CDC says rabies exposures are up this summer. Here's the animal-contact check.
A new CDC advisory reports a summer jump in rabies exposures and treatment; here is what to do in the first 15 minutes after an animal contact, which bites and scratches need a same-day risk assessment, and which ones usually do not.
A CDC health advisory published September 10 opens with a number worth knowing. Between July and August, the agency handled 17% more rabies-related inquiries than in the same two months last year, including several events in which a single animal exposed multiple people. 1
At least eight state health departments told the CDC they had seen more people getting rabies treatment this summer, more mistakes in how that treatment was given, or both. 1 Weekly pharmacy data through September 2 shows use of the two rabies vaccines licensed in the United States up roughly 33% over the same stretch of last year, and use of rabies immune globulin, the antibody dose that goes along with the vaccine, up roughly 76%. 1
Rabies kills nearly everyone who develops symptoms, and it spares nearly everyone who is treated before symptoms start. 1 About 100,000 Americans receive that treatment each year, drawn from roughly 1.4 million people who go looking for care after an animal contact. 2 A full course typically costs between $11,000 and $14,000. 1
Most of those 1.4 million people need reassurance rather than treatment, since only about 100,000 of them end up receiving it. The whole system rests on one judgment call, and it is a call you can learn to make alongside the health department: does this specific bite, scratch, or brush with an animal need rabies treatment?
How one infected animal becomes 284 phone calls
North Carolina confirmed rabies in baby goats from a mobile petting zoo in Iredell County this summer. The farm had taken the goats to at least ten events between July 28 and August 27, among them a back-to-school bash and several assisted living centers. A skunk had gotten into the goats' pen in late July. 3
County and state health departments ended up evaluating 284 people and recommending treatment for 213 of them. 3 Mecklenburg County's alert told residents that only people in close contact with those goats were at risk, and asked them to call rather than wait for symptoms. 4
One sick animal, a few hundred people to sort, and a product that costs thousands of dollars per person. That is the math behind this summer's numbers.
The 15 minutes you control
Start the clock as soon as the contact happens, whatever else you plan to do later. Wash the wound with soap and water for a full 15 minutes. Rinsing that long flushes virus out of the tissue before it can travel. 5
If you have povidone-iodine at home, irrigating the wound with it adds another layer of protection. 1 And if saliva or brain material from an animal reaches your eyes, nose, mouth, or an open cut, treat that as its own exposure and get seen urgently — rabies can enter through intact-looking membranes with no bite at all. 6
Leave the wound open for now. A professional needs to see it before anyone closes it. 1
Contacts that need a call today
Health officials run every contact through a set of criteria, and the CDC spells them out for the situations that get assessed immediately. 7
- Direct contact with a bat, unless a bite or scratch can be ruled out definitively.
- A bite or scratch from a raccoon, skunk, fox, or mongoose.
- A bite that came out of nowhere, or from an animal that looked sick or was active during the day when it usually isn't.
- Several bite wounds, or a wound on the head or neck.
- A bite from an unfamiliar dog or cat while traveling abroad.
Among skunks and foxes that bite people or pets, more than 20% test positive for rabies; among raccoons in the eastern United States the figure is about 10%; among mongooses in Puerto Rico it runs above 80%. 2 Bats carry the biggest share of the human toll: at least 7 in 10 Americans who die of rabies were infected by a bat. 8
A bat bite can be tiny and painless, which is why health officials treat any direct contact as a possible exposure. CDC's guidance covers the version of this that happens at 3 a.m.: if you wake up with a bat in the room, assume you may have been exposed and get seen. 9 Then keep the bat. Animal control or your health department can capture and test it, and a negative test is what closes the question. Releasing it throws away the answer. 6
Most of these exposures call for a same-day conversation, and a trip to the emergency room is only needed when the wound itself needs urgent medical attention. 7 Your health department can run the assessment over the phone and tell you where to go.
Contacts that usually don't
Rabies treatment is usually unnecessary when the animal is a healthy pet that can be observed for 10 days, when a test on the animal comes back negative, or when health officials determine the contact carried no risk. 7
Pet bites are the common case here. Rabid dogs are rare in the United States because vaccination and animal control programs worked, and the animals that do carry rabies are overwhelmingly wildlife — more than 90% of reported animal rabies cases. 8 Ask the owner for proof the pet is current on its rabies vaccine, and ask what the animal's behavior was like around the bite. 5
The rabies question sits on top of a wound question. Any bite that breaks skin can get infected, and a bite that keeps bleeding, or that leaves a wound you can't clean properly, still deserves a medical visit on its own merits. 7
What the treatment actually is
Post-exposure prophylaxis, or PEP, is three things. 1
First comes the wound care above. Then, if you have never had a rabies vaccine, a single dose of human rabies immune globulin, injected into and around the wound itself, so the antibodies sit exactly where the virus would have to travel. Then the vaccine: one dose in the arm on day 0, and more on days 3, 7, and 14.
If you were vaccinated against rabies previously, the protocol shortens to two vaccine doses, on days 0 and 3, with no immune globulin at all. 1 If your immune system is suppressed by a condition or a medication, the series runs to five doses with a blood test at the end to confirm your body responded. 1
Adults get the shots in the shoulder muscle now, and side effects are usually mild — a sore arm, a headache, an upset stomach. The 30-shot stomach series is long gone. 3 You also don't need every dose on the minute. Running a few days behind on the schedule is generally fine; a longer gap is a phone call to public health, not a restart. 1
Immune globulin can be hard to stock, and the guidance for that is simple: start the vaccine sequence anyway and add the globulin later if it becomes available. Nobody waits on the antibody shot. 1
The bill, and the questions to ask first
A typical course lands between $11,000 and $14,000, which is why the CDC's advisory spends as much space on avoiding unnecessary treatment as on encouraging needed treatment. 1
Before the first injection, ask whether your insurance covers immune globulin and the vaccine, whether the health department is supplying either one, and what the billing path looks like if the treatment happens in an emergency department. Local health departments are set up to run the risk assessment and route people to the cheapest correct answer. 5
If you were exposed and never got checked
Rabies sits quietly for weeks to months after the virus enters the body, and that silence is the part that catches people. The bite heals. Nothing feels wrong. 8
The first symptoms, when they come, look like a bad flu: weakness, fever, headache. Alongside them, a prickling, tingling, or itching at the spot where the animal broke the skin. 8 Severe illness usually follows within about two weeks — anxiety, confusion, agitation, hallucinations, panic around drinking, heavy salivation. Once those appear, the disease is nearly always fatal. 8
If an animal contact happened weeks ago and nobody assessed it, call your health department today. Waiting to see whether symptoms arrive spends the one resource that treatment needs.
When to call 911
Rabies is a disease of the nervous system once it takes hold, so the emergency signs are neurological. Call 911 for:
- Confusion, agitation, or hallucinations
- A seizure
- Weakness or paralysis in an arm or leg
- Trouble swallowing, or trouble managing your own saliva
- Bleeding that won't stop, or a wound that needs surgical repair
Say "possible rabies exposure" when you call. First responders and the receiving hospital need that detail to route you correctly and to protect staff. 7
Staying off the list
Leave wildlife alone, especially anything you can approach easily, anything out in daylight that should be nocturnal, and anything injured or dead. Those animal behaviors are the ones health officials treat as possible rabies. 5 If you keep pets, keep them current on rabies vaccines and keep them away from wild animals. 8 If bats are getting into your attic or a crawl space, the openings can be sealed, and outside the May-to-August window is the safer time to do it. 6
Travel changes the math. Dogs still carry rabies across much of Africa, Asia, and parts of Central and South America, and more than 80 Americans have died since 1990 after being infected abroad. 8 Keep your distance from stray and unfamiliar dogs, and know where you'd go for treatment before you need it.
References
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- 8About Rabies — CDC
cdc.gov
- 9Bats Lead in U.S. Rabies Risk — CDC
archive.cdc.gov
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