Good Medicine: The Reality About Rabies

As wild animals and outdoor pets become more active in the spring, people’s chance of random encounters with them begin to rise as well. Sometimes these encounters can get too close: There are 4 million animal bites reported annually in the United States – of those, some 60,000 require preventive treatment with a rabies vaccine.

Untreated, the rabies virus is deadly. It is spread to people from the saliva of infected mammals, most often bats, beavers, dogs, cats, domestic ferrets, foxes, livestock, raccoons, skunks and woodchucks. Smaller mammals like rats, mice, guinea pigs, chipmunks, rabbits, opossum and squirrels almost never contract rabies because they are typically killed in an attack by a rabid predator. Birds, turtles, lizards, snakes, fish and insects do not carry rabies. 

Dog bites were the primary cause of human rabies in the U.S. until 1960. Now they are the source of only 25% of all cases, with most of those sustained during international travel. This significant decline is attributed to state-mandated pet vaccination programs (only Ohio and Hawaii do not participate). Most counties in New York provide free rabies clinics to immunize dogs, cats and ferrets, such as the one recently held in Ancram sponsored by the Columbia County Department of Health. 

Human rabies deaths in the U.S. have fallen from 100 per year a century ago to three in 2020. Compare this to the 59,000 rabies deaths worldwide every year, 90% due to dog bites. (The rabies vaccine has been available for 100 years, but it’s not easily accessible in developing countries.) 

Bats, on the other hand, have become increasingly problematic. They are timid, and only 1% of the bat population is rabid, but they account for 70% of all U.S. rabies exposures. According to the Centers for Disease Control and Prevention (CDC), human deaths from rabies rose to five per year in both 2021 and 2022 – all attributable to bats. In Dutchess County, exposures have risen by 30% since 2020.  

Bat bites rarely occur outdoors; the problem arises when they get into homes. They can easily squeeze through half-inch holes around window air conditioners or soffits. The marks they leave can be so tiny that people can sustain a bite without even knowing it.  

A bite from an animal carrying rabies injects the virus into the bloodstream. It spreads along the nerves, causing damage as it goes. Rabies hides from the immune system and kills once it reaches the brain.  

Any animal infected with rabies may seem normal or even uncharacteristically tame. In later stages they can stagger, appear sickly, drool or foam at the mouth, nip at imaginary objects, or become aggressive. 

Rabies can present itself in humans in one of two ways, both fatal without treatment: furious and paralytic. In furious rabies, the victim hallucinates, becomes agitated, salivates excessively and can develop acute phobias: fear of water or water drinking, or fear of air being blown in the face. In the paralytic variety, the victim has fever, headache, weakness starting at the bite site and eventually becomes comatose. 

All animal bites should be washed immediately with soap and lots of water. People with wounds that are deep or bleeding heavily should go to an emergency room or call their medical provider for instruction. Victims of bites may be advised to contact their county health department or be sent directly to an urgent care facility to determine the need for a rabies vaccination series, which is 100% effective.  

A series comprises a fast-acting injection of rabies immune globulin at the bite site, providing antibodies until a person’s natural immune system takes over. A series of four vaccinations over two weeks follows the initial injection. It’s best to be vaccinated as soon as possible, but people can wait up to 14 days to get treatment. 

If a person is bitten by a domestic animal, the pet’s vaccination record will determine whether the person needs to receive rabies shots. Pine Plains residents can contact the dog control office. If the pet is healthy but unvaccinated, treatment can be delayed while the animal is observed over 10 days for signs of developing rabies. The only other method of diagnosis is by examination of the (killed) animal’s brain. All animal bites, even ones that seem minor, should be reported to Dutchess County health officials by calling 845-486-3404.  

To reduce the risk of rabies exposure, people should avoid direct contact with wildlife and report obviously sick animals to the county health department. Don’t approach or handle unfamiliar domestic animals. If it’s absolutely necessary to break up a dog fight, wear protective clothing and gloves. Keep your yard free of foodstuffs, stored birdseed and open garbage cans; check your house for openings around air conditioners, eaves, vents and window screens. Close chimney dampers when not in use and cap the chimney to deter raccoons. 

If you have a bat in your house, you can call a local wildlife removal expert or try capturing it yourself. The CDC recommends getting a large lidded box with tiny air holes. Wear heavy work gloves and when the bat lands, approach it slowly and put the box over it. Tape it closed and contact your county health department. The state Department of Health recommends a bat capture kit that uses a coffee can and a pole. 

Rabies vaccinations can be given as a preventive measure for people who are at high risk of exposure because they explore caves that have bats, travel to a developing country where rabies is common, or have a career – like a veterinarian or vet tech – which involves frequent interaction with sick animals.  

Pet and livestock owners should keep their animals’ vaccination records up to date. The National Wildlife Management Program is working to stop the spread of rabies in wildlife by spreading edible bait injected with oral rabies vaccines. Its goal is to eliminate rabies among ground-dwelling U.S. mammals altogether.  

Mary Jenkins is recently retired after nearly 40 years as a family practice physician in New York state.