Rabies
An almost invariably fatal viral infection of the nervous system that is preventable when wound care and post-exposure prophylaxis begin before symptoms.
What causes Rabies?
Rabies is caused by lyssaviruses transmitted through saliva, usually by an infected animal bite. Scratches or saliva contact with broken skin or mucous membranes can also expose a person.
Symptoms and what to notice
Early fever, headache, weakness, or tingling at the bite site can progress to anxiety, confusion, agitation, difficulty swallowing, hydrophobia, paralysis, coma, and death.
How long can it last?
Incubation is commonly weeks to months but can vary. Once neurologic symptoms begin, disease usually progresses over days and is nearly always fatal. Prompt post-exposure prophylaxis before symptoms is highly effective.
How serious is Rabies?
Rabies is a medical emergency because symptomatic disease is almost always fatal. Bat exposures may be unnoticed, and all potential exposures need prompt risk assessment rather than waiting for symptoms.
Treatment and management
Immediately wash wounds thoroughly with soap and water and seek public-health-guided assessment. For an unvaccinated person, PEP includes human rabies immune globulin and vaccine on days 0, 3, 7, and 14; immunocompromised patients receive an additional day-28 dose. Previously vaccinated people receive vaccine on days 0 and 3 without HRIG.
Vaccine: who and when?
U.S. rabies vaccines are Imovax Rabies (HDCV) and RabAvert (PCECV). Risk-based pre-exposure prophylaxis uses a two-dose primary series on days 0 and 7 with titer or booster follow-up based on exposure category. These vaccines are also used in post-exposure prophylaxis.
Cost note: Patient cost varies by product, provider, insurance, location, and eligibility. Many recommended vaccines are covered in network without cost sharing, and qualifying children may use the Vaccines for Children program.
Trusted source
Patient cost varies by insurance, provider, location, and eligibility. Coverage and public-health access differ, so listed prices are examples rather than guaranteed patient prices. This page is for general education and does not replace individualized medical advice, diagnosis, vaccination assessment, or treatment.
Rabies: Symptoms, Causes, Treatment, Prevention, and Vaccine Information
Rabies is unique among infections because excellent prevention is available after exposure but before symptoms. The decision window is therefore critical. In the United States, bats are a leading source of human rabies, while dog rabies remains a major international threat. Public-health experts assess the animal species, local epidemiology, circumstances, and testing availability to decide whether PEP is needed.
Important: This page is for general education. It does not replace diagnosis, treatment, vaccination advice, or emergency care from a qualified healthcare professional.
Quick Facts
| Topic | Current information |
|---|---|
| Cause | Rabies is caused by lyssaviruses transmitted through saliva, usually by an infected animal bite. Scratches or saliva contact with broken skin or mucous membranes can also expose a person. |
| Main symptoms | Early fever, headache, weakness, or tingling at the bite site can progress to anxiety, confusion, agitation, difficulty swallowing, hydrophobia, paralysis, coma, and death. |
| Typical course | Incubation is commonly weeks to months but can vary. Once neurologic symptoms begin, disease usually progresses over days and is nearly always fatal. Prompt post-exposure prophylaxis before symptoms is highly effective. |
| Treatment | Immediately wash wounds thoroughly with soap and water and seek public-health-guided assessment. For an unvaccinated person, PEP includes human rabies immune globulin and vaccine on days 0, 3, 7, and 14; immunocompromised patients receive an additional day-28 dose. Previously vaccinated people receive vaccine on days 0 and 3 without HRIG. |
| Vaccine status | U.S. rabies vaccines are Imovax Rabies (HDCV) and RabAvert (PCECV). Risk-based pre-exposure prophylaxis uses a two-dose primary series on days 0 and 7 with titer or booster follow-up based on exposure category. These vaccines are also used in post-exposure prophylaxis. |
History and Public-Health Importance
Rabies has been feared since antiquity. Pasteur’s nineteenth-century vaccine proved that post-exposure vaccination could prevent disease. Modern purified vaccines and human immune globulin are much safer and highly effective. U.S. canine vaccination eliminated the dog-maintained rabies variant, but wildlife reservoirs persist, and travelers may be exposed to rabid dogs abroad.
What Causes Rabies?
Rabies is caused by lyssaviruses transmitted through saliva, usually by an infected animal bite. Scratches or saliva contact with broken skin or mucous membranes can also expose a person.
Virus in saliva enters through bites, scratches, or mucous membranes and travels through peripheral nerves toward the brain. Touching fur, blood, urine, or stool is not a rabies exposure. Bat bites can be tiny, so a bat in a room with a sleeping person, unattended child, or someone unable to report contact needs public-health assessment.
Symptoms and Typical Course
Early fever, headache, weakness, or tingling at the bite site can progress to anxiety, confusion, agitation, difficulty swallowing, hydrophobia, paralysis, coma, and death.
Prodromal symptoms are nonspecific, sometimes with pain or tingling at the wound. Encephalitic rabies causes agitation, hydrophobia, aerophobia, and fluctuating consciousness; paralytic rabies produces ascending weakness. Both progress to coma and death. The long, variable incubation means a person should still seek PEP after a delayed report if symptoms have not begun.
Complications and Who Is at Higher Risk
Rabies is a medical emergency because symptomatic disease is almost always fatal. Bat exposures may be unnoticed, and all potential exposures need prompt risk assessment rather than waiting for symptoms.
Once clinical disease develops, survival is extraordinarily rare and survivors often have severe neurologic disability. The preventable harm lies in missing or delaying an exposure assessment, giving HRIG incorrectly, injecting vaccine in the buttock, or failing to complete the schedule.
How It Is Diagnosed
There is no single adequate test in a living person. Public-health laboratories combine saliva, nuchal-skin biopsy, serum, and cerebrospinal-fluid testing when rabies is suspected. Animal testing can sometimes rule out risk. Diagnosis after symptoms does not replace preventive PEP decisions after exposure.
Treatment and Recovery
Immediately wash wounds thoroughly with soap and water and seek public-health-guided assessment. For an unvaccinated person, PEP includes human rabies immune globulin and vaccine on days 0, 3, 7, and 14; immunocompromised patients receive an additional day-28 dose. Previously vaccinated people receive vaccine on days 0 and 3 without HRIG.
Wash and irrigate all wounds immediately; virucidal antiseptic can add benefit. HRIG is infiltrated into and around wounds as anatomically feasible, with remainder given away from vaccine. Vaccine is injected in the deltoid or anterolateral thigh, never the gluteal area. PEP can be given during pregnancy when indicated. Symptomatic rabies care is intensive and supportive.
Vaccine Information
U.S. rabies vaccines are Imovax Rabies (HDCV) and RabAvert (PCECV). Risk-based pre-exposure prophylaxis uses a two-dose primary series on days 0 and 7 with titer or booster follow-up based on exposure category. These vaccines are also used in post-exposure prophylaxis.
Imovax Rabies is a human diploid-cell vaccine and RabAvert is a purified chick-embryo-cell vaccine. They are used interchangeably when necessary. The two-dose pre-exposure series does not eliminate the need for post-exposure vaccine but removes HRIG and shortens the schedule. People with sustained occupational risk need titers or boosters based on ACIP risk category.
Prevention
Vaccinate pets, avoid handling wildlife, secure homes against bats, supervise children around animals, obtain pre-exposure vaccination for qualifying work or travel, and seek immediate assessment after bites or suspicious bat contact. Do not release a potentially testable animal without public-health advice.
When to Seek Medical Care
Wash the area and contact a clinician or health department immediately after any bite from a wild mammal, an unfamiliar dog abroad, or possible bat contact. Do not wait for symptoms. Emergency evaluation is needed for severe wounds or illness.
Frequently Asked Questions
Is rabies curable after symptoms begin?
Almost never. Prevention with prompt wound care, HRIG when indicated, and vaccine must occur before symptoms.
Do previously vaccinated people need PEP?
Yes, but they receive two vaccine doses on days 0 and 3 and no HRIG.
Can a tiny bat bite matter?
Yes. Bat teeth can leave little evidence, so uncertain contact needs public-health risk assessment.
What vaccine products are available?
Imovax Rabies and RabAvert are the two licensed U.S. human rabies vaccines.
Key Takeaway
Rabies is nearly always fatal after symptoms but preventable after exposure. Immediate wound washing and expert-guided PEP must never be delayed while waiting to see what happens.
Medical, treatment, and vaccine information was reviewed against official U.S. public-health guidance available through September 2026.