Rabies: symptoms, how it spreads, treatment and prevention

The NHS says symptoms of rabies usually take 3 to 12 weeks to appear, but they can appear after a few days or not for several months or years. UKHSA gives the same typical incubation period of 3 to 12 weeks, and notes that it is very variable.

NHS inform lists early symptoms such as headache, fever, weakness or feeling generally unwell, and pain, numbness or tingling where you were bitten or scratched. Later symptoms include muscle spasms, hallucinations, confusion, aggression and paralysis. The NHS adds difficulty swallowing or breathing and feeling very anxious or energetic.

UKHSA notes that spasms of the swallowing muscles can make drinking difficult or impossible, and that early symptoms can be non-specific. Because the incubation period is long and variable, there is no safe interval after which a bite can be ignored. Once symptoms appear, rabies is almost always fatal, which is why prevention is the entire focus.

UKHSA describes rabies as an infection of the central nervous system caused by the rabies virus. Humans generally catch it through being bitten or scratched by an infected animal. The NHS adds that you can also get it if an infected animal licks your eyes, nose or mouth, or licks a wound you have.

Dogs are the cause of most human rabies worldwide, according to both NHS inform and UKHSA, but all mammals can catch and pass on the virus, including cats, monkeys, foxes and bats. UKHSA says there has never been a laboratory-documented human-to-human case other than a very few after organ or tissue transplants.

Rabies is caught from animals, not from everyday contact with other people. UKHSA says that, despite tens of thousands of cases worldwide each year, there has never been a laboratory-documented case of human-to-human transmission, other than a very few cases resulting from organ or tissue transplants.

UKHSA adds that the rabies virus can be found in saliva and other body fluids after symptoms begin, so there is a small theoretical risk at that stage. Spread by kissing or intimate contact has never been laboratory confirmed. For this reason close contacts of a person with rabies are risk assessed, and may be offered immunisation as a precaution.

NHS inform advises washing saliva off the skin, or rinsing broken skin under a running tap for several minutes, using an antiseptic such as iodine or alcohol if possible, covering wounds with a clean dressing and pressing on the wound if there is heavy bleeding. If saliva reached your eyes, mouth or nose, rinse thoroughly with clean water. UKHSA also says to wash a bite or scratch with soap and water immediately.

Then get medical help immediately. If you are abroad, do not wait until you return to the UK. If you are in the UK, ask for an urgent GP appointment or call NHS 111. This applies even if you have been vaccinated before. If treated abroad, tell your GP when you get back so they can check whether further doses are needed.

• Wash the wound with soap and running water for several minutes

• Use antiseptic if available and cover with a clean dressing

• Rinse eyes, nose or mouth with clean water if saliva reached them

• Seek medical help immediately, wherever you are

• Report any bat contact in the UK, even if there is no visible mark

There is no specific treatment for rabies once symptoms develop, except for making the person as comfortable as possible (NHS inform). Treatment therefore means stopping the infection before symptoms start, which is why anyone who may have been exposed should seek help at once.

A doctor assesses whether treatment is needed. The NHS says it usually involves 2 or more doses of rabies vaccine, plus rabies immunoglobulin, a liquid given into the wound or by injection, which is only needed if you have not had the rabies vaccine before or have a weakened immune system. UKHSA says post-exposure treatment is extremely effective at preventing rabies when started promptly.

For UK bat bites, UKHSA states that post-exposure treatment involves a course of rabies vaccine and that health professionals can obtain specialist advice and free vaccine through public health services.

The NHS says rabies is found throughout the world and is more common in parts of Asia, Africa, and Central and South America. UKHSA says that rabies has been eliminated from land animals in the UK, and human rabies is extremely rare. Since 1946, 26 cases have been reported in the UK, all imported, usually through dog bites abroad, with one exception from a bat.

In the UK, a rabies-like virus called European bat lyssavirus is found in some bats. UKHSA says it very rarely crosses to humans, but it can cause clinical rabies, so all bats should be considered a potential risk, as infected bats may not show signs of illness. A bat bite is often felt rather than seen and may not bleed or leave an obvious mark.

The NHS says the vaccine is recommended if you travel to a part of the world where rabies is more common, especially if medical help may be hard to reach quickly, if you may come into contact with infected animals, for example through lots of outdoor activities like cycling or running, or if you are staying over a month. NHS inform adds higher-risk contact with animals including bats, such as cave exploring, and notes children are also considered.

Advice from a travel health clinic is suggested around 8 weeks before you travel. The NHS says the rabies vaccine for travel is paid for rather than free, and can be obtained from travel health clinics and pharmacies with travel health services. UKHSA lists groups in the UK who should be immunised because of their work, including laboratory staff working with rabies virus, people who regularly handle bats and some veterinary staff.

The NHS advises not touching or going near wild or stray animals, even if they do not seem unwell, since animals with rabies may show no symptoms, and not feeding any animals, including in zoos or sanctuaries. NHS inform adds not touching bats. Find out where urgent medical care is available at your destination and check country-specific advice on the TravelHealthPro website.

Children are often attracted to animals and may not report a lick or scratch, so it helps to tell them to speak up straight away. Keep a note of what happened, where and when, as this helps the doctor judge the level of risk.

The NHS says to get medical help immediately if you have been bitten or scratched by an animal while abroad, if an animal has licked your eyes, nose or mouth or a wound you have while abroad, or if you have been bitten or scratched by a bat in the UK. Rabies can be prevented if treatment is started quickly, and it is important to get help even if you have been vaccinated.

If you are abroad, get medical help as soon as possible and do not wait until you get back to the UK. In the UK, NHS inform says to phone 111 or phone your GP and ask for an urgent appointment. If you develop symptoms such as numbness or tingling where you were bitten, hallucinations, difficulty swallowing or breathing, or paralysis, you need emergency medical care straight away.

After a possible exposure, assessment is arranged through urgent NHS routes: a GP, NHS 111 or hospital care, or local medical care if you are abroad. UKHSA says post-exposure rabies vaccine for bat bites is provided free through public health services, arranged by the health professional who assesses you.

Before travel, the NHS says you have to pay for the rabies vaccine, which is available from travel health clinics and pharmacies with travel health services. The NHS suggests getting advice from a travel health clinic around 8 weeks before you travel.