, the animal from which the bite was received should also be examined for rabies.
Some
light microscopy
Microscopy is the technical field of using microscopes to view subjects too small to be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of microscopy: optical, el ...
techniques may also be used to diagnose rabies at a tenth of the cost of traditional fluorescence microscopy techniques, allowing identification of the disease in less-developed countries. A test for rabies, known as LN34, is easier to run on a dead animal's brain and might help determine who does and does not need post-exposure prevention.
The test was developed by the
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
(CDC) in 2018.
The
differential diagnosis
In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...
in a case of suspected human rabies may initially include any cause of
encephalitis
Encephalitis is inflammation of the Human brain, brain. The severity can be variable with symptoms including reduction or alteration in consciousness, aphasia, headache, fever, confusion, a stiff neck, and vomiting. Complications may include se ...
, in particular infection with viruses such as
herpesviruses,
enterovirus
''Enterovirus'' is a genus of positive-sense single-stranded RNA viruses associated with several human and mammalian diseases. Enteroviruses are named by their transmission-route through the intestine ('enteric' meaning intestinal).
Serologic ...
es, and
arboviruses
Arbovirus is an informal name for any virus that is transmitted by arthropod vectors. The term ''arbovirus'' is a portmanteau word (''ar''thropod-''bo''rne ''virus''). ''Tibovirus'' (''ti''ck-''bo''rne ''virus'') is sometimes used to more spe ...
such as
West Nile virus
West Nile virus (WNV) is a single-stranded RNA virus that causes West Nile fever. It is a member of the family ''Flaviviridae'', from the genus ''Flavivirus'', which also contains the Zika virus, dengue virus, and yellow fever virus. The virus ...
. The most important viruses to rule out are
herpes simplex virus
Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) are two members of the Herpesviridae#Human herpesvirus types, human ''Herpesviridae'' family, a set of viruses that produce Viral disease, viral infections in the majority of humans. Both HSV-1 a ...
type one,
varicella zoster virus
Varicella zoster virus (VZV), also known as human herpesvirus 3 (HHV-3, HHV3), is one of nine known herpes viruses that can infect humans. It causes chickenpox (varicella) commonly affecting children and young adults, and shingles (herpes zos ...
, and (less commonly) enteroviruses, including
coxsackievirus
Coxsackieviruses are a few related enteroviruses that belong to the ''Picornaviridae'' family of viral envelope, nonenveloped, linear, positive-sense single-stranded RNA viruses, as well as its genus ''Enterovirus'', which also includes poliovi ...
es,
echovirus
Echovirus is a polyphyletic group of viruses associated with enteric disease in humans. The name is derived from "enteric cytopathic human orphan virus". These viruses were originally not associated with disease, but many have since been identifi ...
es,
poliovirus
Poliovirus, the causative agent of polio (also known as poliomyelitis), is a serotype of the species '' Enterovirus C'', in the family of '' Picornaviridae''. There are three poliovirus serotypes, numbered 1, 2, and 3.
Poliovirus is composed ...
es, and human enteroviruses 68 to 71.
New causes of viral encephalitis are also possible, as was evidenced by the 1999 outbreak in Malaysia of 300 cases of encephalitis with a mortality rate of 40% caused by
Nipah virus
Nipah virus (''Henipavirus nipahense'') is a bat-borne, Zoonosis, zoonotic virus that causes Nipah virus infection in humans and other animals, a disease with a very high mortality rate (40-75%). Numerous disease outbreaks caused by Nipah virus ...
, a newly recognized
paramyxovirus.
Likewise, well-known viruses may be introduced into new locales, as is illustrated by the outbreak of encephalitis due to West Nile virus in the eastern United States.
Prevention
Almost all human exposure to rabies was fatal until a vaccine was developed in 1885 by
Louis Pasteur
Louis Pasteur (, ; 27 December 1822 – 28 September 1895) was a French chemist, pharmacist, and microbiologist renowned for his discoveries of the principles of vaccination, Fermentation, microbial fermentation, and pasteurization, the la ...
and
Émile Roux
Pierre Paul Émile Roux FRS (; 17 December 18533 November 1933) was a French physician, bacteriologist and immunologist. Roux was one of the closest collaborators of Louis Pasteur (1822–1895), a co-founder of the Pasteur Institute, and respo ...
. Their original vaccine was harvested from infected rabbits, from which the virus in the nerve tissue was weakened by allowing it to dry for five to ten days. Similar nerve tissue-derived vaccines are still used in some countries, as they are much cheaper than modern cell culture vaccines.
The human diploid cell rabies vaccine was started in 1967. Less expensive purified chicken embryo cell vaccine and purified
vero cell
Vero cells are a lineage of cells used in cell cultures. The 'Vero' lineage was isolated from kidney epithelial cells extracted from an African green monkey ('' Chlorocebus'' sp.; formerly called ''Cercopithecus aethiops'', this group of monk ...
rabies vaccine are now available.
A
recombinant vaccine Recombinant may refer to:
* Recombinant organism – an organism that contains a different combination of alleles from either of its parents.
* Recombinant DNA – a form of artificial DNA sequence
* Recombinant protein - artificially produced (and ...
called V-RG has been used in Belgium, France, Germany, and the United States to prevent outbreaks of rabies in undomesticated animals.
Immunization before exposure has been used in both human and nonhuman populations, where, as in many jurisdictions, domesticated animals are required to be vaccinated.

The Missouri Department of Health and Senior Services Communicable Disease Surveillance 2007 Annual Report states the following can help reduce the risk of contracting rabies:
* Vaccinating dogs, cats, and ferrets against rabies
* Keeping pets under supervision
* Not handling wild animals or strays
* Contacting an animal control officer upon observing a wild animal or a stray, especially if the animal is acting strangely
* If bitten by an animal, washing the wound with soap and water for 10 to 15 minutes and contacting a healthcare provider to determine if post-exposure prophylaxis is required
28 September is
World Rabies Day, which promotes the information, prevention, and elimination of the disease.
In Asia and in parts of the Americas and Africa, dogs remain the principal host. Mandatory vaccination of animals is less effective in rural areas. Especially in developing countries, pets may not be privately kept and their destruction may be unacceptable. Oral vaccines can be safely distributed in baits, a practice that has successfully reduced rabies in rural areas of
Canada
Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
,
France
France, officially the French Republic, is a country located primarily in Western Europe. Overseas France, Its overseas regions and territories include French Guiana in South America, Saint Pierre and Miquelon in the Atlantic Ocean#North Atlan ...
, and the
United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
. In
Montreal
Montreal is the List of towns in Quebec, largest city in the Provinces and territories of Canada, province of Quebec, the List of the largest municipalities in Canada by population, second-largest in Canada, and the List of North American cit ...
, Quebec, Canada, baits are successfully used on raccoons in the Mount-Royal Park area. Vaccination campaigns may be expensive, but cost-benefit analysis suggests baits may be a cost-effective method of control. In
Ontario
Ontario is the southernmost Provinces and territories of Canada, province of Canada. Located in Central Canada, Ontario is the Population of Canada by province and territory, country's most populous province. As of the 2021 Canadian census, it ...
, a dramatic drop in rabies was recorded when an aerial bait-vaccination campaign was launched.
The number of recorded human deaths from rabies in the United States has dropped from 100 or more annually in the early 20th century to one or two per year because of widespread vaccination of domestic dogs and cats and the development of human vaccines and immunoglobulin treatments. Most deaths now result from bat bites, which may go unnoticed by the victim and hence untreated.
Treatment
After exposure
Treatment after exposure can prevent the disease if given within 10 days. The rabies vaccine is 100% effective if given before symptoms of rabies appear.
Every year, more than 15 million people get vaccinated after potential exposure. While this works well, the cost is significant. In the US it is recommended people receive one dose of human rabies immunoglobulin
An antibody (Ab) or immunoglobulin (Ig) is a large, Y-shaped protein belonging to the immunoglobulin superfamily which is used by the immune system to identify and neutralize antigens such as pathogenic bacteria, bacteria and viruses, includin ...
(HRIG) and four doses of rabies vaccine over a 14-day period. HRIG is expensive and makes up most of the cost of post-exposure treatment, ranging as high as several thousand dollars. In the UK, one dose of HRIG costs the National Health Service £1,000, although this is not flagged as a "high-cost medication". A full course of vaccine costs £120–180. As much as possible of HRIG should be injected around the bites, with the remainder being given by deep intramuscular injection at a site distant from the vaccination site.
People who have previously been vaccinated against rabies do not need to receive the immunoglobulin—only the postexposure vaccinations on days 0 and 3. The side effects of modern cell-based vaccines are similar to the side effects of flu shots. The old nerve-tissue-based vaccination required multiple injections into the abdomen with a large needle but is inexpensive. It is being phased out and replaced by affordable World Health Organization intradermal-vaccination regimens. In children less than a year old, the lateral thigh is recommended.
Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is effective in reducing the number of viral particles. Povidone-iodine
Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may ...
or alcohol is then recommended to reduce the virus further.
Awakening to find a bat in the room, or finding a bat in the room of a previously unattended child or mentally disabled or intoxicated person, is an indication for post-exposure prophylaxis
Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.
It should be contrasted with pre-exposure prophy ...
(PEP). The recommendation for the precautionary use of PEP in bat encounters where no contact is recognized has been questioned in the medical literature, based on a cost–benefit analysis
Cost–benefit analysis (CBA), sometimes also called benefit–cost analysis, is a systematic approach to estimating the strengths and weaknesses of alternatives. It is used to determine options which provide the best approach to achieving benefits ...
. However, a 2002 study has supported the protocol of precautionary administration of PEP where a child or mentally compromised individual has been alone with a bat, especially in sleep areas, where a bite or exposure may occur with the victim being unaware.
Despite common misconception, the rabies vaccine in many countries is no longer given as a series of painful injections into the abdomen
The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...
. Rather, it is given as a series of intramuscular injections
Intramuscular injection, often abbreviated IM, is the medical injection, injection of a substance into a muscle. In medicine, it is one of several methods for parenteral, parenteral administration of medications. Intramuscular injection may be ...
into the upper arm. Fears about the pain of post-exposure prophylaxis are especially dangerous as they may prevent those who have been exposed to rabies from seeking medical attention in a timely fashion.
After onset
Once rabies develops, death almost certainly follows. Palliative care
Palliative care (from Latin root "to cloak") is an interdisciplinary medical care-giving approach aimed at optimizing quality of life and mitigating or reducing suffering among people with serious, complex, and often terminal illnesses. Man ...
in a hospital setting is recommended with administration of large doses of pain medication, and sedatives in preference to physical restraint. Ice fragments can be given by mouth for thirst, but there is no good evidence intravenous hydration is of benefit.
A treatment known as the Milwaukee protocol, which involves putting people with rabies symptoms into a chemically induced coma and using antiviral medication
Antiviral drugs are a class of medication used for treating viral infections. Most antivirals target specific viruses, while a broad-spectrum antiviral is effective against a wide range of viruses. Antiviral drugs are a class of antimicrobial ...
s in an attempt to protect their brain until their body has had time to produce rabies antibodies, has been occasionally used. It was initially attempted in 2004 on Jeanna Giese, a teenage girl from Wisconsin
Wisconsin ( ) is a U.S. state, state in the Great Lakes region, Great Lakes region of the Upper Midwest of the United States. It borders Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake Michigan to the east, Michig ...
, who subsequently became the first human known to have survived rabies without receiving post-exposure prophylaxis before symptom onset. Giese did require extensive rehabilitation afterward, and her balance and neural function remained impaired. The protocol has been enacted on many rabies victims since, but has been adjudged a failure; some survivors of the acute initial phase later died of rabies. Concerns have also been raised about its monetary costs and its ethics.
Antiviral therapy to combat the effects of rabies has also been researched; favipiravir
Favipiravir, sold under the brand name Avigan among others, is an antiviral medication used to treat influenza in Japan. It is also being studied to treat a number of other viral infections, including SARS-CoV-2. Like the experimental antivira ...
, for example, has shown potential at inhibiting the development of encephalitis. It has been suggested that such therapy in combination with immunotherapy
Immunotherapy or biological therapy is the treatment of disease by activating or suppressing the immune system. Immunotherapies designed to elicit or amplify an immune response are classified as ''activation immunotherapies,'' while immunotherap ...
and neuroprotective measures could be beneficial.
Prognosis
Vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
after exposure, PEP, is highly successful in preventing rabies. In unvaccinated humans, rabies is almost certainly fatal after neurological
Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the s ...
symptoms have developed.
Epidemiology
In 2010, an estimated 26,000 people died from rabies, down from 54,000 in 1990. The majority of the deaths occurred in Asia and Africa. , India (approximately 20,847), followed by China (approximately 6,000) and the Democratic Republic of the Congo (5,600), had the most cases. A 2015 collaboration between the World Health Organization, World Organization of Animal Health (OIE), Food and Agriculture Organization of the United Nation (FAO), and Global Alliance for Rabies Control
The Global Alliance for Rabies Control (GARC) is a non-profit organization that aims to eliminate deaths from canine rabies by 2030. Rabies is a neglected disease of poverty, which is almost 100% fatal, but can also be prevented with available ...
has a goal of eliminating deaths from rabies by 2030.
India
India
India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...
has the highest rate of human rabies in the world, primarily because of stray dogs, whose number has greatly increased since a 2001 law forbade the killing of dogs. Effective control and treatment of rabies in India is hindered by a form of mass hysteria
Mass psychogenic illness (MPI), also called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria or mass hysteria, involves the spread of illness symptoms through a population where there is no infectious agent responsible for c ...
known as puppy pregnancy syndrome (PPS). Dog bite victims with PPS, male as well as female, become convinced that puppies are growing inside them, and often seek help from faith healer
Faith healing is the practice of prayer and gestures (such as laying on of hands) that are believed by some to elicit divine intervention in spiritual and physical healing, especially the Christian practice. Believers assert that the healing ...
s rather than medical services. An estimated 20,000 people die every year from rabies in India, more than a third of the global total.
Australia
Australia has an official rabies-free status, although Australian bat lyssavirus
Australian bat lyssavirus (ABLV) is a enzootic virus closely related to the rabies virus. It was first identified in a 5-month-old juvenile black flying fox (''Pteropus alecto'') collected near Ballina, New South Wales, Ballina in northern New ...
(ABLV), discovered in 1996, is a rabies-causing virus related to the rabies virus
Rabies virus (''Lyssavirus rabies'') is a neurotropic virus that causes rabies in animals, including humans. It can cause violence, hydrophobia, and fever. Rabies transmission can also occur through the saliva of animals and less commonly throu ...
prevalent in Australian native bat populations.
United States
Canine-specific rabies has been eradicated in the United States, but rabies is common among wild animals, and an average of 100 dogs become infected from other wildlife each year.
High public awareness of the virus, efforts at vaccination of domestic animals and curtailment of feral populations, and availability of postexposure prophylaxis have made rabies very rare in humans in the United States. From 1960 to 2018, a total of 125 such cases were reported in the United States; of them, 36 (28%) were attributed to dog bites suffered during international travel.[ Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats.] The most recent rabies death in the United States was in November 2021, where a Texas child was bitten by a bat in late August 2021 but his parents failed to get him treatment. He died less than three months later.
Europe
Either no or very few cases of rabies are reported each year in Europe; cases are contracted both during travel and in Europe.
In Switzerland the disease was virtually eliminated after scientists placed chicken heads laced with live attenuated vaccine
An attenuated vaccine (or a live attenuated vaccine, LAV) is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable (or "live"). Attenuation takes an infectious agent and alters it so that it becomes harmless or le ...
in the Swiss Alps
The Alps, Alpine region of Switzerland, conventionally referred to as the Swiss Alps, represents a major natural feature of the country and is, along with the Swiss Plateau and the Swiss portion of the Jura Mountains, one of its three main Physica ...
. Foxes, proven to be the main source of rabies in the country, ate the chicken heads and became immunized.
Italy, after being declared rabies-free from 1997 to 2008, has witnessed a reemergence of the disease in wild animals in the Triveneto
The Triveneto () or (; ; ; ), also often referred to as North-Eastern Italy or simply North-EastNot to be misunderstood with the statistical region Northeast Italy, which includes Emilia-Romagna, too. ( or ), is a historical region of Italy. The ...
regions (Trentino-Alto Adige/Südtirol
Trentino-Alto Adige/Südtirol ( ; ; ), often known in English as Trentino-South Tyrol or by its shorter Italian name Trentino-Alto Adige, is an Regions of Italy#Autonomous regions with special statute, autonomous region of Italy, located in the ...
, Veneto
Veneto, officially the Region of Veneto, is one of the 20 regions of Italy, located in the Northeast Italy, north-east of the country. It is the fourth most populous region in Italy, with a population of 4,851,851 as of 2025. Venice is t ...
and Friuli-Venezia Giulia
Friuli-Venezia Giulia () is one of the 20 regions of Italy and one of five autonomous regions with special statute. The regional capital is Trieste on the Gulf of Trieste, a bay of the Adriatic Sea.
Friuli-Venezia Giulia has an area of and a ...
) due to the spreading of an epidemic in the Balkans
The Balkans ( , ), corresponding partially with the Balkan Peninsula, is a geographical area in southeastern Europe with various geographical and historical definitions. The region takes its name from the Balkan Mountains that stretch throug ...
that also affected Austria. An extensive wild animal vaccination campaign eliminated the virus from Italy again, and it regained the rabies-free country status in 2013, the last reported case of rabies being reported in a red fox in early 2011.
The United Kingdom has been free of rabies since the early 20th century except for a rabies-like virus (EBLV-2) in a few Daubenton's bat
Daubenton's bat or Daubenton's myotis (''Myotis daubentonii'') is a Eurasian bat with rather short ears. It occurs across Eurasia, from Ireland in the west to Hokkaido in the east, and is believed to be increasing its numbers in many areas of it ...
s. There has been one fatal case of EBLV-2 transmission to a human. There have been four deaths from rabies, transmitted abroad by dog bites, since 2000. The last infection in the UK occurred in 1922, and the last death from indigenous rabies was in 1902.
Sweden and mainland Norway have been free of rabies since 1886. Bat rabies antibodies (but not the virus) have been found in bats. On Svalbard, animals can cross the arctic ice from Greenland or Russia.
Mexico
Mexico was certified by the World Health Organization
The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
as being free of dog-transmitted rabies in 2019 because no case of dog-human transmission had been recorded in two years.
Asian countries
Despite rabies being preventable and the many successes of the years from countries such as North America, South Korea and Western Europe, Rabies remains endemic in many Southeast Asian countries including Cambodia
Cambodia, officially the Kingdom of Cambodia, is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. It is bordered by Thailand to the northwest, Laos to the north, and Vietnam to the east, and has a coastline ...
, Bangladesh
Bangladesh, officially the People's Republic of Bangladesh, is a country in South Asia. It is the List of countries and dependencies by population, eighth-most populous country in the world and among the List of countries and dependencies by ...
, Bhutan
Bhutan, officially the Kingdom of Bhutan, is a landlocked country in South Asia, in the Eastern Himalayas between China to the north and northwest and India to the south and southeast. With a population of over 727,145 and a territory of , ...
, North Korea
North Korea, officially the Democratic People's Republic of Korea (DPRK), is a country in East Asia. It constitutes the northern half of the Korea, Korean Peninsula and borders China and Russia to the north at the Yalu River, Yalu (Amnok) an ...
, India
India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...
, Indonesia
Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania, between the Indian Ocean, Indian and Pacific Ocean, Pacific oceans. Comprising over List of islands of Indonesia, 17,000 islands, including Sumatra, ...
, Myanmar
Myanmar, officially the Republic of the Union of Myanmar; and also referred to as Burma (the official English name until 1989), is a country in northwest Southeast Asia. It is the largest country by area in Mainland Southeast Asia and has ...
, Nepal
Nepal, officially the Federal Democratic Republic of Nepal, is a landlocked country in South Asia. It is mainly situated in the Himalayas, but also includes parts of the Indo-Gangetic Plain. It borders the Tibet Autonomous Region of China Ch ...
, Sri Lanka
Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka, also known historically as Ceylon, is an island country in South Asia. It lies in the Indian Ocean, southwest of the Bay of Bengal, separated from the Indian subcontinent, ...
, and Thailand
Thailand, officially the Kingdom of Thailand and historically known as Siam (the official name until 1939), is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. With a population of almost 66 million, it spa ...
. Half the global rabies deaths occur in southeast Asia, approximately 26,000 per year.
Much of what prevents Asia from implementing the same measures as other countries is cost
Cost is the value of money that has been used up to produce something or deliver a service, and hence is not available for use anymore. In business, the cost may be one of acquisition, in which case the amount of money expended to acquire it i ...
. Treating wild canines is the primary means of preventing rabies; however, it costs 10 times more than treating individuals as they come with bites, and research also increases cost. As a result, India and other surrounding countries are unable to apply many preventative measures because of financial restrictions.
Thailand
In 2013 human rabies was nearly eradicated in the state of Thailand after new measures were put into place requiring the vaccination of all domestic dogs as well as programs seeking to vaccinate wild dogs and large animals. However, neighboring countries unable to afford rabies control measures – Cambodia, Laos, and Myanmar
Myanmar, officially the Republic of the Union of Myanmar; and also referred to as Burma (the official English name until 1989), is a country in northwest Southeast Asia. It is the largest country by area in Mainland Southeast Asia and has ...
– allowed infected animals to continue to pass the border and infect the Thai population, leading to ~100 cases a year. These areas around the border are called Rabies Red areas and are where Thailand continuously struggles with eradication and will do so until the surrounding countries eliminate the virus.[
Thailand has the resources and medicine necessary to tackle rabies such as implementing regulations that require all children to receive a rabies vaccination before attending schools and having clinics available for those bit or scratched by a possible rabid animal. However, individual choice is still a factor, and 10 people per year die out of refusal to seek treatment.
]
Cambodia
Cambodia has approximately 800 cases of human rabies per year, making it one of the top countries in human rabies incidences. Much of this falls on their lack of animal care; Cambodia has hundreds of thousands of animals infected with rabies, another global high, yet little surveillance of said animals and few laws requiring pets and other household animals to be vaccinated.[ In recent years ]Cambodia
Cambodia, officially the Kingdom of Cambodia, is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. It is bordered by Thailand to the northwest, Laos to the north, and Vietnam to the east, and has a coastline ...
has improved significantly in their human rabies medical practices, with clinics all over the countries being made with treatments and vaccination on hand as well as rabies-related education in school classes. However, it is still lacking in terms of animal surveillance and treatment which leads to bleeding into surrounding countries.[
]
History
Rabies has been known since around 2000 BC. The first written record of rabies is in the Mesopotamia
Mesopotamia is a historical region of West Asia situated within the Tigris–Euphrates river system, in the northern part of the Fertile Crescent. Today, Mesopotamia is known as present-day Iraq and forms the eastern geographic boundary of ...
n Codex of Eshnunna (), which dictates that the owner of a dog showing symptoms of rabies should take preventive measures against bites. If another person were bitten by a rabid dog and later died, the owner was heavily fined.
In ancient Greece, rabies was believed to be caused by Lyssa
Lyssa ( ; ), also called Lytta (; ) by the Athenians, is a minor goddess in Greek mythology, the spirit of rage, fury, and rabies in animals. She was closely related to the Maniae, the spirits of madness and insanity. Her Roman equivalent was ...
, the spirit of mad rage.
Ineffective folk remedies abounded in the medical literature of the ancient world. The physician Scribonius Largus
Scribonius Largus Designatianus ( – ) was the court physician to the Roman emperor Claudius.
Around 47 AD, at the request of Gaius Julius Callistus, the emperor's freedman, he drew up a list of 271 prescriptions (''Compositiones''), most o ...
prescribed a poultice of cloth and hyena skin; Antaeus
Antaeus (; , derived from ), known to the Berbers as Anti, was a figure in Traditional Berber religion, Berber and Greek mythology. He was famed for his defeat by Heracles as part of the Labours of Hercules.
Family
In Greek sources, he was ...
recommended a preparation made from the skull of a hanged man.
Rabies appears to have originated in the Old World, the first epizootic
In epizoology, an epizootic (or epizoötic, from Greek: ''epi-'' "upon" + ''zoon'' "animal") is a disease event in a nonhuman animal population analogous to an epidemic in humans. An epizootic disease (or ) may occur in a specific locale (an ...
in the New World occurring in Boston in 1768.
Rabies was considered a scourge for its prevalence in the 19th century. In France and Belgium, where Saint Hubert
In Christian belief, a saint is a person who is recognized as having an exceptional degree of holiness, likeness, or closeness to God. However, the use of the term ''saint'' depends on the context and denomination. In Anglican, Oriental Ortho ...
was venerated, the "St Hubert's Key
St. Hubert’s Key (, ) is a sacramental object, typically in the form of a metal nail, cross, or cone. It was primarily used in Western Europe until the early 20th century as a traditional cure for rabies. The key is named after St. Hubert, the ...
" was heated and applied to cauterize the wound. By an application of magical thinking
Magical thinking, or superstitious thinking, is the belief that unrelated events are causally connected despite the absence of any plausible causal link between them, particularly as a result of supernatural effects. Examples include the idea tha ...
, dogs were branded with the key in hopes of protecting them from rabies.
It was not uncommon for a person bitten by a dog merely suspected of being rabid to commit suicide or to be killed by others.
In ancient times the attachment of the tongue (the lingual frenulum
The frenulum (or frenum) of the tongue, tongue web, lingual frenulum, frenulum linguae, or fraenulum is a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the human tongue.
Development
The ton ...
, a mucous membrane) was cut and removed, as this was where rabies was thought to originate. This practice ceased with the discovery of the actual cause of rabies. Louis Pasteur's 1885 nerve tissue vaccine was successful, and was progressively improved to reduce often severe side-effects.[
In modern times, the fear of rabies has not diminished, and the disease and its symptoms, particularly agitation, have served as an inspiration for several works of ]zombie
A zombie (Haitian French: ; ; Kikongo: ''zumbi'') is a mythological undead corporeal revenant created through the reanimation of a corpse. In modern popular culture, zombies appear in horror genre works. The term comes from Haitian folkl ...
or similarly themed fiction, often portraying rabies as having mutated into a stronger virus which fills humans with murderous rage or incurable illness, bringing about a devastating, widespread pandemic.
File:Cantigas de Santa Maria-275-5.jpg, Miniature of the ''Cantiga'' #275 depicting two monks hospitaller with rabies being carried before St. Mary of Terena
File:Middle Ages rabid dog.jpg, A woodcut
Woodcut is a relief printing technique in printmaking. An artist carves an image into the surface of a block of wood—typically with gouges—leaving the printing parts level with the surface while removing the non-printing parts. Areas that ...
from the Middle Ages
In the history of Europe, the Middle Ages or medieval period lasted approximately from the 5th to the late 15th centuries, similarly to the post-classical period of global history. It began with the fall of the Western Roman Empire and ...
showing a rabid dog
File:Sauvages de la Croix, François Boissier de – Dissertation sur la nature et la cause de la Rage, 1777 – BEIC 3001126.jpg, François Boissier de Sauvages de Lacroix
François () is a French masculine given name and surname, equivalent to the English name Francis.
People with the given name
* François Amoudruz (1926–2020), French resistance fighter
* François-Marie Arouet (better known as Voltaire ...
, ''Della natura e causa della rabbia'' (''Dissertation sur la nature et la cause de la Rage''), 1777
File:Medieval rabies folio.jpg, alt=An ancient folio from the medieval times depicting a rabid dog biting a man. circa 1224, An Arabic folio
The term "folio" () has three interconnected but distinct meanings in the world of books and printing: first, it is a term for a common method of arranging Paper size, sheets of paper into book form, folding the sheet only once, and a term for ...
from the medieval
In the history of Europe, the Middle Ages or medieval period lasted approximately from the 5th to the late 15th centuries, similarly to the post-classical period of World history (field), global history. It began with the fall of the West ...
times depicting a rabid dog
The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the gray wolf. Also called the domestic dog, it was selectively bred from a population of wolves during the Late Pleistocene by hunter-gatherers. ...
biting a man, c. 1224
Year 1224 ( MCCXXIV) was a leap year starting on Monday of the Julian calendar.
Events
January – March
* January 14 – Emperor Xuan Zong of the Chinese Jurchen-led Jin dynasty dies after a 10-year reign. He is succeeded by his 25-ye ...
Other animals
Rabies is infectious to mammal
A mammal () is a vertebrate animal of the Class (biology), class Mammalia (). Mammals are characterised by the presence of milk-producing mammary glands for feeding their young, a broad neocortex region of the brain, fur or hair, and three ...
s; three stages of central nervous system infection are recognized. The clinical course is often shorter in animals than in humans, but result in similar symptoms and almost always death. The first stage is a one- to three-day period characterized by behavioral changes and is known as the prodromal stage. The second is the excitative stage, which lasts three to four days. This stage is often known as "furious rabies" for the tendency of the affected animal to be hyper-reactive to external stimuli and bite or attack anything near. In some cases, animals skip the excitative stage and develop paralysis, as in the third phase; the paralytic phase. This stage develops by damage to motor neuron
A motor neuron (or motoneuron), also known as efferent neuron is a neuron whose cell body is located in the motor cortex, brainstem or the spinal cord, and whose axon (fiber) projects to the spinal cord or outside of the spinal cord to directly o ...
s. Incoordination is seen, owing to rear limb paralysis
Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...
, and drooling and difficulty swallowing is caused by paralysis of facial and throat muscles. Death is usually caused by respiratory arrest
Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long period ...
.
See also
* Dog meat
Dog meat, also known as fragrant meat or simply fragrant, is the meat derived from dogs. Historically human consumption of dog meat has been recorded in many parts of the world.
In the 21st century, dog meat is consumed to a limited extent in ...
* Dog meat consumption in Nigeria
Dog meat is consumed in Nigeria, particularly in the southern parts of the country. It is embedded in local cultures and traditions. The practice has drawn attention for its implications on public health, particularly in relation to rabies transmi ...
* Dog meat consumption in South Korea
The dog meat industry is currently heavily restricted and soon to be illegal in South Korea. On January 9, 2024, the National Assembly (South Korea), National Assembly of South Korea unanimously passed a law banning the production and sale of dog ...
* Dog meat consumption in Vietnam
Dog meat consumption is common and legal in Vietnam.
According to the Four Paws February 2020 report on the dog and cat meat trade in Southeast Asian countries, roughly 5 million dogs are killed for their meat each year in Vietnam. Although the ...
* Dog meat festival
The Dog Meat Festival (), also known as the Yulin Dog Meat Festival or Lychee and Dog Meat Festival, is an annual festival held in Yulin, Guangxi, China, during the summer solstice from 21 June to 30 June in which festival observers consume dog ...
* Eradication of infectious diseases
The Extinction, eradication of infectious diseases is the reduction of the prevalence of an Infection, infectious disease in the Earth, global Host (biology), host population to zero.
Two infectious diseases have successfully been eradicated ...
* Madstone (folklore)
* Rabies in Haiti
* Rabies in popular culture
References
Further reading
*Pankhurst, Richard. "The history and traditional treatment of rabies in Ethiopia." ''Medical History'' 14, no. 4 (1970): 378–389.
External links
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