Rabies is a serious, potentially fatal disease affecting mammals that is much more common in animals than people. In Thailand, the main carriers of rabies are dogs, cows and cats. People with frequent animal contact, such as veterinarians, are considered at high risk for contracting rabies and are vigilant about getting vaccinated to protect them from rabies.
 
Here are answers to the most common questions about the rabies virus, how to prevent becoming infected, and what you should know about rabies vaccination.
 
Q: How is rabies transmitted to people?
 
A: The disease is typically transmitted through the saliva of an animal infected with the rabies virus when a person is bitten or scratched by the animal. Dogs are responsible for about 90% of animal-to-human transmissions in Thailand, with occasional transmissions from monkeys and cats. Since saliva carries the rabies virus, it is possible to become infected by a rabid animal licking an area of broken skin, or if the saliva gets into a person’s eyes, mouth or nose. It is extremely rare for rabies to be passed from one person to another (“human-to-human”).
 
Q: How can rabies be prevented?
 
A: The two most effective forms of prevention are 1) avoiding infected animals and 2) vaccination. The rabies vaccine usually involves a series of 3 doses given over the span of 3 to 4 weeks. The vaccine is very reliable when administered correctly, i.e., when the complete series of doses is given according to the recommended schedule via intradermal or intramuscular injection. Experienced personnel can give the vaccine via the intradermal route.
 
Q: What are the symptoms of rabies?
 
A: The onset of symptoms typically occurs several days to several weeks after infection, but in rare cases, symptoms may first be seen up to one year after exposure to the virus. Initial symptoms include fever, fatigue and/or irritability, and as the infection progresses, symptoms may include seizures, hallucinations and paralysis. The prognosis is almost always fatal if left untreated until after the onset of first symptoms.
 
Q: What should be done after an animal bite?
 
A: First, clean the wound. Press gently on the wound to stimulate bleeding as a way to flush out any potential source of infection, wash with warm water and mild soap, then continue rinsing with water. Use a clean cloth to slow the bleeding, apply antibiotic cream, if available, to the wound and cover with a sterile bandage. Then seek urgent medical care, no matter whether you have been previously vaccinated against rabies, or not.
 
Q: What is the treatment for someone bitten by an infected animal?
 
A: The rabies vaccine is used in two ways: 1. It is given to a person who has a higher risk of coming into contact with an infected animal, to immunize them against rabies in case they are bitten by a rabid animal. 2. The vaccine is given to a person who has been bitten by an infected animal to prevent the virus from developing into rabies.
 
The protocol for a person exposed to the virus who has not previously been vaccinated against rabies calls for receiving 4 doses of the rabies vaccine over a 14-day period, as well as receiving 1 dose of rabies immunoglobulin to be given right after the first vaccine dose. When a person who has already been vaccinated against rabies is bitten by an infected animal, the standard protocol calls for receiving 2 more doses of the rabies vaccine to be given 3 days apart as soon as possible after being bitten, though rabies immunoglobulin is not necessary.
 
Treatment with the rabies vaccine is very effective when given during the post-bite rabies incubation period, before the onset of any symptoms.
 
Q: What is rabies immunoglobulin?
 
A: Rabies immunoglobulin is a medication containing rabies virus antibodies. It is usually given to a person who has been bitten by a rabies-infected animal but who has not previously received the rabies vaccine.
 
Rabies immunoglobulin acts by quickly giving the body antibodies that provide short-term protection against the rabies virus until the body is able to produce its own rabies antibodies. It is administered by injection in a single dose as soon as possible after the bite occurs, and just after the patient is given the first vaccine dose. If rabies immunoglobulin is not available on the first visit, its use can be delayed by up to 7 days from the date of the first vaccine dose. 
 
Q: What potential side effects might occur after rabies vaccination?
 
A: The most common side effects are mild in nature, resolve themselves within a few days, and typically involve soreness, swelling or itching at the injection site. Some people experience headache or nausea after getting vaccinated but the symptoms usually last only a few hours. About 1 in 20 vaccinations results in minor joint pain, fever or hives. In rare cases, side effects may include high fever, difficulty breathing or an elevated heart rate, requiring urgent medical attention.
 
Talk to Your Doctor
Despite its serious nature, rabies is highly preventable thanks to the effectiveness of the rabies vaccine. If you are considering vaccination but have questions or concerns, talk to your doctor and find out whether rabies vaccination is right for you.
 
By Dr. Ekachai Singhatiraj, a U.S. board certified specialist in Infectious Disease and Internal Medicine at Bumrungrad International Hospital