Rabies

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What is rabies?

Rabies is a virus that infects the brain and central nervous system of humans and animals.

What are the symptoms of rabies infection?

Early symptoms of rabies infection include fever, headaches, weakness, and discomfort, as well as a prickling or itching sensation at the site of the bite.

Later symptoms include agitation, anxiety, insomnia, confusion, delirium, hallucinations, hydrophobia (fear of water), difficulty swallowing, drooling, partial paralysis, and eventual death (nearly 100% fatal).

How long after exposure do symptoms begin?

It may take weeks or months to get sick after exposure. This can vary depending upon the location of the bite, type of rabies virus, and any existing rabies immunity.

How is rabies spread?

The rabies virus is found in the saliva of infected animals. The virus is spread through a bite or scratch from an infected animal.

What animals are most often affected?

Animals most often affected by rabies are bats, skunks, foxes, and raccoons. Bats are the most common source of human rabies exposure in the United States. Domestic cats and dogs are rarely found to be rabid. Small rodents, such as squirrels, chipmunks, mice, rats, hamsters, rabbits or hares are almost never found to be infected with rabies and have not been known to transmit rabies to humans.

How can rabies be prevented?

Have pets vaccinated regularly. This will protect them if exposed to animals with the disease and prevent them from becoming ill and infecting humans.
Do not handle stray, wild, or dead animals. Keep away from unfamiliar animals, especially if they are acting strangely, such as having problems swallowing, exhibiting lots of drool or saliva, appearing more tame than you would expect, biting at everything, and/or having trouble moving or is paralyzed.
If you find a bat in your home, do not release it. Safely capture it using the following instructions:
- Find a small container (like a box or a large can) and a piece of cardboard large enough to cover the opening in the container. Punch small air holes in the cardboard.
- Put on leather work gloves. When the bat lands, approach it slowly and place the container over it. Slide the cardboard under the container to trap the bat inside.
- Tape the cardboard to the container to secure the bat inside, then contact your health department to have the bat tested for rabies.
Keep pets indoors and supervised when outdoors, to limit their exposure to wild animals that might be rabid. Use a leash when walking dogs or keep them in a fenced-in yard and supervised.
Do not feed or put water for pets outside unsupervised. Do not leave pet food outside overnight.
Keep garbage securely covered, as these items may attract wild or stray animals.

What to do if exposed and/or bitten?

Clean the wound immediately and thoroughly with soap and warm water; this is the most effective prevention against rabies.
Promptly contact a medical professional.
If a domestic animal was bitten, call a veterinarian and follow his/her advice.

What information is needed to help decide if rabies treatment is required?

The kind of animal involved.
If the animal was wild, domestic, or stray (in general, wild animal bites are always of more concern than domestic pets).
If the animal was domestic, whether it was vaccinated.
If the skin was broken from the bite, what extent was the skin broken, and if there was bleeding from the wound.

What are the general guidelines for rabies treatment?

Rabies treatment is usually recommended for a wild animal bite, and sometimes for a domestic animal bite, when the animal is not available for testing/observation. Rabies treatment is also recommended after exposure to a bat while sleeping.

What is used to prevent rabies infection after exposure?

Two types of treatment must be used together to prevent rabies disease once a person has been exposed:

Rabies Immune Globulin containing antibodies to fight the virus; AND
Rabies vaccine – typically four doses given over two weeks helps you develop your own antibodies to the rabies virus.

What may happen to animals that have bitten someone?

Healthy dogs/cats: Observed for ten days for signs of illness.
Wild and stray animals: Humanely destroyed and brain tissue sent for immediate testing.

For more information about possible rabies exposure, call (248) 858-1286, or toll free 1 (800) 848-5533, Ext 8-1286. If bitten after Health Division business hours, seek medical attention for wound care. Your provider will work with the Health Division to report the bite and assess for potential rabies exposure.

Additional Info

Post-Exposure Prophylaxis Regimen

Persons who have not previously received post-exposure or pre-exposure prophylaxis and are not immunocompromised:

Day 0: Rabies immunoglobulin (RIG) and Rabies Vaccine 1
Day 3: Rabies Vaccine 2
Day 7: Rabies Vaccine 3
Day 14: Rabies Vaccine 4

Persons who have not previously received post-exposure or pre-exposure prophylaxis and are immunocompromised:

Day 0: Rabies immunoglobulin (RIG) and Rabies Vaccine 1
Day 3: Rabies Vaccine 2
Day 7: Rabies Vaccine 3
Day 14: Rabies Vaccine 4
Day 28: Rabies Vaccine 5

Patients should do serum testing to assess immune response to vaccination 1-2 weeks after treatment is complete.

Persons who have previously received post-exposure or pre-exposure prophylaxis:

Day 0: Rabies Vaccine 1
Day 3: Rabies Vaccine 2

For Health Professionals

The Centers for Disease Control and Prevention (CDC) recommends that treatment be initiated, if warranted, within 2 weeks (14 days) of an animal exposure. Unless the wounds are to the neck or the face, there is plenty of time to assess the situation, wait for an animal to be quarantined, or wait for test results.

Bites to Humans

Skunks, Raccoons, Foxes, Groundhogs, Beavers - Treatment should be initiated for any person that has been bitten or scratched and the animal is not available for testing. If the animal is available for testing, so long as the wound is not to the neck of face, initiation of treatment can wait until the test results on the animal come back.

Feral or Stray Cats - Treatment should be initiated for any person that has been bitten or scratched by a feral or stray cat that is not available for quarantine or testing. If the cat is a known stray (i.e. a cat the victim feeds every day) the victim can monitor the cat to make sure they continue to see it for 10 days after the bite. If the animal disappears or cannot be found on or after the 10-day mark, rabies treatment should be initiated. If the animal displays neurological symptoms/symptoms of rabies during the 10-day quarantine, the animal should be tested. If testing is not possible, treatment should be initiated.

Domestically Owned Dogs, Cats, and Ferrets - Rabies in domestic animals is exceedingly rare in the United States. If the animal has an owner, the animal can be quarantined for 10 days. If the animal displays neurological symptoms/symptoms of rabies during the 10-day quarantine, the animal should be tested. If the animal is alive, well, eating and drinking 10 days after the bite, no treatment is needed.

Squirrels, Rabbits, and Rodents (Hamsters, Guinea Pigs, Gerbils) - These animals are considered too small to survive an attack by a rabid animal. Oakland County Health Division does not recommend rabies treatment for exposures to these animals.

Human-Bat Encounters

Per the CDC: "Recent data suggest that transmission of rabies virus can occur from minor, seemingly unimportant, or unrecognized bites from bats".

CDC and Oakland County Health Division recommend consideration of post-exposure prophylaxis (PEP) if:

Direct contact has occurred between a human and a bat and the animal is not available for testing
Persons who have been in a room with a bat and may be unsure/unaware if contact with the bat occurred
- Person who was asleep and awoke to a bat
- Adult sees a bat in a room with a previously unattended child, person with a disability, or intoxicated person who either cannot articulate if they were in contact with the bat or cannot reliably indicate if there was/was not an exposure

Clinical Overview of Rabies

Rabies Testing and Specimen Submission

Testing of animals that have come in contact with humans or domestically owned animals can be facilitated by animal control agencies. Most of Oakland County is serviced by Oakland County Animal Control, however, certain cities and townships have their own animal control departments. Please contact Oakland County Animal Control at 248-858-1090 during business hours for assistance with animal testing.

For the animal control webpage regarding animal testing, please visit our Animal Bite Investigations page.

For Veterinarians

The National Association of State Public Health Veterinarians (NASPHV) publishes the Compendium of Animal Rabies Prevention and Control. The recommendations in this document serve as a basis for animal rabies prevention and control programs throughout the United States and facilitate standardization of procedures among jurisdictions, thereby contributing to an effective national rabies control program.

Oakland County, MI

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Oakland County Health Division

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Clinic Hours of Operation Hearing and vision screening are by appointment during regular business hours.