Rabies: Symptoms and Treatment

Medically Reviewed by Zilpah Sheikh, MD on February 05, 2024
11 min read

Rabies is a virus that attacks the central nervous system. It's found only in mammals, which are warm-blooded animals with fur or hair (including humans).

Human cases of the virus are extremely rare in the United States, but if it's not treated before symptoms appear, it's deadly. Rabies has the highest mortality rate -- 99.9% -- of any disease on earth. The key is to get treated right away if you think you've been exposed to an animal that has rabies.

The rabies virus causes the rabies infection and can spread through saliva, often from an infected animal biting another animal or human.

The virus is found only in mammals. In the United States, rabies is mostly found in wild animals like coyotes, raccoons, skunks, bats, and foxes. Pets (such as dogs and cats) and livestock (like horses and cattle) can also get rabies. Most pets and livestock that get rabies were not vaccinated against it. In the U.S., dog owners are required to vaccinate their pets against rabies, but in other countries without that law, it's common for dogs to get rabies.

Normally, rabies is spread through a deep bite or scratch from an infected animal. Rabies is passed through direct contact with saliva, such as through a cut in the skin, or mucous membranes like the eyes, nose, or mouth. You could also get rabies from touching brain or nervous system tissue from an infected animal.

Human cases of the virus are very rare in the United States, but if it's not treated before symptoms appear, it's deadly. Most humans in this country who were infected with rabies got it from bats. People may not recognize a scratch or bite from a bat, because it can be very small. Exposure to rabid dogs outside the U.S. is the second leading cause of rabies deaths in Americans and the top cause in other countries. 

There are two forms of rabies:

Furious rabies 

Furious rabies is known for causing hyperactivity (being extremely excitable  or having overactive movement) and hallucinations (seeing, hearing, or sensing something that isn't there). Other symptoms include hydrophobia (fear of water) and sometimes aerophobia (fear of fresh air, or drafts). After a few days, furious rabies leads to death from cardiorespiratory arrest (when heart activity and breathing stops).

Paralytic rabies 

Paralytic rabies is known for causing paralysis (being unable to move) and coma (a deep state of unconsciousness). This form of rabies is found in 20% of human cases and is often misdiagnosed. Symptoms include muscle paralysis that starts at the location of the bite or scratch. People with paralytic rabies slowly become comatose and eventually die.

Typically, there are no symptoms right away. Rabies can lay dormant in your body for 1 to 3 months. Doctors call this the "incubation period." Symptoms will appear once the virus travels through your central nervous system and hits your brain.

The first sign that something is wrong is fever. You might feel generally tired or weak or have a headache or flu-like symptoms. You may have a cough or sore throat, muscle pain, nausea and vomiting, or diarrhea. You may also feel pain, tingling, or burning at the site of the wound. These symptoms may last for days. As the virus spreads through your central nervous system, you'll develop other, more severe symptoms. They include:

  • Inability to sleep (insomnia)
  • Anxiety
  • Confusion (which can affect your movement, thinking, emotions, and more)
  • Brain dysfunction
  • Slight or partial paralysis
  • Hyperactivity
  • Being easily agitated
  • Hallucinations
  • Seizures
  • Salivating more than usual
  • Difficulty swallowing
  • Abnormal behavior
  • Breathing fast (hyperventilation)
  • Racing heart
  • Muscle twitching
  • Different sized pupils
  • Neck stiffness (related to paralytic rabies)

In time, these symptoms give way to coma, heart or lung failure, and death.

Rabies hydrophobia

Hydrophobia is a symptom of furious rabies. It is a fear of water that can happen in the late stage of a rabies infection. People with hydrophobia have muscle spasms when they see, hear, or taste water.

Rabies travels from an infected wound to your brain over a period of time. There are several phases most people go through when exposed to the rabies virus: incubation, prodromal phase, acute neurologic phase, and coma. Once rabies is past the incubation phase, it cannot be treated.  If you think you've been exposed to an animal that has rabies, it is very important to get treated right away, before the virus moves to the prodromal phase.

Incubation. Incubation is the first phase after exposure to the rabies virus. The virus can spend days to weeks in your body before it moves to your nervous system. You won't have any symptoms during the incubation phase.

Prodromal phase. This phase starts when the rabies virus (RABV) enters your nervous system. The virus moves through your nerve cells into your brain and spinal cord and damages your nerves along the way. During this phase, your immune system will try to fight the virus, which causes flu-like symptoms. Nerve damage may cause tingling, pain, or numbness where you were bitten or scratched. The prodromal phase lasts 2-10 days. 

Acute neurologic phase. This phase is when the rabies virus begins to damage your brain and spinal cord. People with furious rabies will have symptoms like aggression, seizures, and delirium. People with paralytic rabies will have weakness and paralysis that moves from the bite wound to the rest of their body. Furious rabies lasts from a few days to a week. Paralytic rabies can last up to a month.

Coma. Coma is the final stage of a rabies infection for many people. Eventually, rabies leads to death.

There are no approved treatments for rabies once you have symptoms. However, there are steps you can take to prevent rabies if you've been bitten or scratched by a wild animal or had contact with an infected animal. 

If you think you may have been exposed to rabies, contact a health care professional right away. If you were bitten or scratched, clean your wound with soap and water. Your provider can give you further instructions on cleaning the wound. If you find a bat in a room where someone was sleeping or children were present, assume there was contact as well.

To prevent RABV from causing rabies, your provider will give you a series of vaccinations (shots). You'll also be given an antibody treatment near your wound if you've never been vaccinated before. These medications prevent an infection from traveling to your brain if you've been exposed to the rabies virus. This is a preventive treatment known as post-exposure prophylaxis (PEP). You may also need a tetanus shot for your wound if you haven't had one in the past 10 years.

If you are pregnant, rabies shots are safe for you and your baby.

Two kinds of PEP medication are used to prevent rabies after you've been exposed to the virus: 

Human rabies immune globulin (HRIG). You will be given a shot of human rabies immune globulin (HRIG) only if you've never had a rabies vaccine before. HRIG immediately gives your body antibodies until it is able to make its own in response to the rabies vaccine. An antibody is a type of protein your immune system makes to fight off harmful viruses, bacteria, and other intruders. 

Rabies vaccine. Your health care provider will also give you a shot of rabies vaccine to prevent a rabies infection after you've been exposed to the virus. The vaccine teaches your body to destroy the rabies virus before it reaches your brain. Current vaccines are given in your arm, not your stomach.

You may have mild side effects from the rabies vaccine. These include:

  • Pain, itching, or swelling where your shots were injected
  • Nausea
  • Headache
  • Dizziness
  • Muscle pain

Let your doctor know if you have any serious side effects.

Vaccine schedule

It is important to get your rabies shots as soon as possible after your exposure to the virus. Your first shots will be given right away. A series of shots must be given on a schedule:

  • HRIG is given right away. It's injected only once, and only to people who have never been vaccinated against rabies before. This is because once you've had a rabies vaccine, your body will know how to make antibodies to fight the infection.
  • The rabies vaccine is given in four doses. You'll get the first shot as soon as possible after exposure. This is also known as day 0. You'll receive your three remaining shots on days 3, 7, and 14 after the first vaccination. If you've been vaccinated against rabies before this exposure, you will only get shots this time on days 0 and 3.

You might have an image in your head of a dog or raccoon acting aggressively and foaming at the mouth. But it's not so easy to tell if you're looking at a rabid animal. Most wild animals that have rabies actually act shy or timid. That's not the way wild animals normally act, so steer clear.

Here are some common-sense rules for dealing with stray or wild animals:

  • Never pet a stray dog or cat.
  • If you see an animal acting strangely (it's aggressive or tries to bite you), call your local animal control.
  • Never touch a wild animal--even if it looks dead.

In the U.S., there is a low risk of dogs getting rabies because of laws requiring vaccines in pets. This reduces the risk of you getting bitten by a dog with rabies. Around the world, humans are at a higher risk of getting rabies from dogs. Children are often at the highest risk of getting bitten by a rabid dog. They are also more likely to have severe exposure to the rabies virus by getting bitten many times. Multiple bites make it harder to prevent a rabies infection. 

Most people in the U.S. have a low risk of being exposed to the rabies virus. However, some people are at a higher risk. This includes people who work with the rabies virus (such as laboratory workers), those who handle animals that could have rabies (such as veterinarians), people who visit caves or other areas with lots of bats, and those who travel to parts of the world where rabies is common and it's harder to get medical care. 

If you are in a high-risk group, there are ways to protect yourself before exposure.

If you are bitten, scratched, or possibly had contact with an animal with rabies, seek medical care right away. Rabies is 100% preventable if you get vaccine doses (post-exposure prophylaxis/PEP) before the virus moves to your brain. Once you show symptoms of the rabies, the disease will become deadly.

Here are additional steps you can take to protect yourself and your pets from rabies:

  • Take your dog, cat, or other pet (only mammals can get rabies) to the veterinarian for regular checkups and make sure your pet is up to date with rabies vaccinations.
  • Don't let your pets wander outdoors, or watch them when outside.
  • Spay or neuter your pets to prevent strays that may not be properly cared for.
  • Call animal control to report any stray animals in your neighborhood, since they may be unvaccinated or sick.
  • Wash animal bites or scratches immediately with soap and water.
  • Avoid contact with wildlife, including injured animals; instead, call animal control or other local authorities for help.
  • Before you travel outside the United States, find out if rabies is present in dogs or wildlife at your destination.
  • If you are traveling to an area with a high risk of rabies, or you work with or near animals known to carry rabies, talk to your doctor about getting pre-exposure prophylaxis (PrEP), a series of rabies vaccine doses given before exposure to the virus.
  • Remember to seek medical attention after possible exposure to the rabies virus, even if you've had PrEP doses of the vaccine. Two additional doses will be needed to prevent the virus from infecting your brain. 

You can survive being exposed to rabies if you're treated as soon as possible, before you have symptoms. Treatment in the U. S. includes one dose of human rabies immune globulin (HRIG) and four doses of rabies vaccine over a 14-day period. You should get HRIG and your first dose of rabies vaccine as soon as possible after exposure. Current vaccines are given in your arm, not your stomach. You may have some pain at the injection site or feel mildly ill after the vaccine.

You can live for several weeks or months without symptoms after being exposed to rabies. Once the virus has moved to your central nervous system (brain and spinal cord), rabies causes death within a few days. That's why early medical care is so important. Once you are showing symptoms that the virus is affecting your brain, there are no effective treatments available. 

Can rabies be cured?

There is no cure for rabies. However, rabies is 100% preventable if you're vaccinated quickly after exposure to the rabies virus. Once you have symptoms, the disease is fatal.

Rabies is a virus that attacks your brain and spinal cord. You get it from being bitten, scratched, or exposed to the saliva of an animal with rabies. Rabies is fully preventable if you get treated with vaccines as soon as possible after exposure. Once the virus has moved to your brain, causing symptoms, the disease will lead to death within days.

  • Why do people or animals with rabies fear water? Furious rabies is one of the two kinds of rabies. A symptom of furious rabies is a fear of water known as hydrophobia (hydro means water, phobia means fear). People or animals with hydrophobia have muscle spasms when they see, hear, or drink water.

  • What is the survival rate of a rabies patient? Rabies is 100% survivable if it's treated properly before the virus has reached the brain. Treatment in the U.S. includes one dose of human rabies immune globulin (HRIG) and four doses of rabies vaccine over a 14-day period. It's important to get your first dose of HRIG and rabies vaccine as soon as possible after exposure to the rabies virus. If you don't get the vaccines, the virus will move through your central nervous system to your brain. Once you have symptoms of rabies, the disease is nearly always fatal. Fewer than 20 people have ever survived after reaching that phase of rabies.

  • What is the lifespan of the rabies virus? Outside the host body, the rabies virus becomes noninfectious when it dries out and is exposed to sunlight. The timing of this will vary depending on the environment. Generally, if the surface containing the virus is dry, the virus is likely noninfectious. To be safe, never handle a dead wild animal with your bare hands.

  • How long before rabies kills a dog? Once a dog has been exposed to rabies, the virus will travel through the nerves to the spinal cord and brain. This can take anywhere from 3-12 weeks and the dog will not show signs of being sick during this phase. Once the virus reaches the brain, the dog will begin showing symptoms of illness and will usually die within 7 days.