Rabies is a fatal viral disease that affects the brain and spinal cord. It is transmitted by animals that are infected with rabies virus. The virus is present in their saliva and therefore bites, scratches and licks by these animals transmit the virus to humans causing the disease. There is no cure for rabies anywhere in the world and the victim almost always dies as the lungs(breathing) and heart cease to function.

The domestic and wild animals listed below are known to transmit rabies

  • Domestic animals: Dogs, cats, monkeys, horses, buffaloes, cows, camels, sheep, donkeys and pigs. In India, dogs and cats are the cause of rabies in 99% of cases. Drinking raw milk from rabid cow and buffalo is not proven to transmit rabies.
  • Wild animals: Mongoose, jackals, foxes and others.

Rodents, squirrels, rabbits, bats and birds are not known to transmit rabies in India.

The signs of rabies in animals are as follows:

  • Running aimlessly and attacking others without any provocation
  • Excessive salivation
  • Change in bark/voice
  • Refusal to feed or eating unusual objects like stone, paper, wood, metal, etc.
  • Becoming drowsy and withdraws to a corner
  • Any change in its normal behaviour suggesting undue aggression or depression

Yes, they can. Pets, even vaccinated ones can contract rabies and there are reports of rabies deaths after a bite from a pet dog. Animal rabies vaccines are not very reliable and so one should never take a risk following bite by even a vaccinated pet dog or cat.

One should never wait and watch as it may prove fatal. The victim should approach a doctor as soon as possible following an exposure.

Rabies may occur as early as 4 days after an exposure and at times even two years later. Therefore a delay in starting treatment should be avoided at all costs. In most cases, the period is 3 weeks to 3 months.

No. According to the World Health Organization (WHO, Geneva, Switzerland) there are 3 categories of rabies exposure called Category I, Category II and Category III and are described below

Category I (No risk)

  • Touching or feeding of animals
  • Licks on intact skin
  • Contact of intact skin with secretions or excretions of rabid animal or person

Category II (Moderate risk)

  • Nibbling of uncovered skin, minor scratches or abrasions without bleeding

Category III (High risk)

  • Any bite or scratch with ooze of blood
  • Licks onbroken skin and mucus membranes, exposure to wild animals or bats ( in some countries abroad )

Category I (no risk) exposures do not need any medical attention. All Category II and Category III exposures need immediate attention of a doctor. Importantly, bites or scratches or licks on broken skin on the head, face, neck, upper limbs, hands, genitalia and those by wild animals are considered as very high risk.

Rabies is practically 100% fatal and so one must immediately seek a doctor’s advice. The doctor will recommend anti-rabies treatment which is life saving. The treatment consists of 3 components, all of which are very important.

  1. Wound wash and care.
  2. Administration of Rabies Immunoglobulins (RIGs).
  3. Administration of rabies vaccine.

Delay in starting the treatment is very risky and may be fatal.

Wound wash removes saliva that gets deposited on the bite area and so helps wash off the virus and reduces the risk of rabies infection & death. Following an exposure one should follow the steps given below:

  • Wash and thoroughly flush all wounds under running water
  • Gently clean all wounds with a detergent or any soap
  • Apply any household antiseptic like Dettol, Savlon or povidone iodine (preferred).

One must

  • Not bandage or dress the wound or get stitches on it
  • Never apply any local applicants like turmeric, neem, red chilli, lime, plant juices, coffee powder, tea powder, coin, kerosene, diesel, etc. (they act as irritants and push the virus in the wound deeper that increases the risk)

After wound wash, the victim of Category III exposures (and Category II exposures in people with weak immune system) needs anti-rabies antibodies or rabies immunoglobulins against rabies for protection. They are special proteins produced by the body that are specifically active against the rabies virus. They neutralize or inactivate the virus and prevent it from causing the disease.

Vaccination against rabies induces the body to produce anti-rabies antibodies or rabies immunoglobulins.

Rabies Immunoglobulins are ready-made anti-rabies antibodies which provide immediate protection (also called passive immunity). Even with the best rabies vaccines, the body takes up to 14 days to produce an adequate level of anti-rabies antibodies for protection. As rabies can occur as early as 4 days after an exposure/bite, the victim is vulnerable, at risk of rabies and at this time only ready-made anti-rabies antibodies can protect the victim.

Failure to use RIGs is one of the reasons for rabies deaths despite the use of rabies vaccines. Due to regular and long periods of shortages, victims were deprived of the life-saving benefits of RIGs. This situation has been corrected with the recent launch of recombinant rabies antibodies.
However, RIGs must always be combined with rabies vaccines and must never be used alone.

Recombinant rabies antibodies or R-Mab (rabies monoclonal antibodies) are the safest, purest and most potent form of rabies antibodies. It is a novel product that was developed in the USA and has received an US patent. It is proven to inactivate all known rabies virus isolates in India. It is far superior to the other RIGs that are derived from human (HRIG, human RIG) or horse blood (ERIG, equine RIG). R-Mabs do not require any prior skin testing nor do they suffer from the potential risk of transmission of blood-borne pathogens or that of shortages. Moreover, the victims need a significantly lower dose than HRIG or ERIG.

Like RIGs, rabies vaccines are an equally important part of anti-rabies treatment. A full course of the vaccine provides an adequate level of protection beyond 14 days after an exposure and for a long period adequate to cover the incubation period.

All category II and III exposures need immediate anti-rabies vaccination.

As per the World Health Organization (WHO) there are two schedules of rabies vaccination depending on when it is taken, after an exposure (post-exposure) or before it (pre-exposure).
Post-Exposure (bite) regimen consists of 5 vaccine doses that are given on -

  • Day 0 (day of first dose of vaccine and may not be the day of bite, in some instances),
  • Day 3,
  • Day 7,
  • Day 14 and
  • Day 28

These injections are given in the deltoid/shoulder muscle (intramuscular) in older children and adults as a 0.5 ml/1 ml injection (depending on type of vaccine). In young children, it is given in the thigh. The vaccine should never be injected into the hip region /buttocks.

Only in government hospitals, the vaccination may be given into the skin by specially trained staff (intradermal route) in both the deltoid areas/shoulders as two 0.1 ml injections. The schedule is as follows –

  • Day 0 (day of first dose of vaccine and may not be day of bite, in some instances),
  • Day 3,
  • Day 7, and
  • Day 28

Pre-Exposure (before a bite) regimen consists of 3 vaccine doses, given on

  • Day 0 (day of first dose of vaccine)
  • Day 7 and
  • Day 21 or 28

Pre-exposure rabies vaccination is very useful for individuals at high risk such as veterinarians, children due to their playful nature, postal, door to door sales and courier staff, animal handlers, etc. The advantage of pre-exposure protection is that if an exposure occurs the body already has some protection which greatly reduces the risk. A doctor must be consulted to manage the wound and take the recommended two doses (instead of five doses (4 in Government Hospitals) otherwise) of the vaccine i.e. on days 0 and 3 to boost the antibody level against rabies. RIGs are not needed in these cases.