Rabies is a deadly viral infection that is spread through the saliva of infected animals. The saliva can enter the human body through a bite, a scratch or broken skin. The rabies virus travels from the wound to the brain, where it causes swelling and inflammation of the brain and spinal cord.

Rabies occurs in more than 150 countries on all continents except Antarctica. Globally, more than 55,000 people die of rabies yearly, with more than 95 percent of deaths in Asia and Africa. Infected dogs are the source of 99 percent of human rabies deaths worldwide, but in the United States, domestic animal control and vaccination programs have resulted in a low rate of human cases. The major source of rabies in this country is infected wildlife such as raccoons, skunks, foxes and bats; rabies among dogs is usually reported near the border with Mexico. More cats than dogs are reported rabid in this country; there are fewer cat vaccination laws, and cats are more likely than dogs to encounter rabid wildlife.

Infected bats are the source of most human deaths from rabies in the United States and Canada and have emerged as a threat in Australia, Latin America and Western Europe. Human deaths following exposure to infected foxes, raccoons, skunks, jackals, mongooses and other wildlife are rare.

Transmission of rabies can occur when infectious saliva of the animal comes in direct contact with human mucosa or fresh skin wounds. Human-to-human transmission by bite is possible but has never been confirmed. You are at a higher risk if you travel or live where rabies is more common and engage in activities that place you in contact with wild animals — exploring caves where bats live, hiking and biking, or camping without taking precautions to keep animals away from your campsite.

Symptoms of rabies in humans include fever, headache and fatigue followed by agitation, anxiety, confusion, difficulty swallowing, fear of water, excessive salivation, hallucinations and paralysis. Once symptoms begin, the disease is usually fatal. If you are bitten by an animal you suspect may be infected, go to the nearest emergency room or call the local emergency number (911 in the United States) to receive immediate medical care. If traveling abroad, ask your hotel concierge or the U.S. Embassy for referral for medical care. Post-exposure treatment can prevent rabies from developing but must begin as soon as possible.

Wound cleaning and immunization within a few hours after contact can prevent the onset of rabies and potential death. Thoroughly flush and wash the wound for 15 minutes with soap and water. Detergent or povidone iodine may kill the rabies virus.

If the animal that bit you is known to have rabies, you will receive a series of prophylactic shots. If the animal cannot be found, it may be safest to assume that it has rabies, depending on the type of animal and the situation in which the bite occurred. Other factors include the clinical symptoms of the animal and its availability for observation and testing. In developing countries, the vaccination status of the animal should not be considered when deciding to initiate prophylaxis.

As soon as possible, a fast-acting rabies immunoglobulin shot is given near the bite, followed by a series of rabies vaccine injections in your arm to help your body identify and fight the virus. You receive five injections over 14 days.

When traveling, avoid exposure to stray animals. Children are more likely to accidentally provoke animals and should be watched closely, especially around dogs, cats and monkeys. Because of their small stature, children are more likely to be bitten and are less likely to report an animal bite. About 40 percent of deaths from rabies occur in children under the age of 15.

A safe, effective pre-exposure rabies vaccine for humans exists and is recommended for travelers to high-risk areas in rabies-affected countries. The vaccine is also recommended for people in high-risk occupations such as laboratory workers dealing with the live rabies virus, veterinarians and animal handlers in rabies-affected areas. Ask your health care provider if you or your children should receive the vaccine. Before your trip, find out if your health insurance covers health care overseas and medical evacuation. If it does not, consider buying travel health insurance. Make sure all your vaccines, including tetanus, are current.

For up-to-date information on rabies by region and country, visit www.cdc.gov/travel.

Prevention Is the Best Medicine

Avoid contact with animals you do not know.
Get vaccinated if you work in a high-risk occupation.
Get vaccinated if you travel to countries with a high rate of rabies.
Immunize your pets. Dogs and cats should receive rabies vaccines by 4 months of age, a booster shot one year later and a booster every one to three years thereafter.
Follow quarantine regulations on importing dogs and other mammals in disease-free countries.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.