Rabies: an invisible deadly enemy

Rabies is an extremely dangerous viral disease that affects the brain and its membranes and is almost always fatal once the first symptoms appear. That is why action (post-exposure prophylaxis) must be taken BEFORE any signs of the disease develop. However, we have reliable ways to prevent the disease from developing even if the virus has already entered the body. The key is to act quickly and correctly.

How can you become infected?

Rabies infection occurs when infected saliva comes into contact with damaged skin (a bite or scratch) or mucous membranes (the eyes or mouth). Infection is also possible if particles of the brain or cerebrospinal fluid of an infected animal come into contact with a person.

Who can transmit rabies?

Wild carnivorous animals are natural reservoirs of rabies. In Ukraine, these are mainly foxes, wolves, and raccoon dogs.

It is important to remember that worldwide, almost 99% of human rabies cases are transmitted by domestic dogs. However, all mammals can become infected with rabies: not only domestic cats and dogs, but also farm animals such as horses, goats, cows, sheep, and others.

It is also important to remember that rodents, including rats and squirrels, as well as hedgehogs, can contract rabies.

Bats deserve special attention because they are considered particularly dangerous in terms of the risk of infection. Even if you cannot see a bite, but a bat has touched unprotected skin, or if you find a bat in a room where a person or child was sleeping, this is considered a potentially dangerous exposure and requires medical advice regarding prophylaxis.

As for birds, they can theoretically become infected, but this is very difficult (a chicken would first have to survive a fox bite). Secondly, it is extremely difficult for a bird to transmit rabies to a person because birds do not have salivary glands. Even if a rabid rooster pecks you, infection will not occur (unless, somehow, a particle of its brain gets onto your mucous membrane).

What happens in the body once the virus has entered?

At first, the virus multiplies at the site where it entered the body. Its “preferred” sites are muscles and nerves. Importantly, the virus multiplies several times faster in nerves than in muscles.

The virus then travels along the nerves at a rate of approximately 5–50 mm per day toward the spinal cord, more precisely, toward the nerve ganglia located nearby. Once the virus reaches these ganglia, it multiplies there again. After that, the virus rapidly travels toward the brain at a rate of 200–400 mm per day, where it causes inflammation that ultimately leads to death.

It may seem that this is quite a long journey. It is. And this is precisely what gives us a chance to prevent the disease if prophylaxis is started in time.

Incubation period

The incubation period is the time from when the virus enters the body until the symptoms of the disease begin. This is the period during which we can stop the virus.

On average, the incubation period in humans is 1–4 months. However, depending on various factors (for example, the location of the bite — the closer the wound is to the head or major nerve ganglia, the shorter the virus's route to the brain and the sooner the first clinical symptoms of rabies may appear), it can range from 5–7 days to one year or sometimes even longer.

It is important to remember that once the disease has become clinically apparent, specific treatment for rabies is no longer effective. Therefore, the only way to prevent death is immediate immunization after contact with a potential source of infection.

What should you do after a bite and how can you protect yourself?

First aid is critically important: immediately wash the wound, scratch, or area where saliva has come into contact with the skin thoroughly with running water and soap (preferably household soap) for 10–15 minutes. This is a simple but extremely effective step: water and soap physically wash away and damage the virus envelope before the virus has a chance to enter the nerve endings.

After that, seek medical attention immediately, because urgent vaccination and administration of rabies immunoglobulin (when indicated) are the only reliable methods of preventing rabies after a bite or scratch.

For general prevention, try to avoid contact with suspicious or wild animals, even if they appear friendly. Also make sure your pets are regularly vaccinated against rabies. In addition, pre-exposure vaccination is recommended for people at increased risk who have occupational contact with animals, such as veterinarians and forestry workers.

Remember: you are not alone!

Being bitten or simply encountering a suspicious animal can, of course, be extremely stressful. And it is completely normal to worry about yourself or your child. But there is no need to panic! Modern medicine knows exactly what to do and has everything necessary to protect you reliably. Forget the old myth about “40 injections in the stomach”: the modern course of post-exposure prophylaxis consists of only a few injections into the shoulder (or the thigh for young children), which are generally well tolerated.

The most important thing is to take a breath, thoroughly wash the wound, do not waste time, and seek medical attention at a trauma center or from a doctor as soon as possible.

Your quick and correct actions are the best protection. Take care of yourself!