Rabies is a severe neurological infection caused by the rabies virus, with a mortality rate close to 100%. The virus is primarily transmitted through the saliva of infected animals, with the most common transmission route being bites or scratches from these animals. Once the virus enters the human body, it travels along the nervous system to the brain, ultimately leading to encephalitis or meningitis, resulting in fatal consequences.
Approximately 59,000 people die from rabies globally each year, with the vast majority of cases occurring in Asia and Africa. Although rabies is almost untreatable once symptoms appear, timely post-exposure prophylaxis can effectively block the virus's infection. Therefore, understanding the transmission routes, symptoms, and preventive measures of rabies is crucial for public health.
The rabies virus (Rabies virus) belongs to the RNA virus family and primarily circulates among mammals such as dogs, cats, foxes, and bats. The virus is present in the saliva and nervous tissue of infected animals, and it enters the human body when bitten, scratched, or when saliva comes into contact with wounds or mucous membranes. After entering the body, the virus slowly moves along the nerve axons to the central nervous system; this process is known as the incubation period, which typically lasts from 1 to 3 months but can be as short as a few days or as long as several years.
Risk factors include:
The symptoms of rabies can be divided into three stages based on the progression of the disease:
This phase lasts 2 to 10 days, during which patients may experience flu-like symptoms such as fever, headache, and fatigue, and may have abnormal tingling or itching sensations at the site of the wound. Some patients may exhibit unusual sensitivity to light, sound, or wind.
Symptoms during this phase include:
In the final stage, patients fall into a coma, and paralysis of the respiratory muscles leads to respiratory failure, with nearly all cases resulting in death within 7 to 10 days. Currently, there is no effective treatment, so the mortality rate is close to 100% once symptoms appear.
Diagnosing rabies requires a comprehensive assessment of clinical manifestations, exposure history, and laboratory tests. Doctors will inquire in detail about the history of animal contact, including the type of animal, the location of the wound, and whether any abnormal behavior was observed in the animal. Laboratory diagnostic methods include:
In suspected cases, even in the absence of laboratory evidence, if the patient has a high-risk exposure history, the doctor will still initiate preventive treatment immediately, as waiting for diagnostic results may result in missing the treatment window.
High-risk groups (such as veterinarians and laboratory personnel) should receive rabies vaccinations. The vaccination schedule typically consists of three doses, and antibodies generated after vaccination can provide several years of protection. For those who have not been vaccinated, if exposed, immediate post-exposure treatment (PEP) should be initiated.
Post-exposure treatment consists of four key steps:
The core of rabies prevention lies in interrupting the virus transmission chain, with primary measures including:
In endemic areas, it is recommended that high-risk groups receive pre-exposure vaccines. Travel medicine centers suggest vaccination before traveling to high-risk areas to shorten the remedial procedures after exposure. New cell-culture vaccines (such as the PUR® vaccine) have simpler administration procedures and less pain at the injection site.
Seek immediate medical attention if:
Even if the wound appears minor (such as a light bite from a bat), it is essential to assess whether vaccination is necessary. The physician will evaluate the risk level based on WHO's "Four-Level Exposure Assessment System" and decide whether to implement complete post-exposure prophylaxis.
Timely medical intervention is the only effective prevention method. Delaying medical care significantly increases the risk of infection, as once the virus reaches the brain, it becomes untreatable. Even in resource-limited areas, immediate post-exposure treatment can still save lives.
Even if more than 24 hours have passed since the bite, it is still necessary to seek medical evaluation to determine whether vaccination is needed. The mortality rate of the rabies virus is nearly 100% once it enters the nervous system, but if vaccination and immunoglobulin are administered before symptoms appear, it may still effectively block infection. Therefore, regardless of how long it has been since the bite, it is crucial to go to the hospital as soon as possible to assess the risk level.
Can the rabies vaccine be administered simultaneously with other vaccines?In principle, the rabies vaccine can be administered simultaneously with other vaccines, but it is important to ensure that the injection sites are separate. If there are special health conditions (such as immunocompromised status) or if other specific vaccines (such as tetanus) are being administered, it is advisable to consult a physician beforehand to avoid potential immune interference or adverse reactions.
If scratched by a pet cat or dog that appears healthy, is treatment still necessary?Yes. Even if the animal appears healthy, if it has had contact with suspected rabid animals or unknown sources, it should still be considered high risk. It is recommended to immediately wash the wound thoroughly with soap and water for 15 minutes and seek medical attention as soon as possible. Domestic dogs and cats should be regularly vaccinated, but after an injury, they should still be observed for 10 days to confirm whether they are shedding the virus.
If fever or swelling occurs after receiving the rabies vaccine, should subsequent doses be stopped?Mild fever or redness at the injection site is a common side effect and usually does not require discontinuation of the vaccination. Antipyretics can be taken to relieve discomfort. However, if severe reactions such as anaphylactic shock or widespread rash occur, the vaccine should be stopped immediately, and medical attention should be sought. Completing the full vaccination series is necessary to ensure adequate protection, and one should not discontinue due to mild discomfort.
If I have previously received rabies vaccinations and am bitten again, do I still need to receive the full dosage?If you have previously completed the vaccination series, usually only 2 accelerated doses (on days 0 and 3) are needed after re-exposure, along with observation of the animal for rabies. However, in cases of high-risk exposure (such as bites to the head or in rabies-endemic areas), the physician may adjust the vaccination schedule based on the situation, and it is essential to follow professional advice.
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