About Rabies

Key Information About Rabies

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• What is rabies?
• How do you get rabies?
• What should you do if you think you have been exposed?
• Rabies Symptoms
• How to Prevent Rabies
• About Rabies Treatment
• Other Times to Consider a Rabies Vaccination
• For Providers
• Additional Resources

What is rabies?

Rabies is a 100% preventable disease that affects the central nervous system of mammalian animals and humans. Rabies is deadly if not treated before symptoms start.  

How do you get rabies?

You can be exposed to rabies if you are in contact with an infected animal's saliva or brain tissue from a bite, or scratch. Other possible exposures include getting infected saliva from a rabid animal into an open wound or in the eyes, nose, or mouth. Rabies is not spread by petting a rabid animal or contact with blood, urine, or stool. 

Most recent human rabies cases in the United States have been associated with bats. People may not know if a bat has bitten them, since bats have small teeth that may not leave marks on the skin. Other common animal rabies vectors in Baltimore City region are raccoons, foxes, cats, groundhogs, beavers, and skunks. 

What should you do if you think you have been exposed? 

1. Find out more about the animal that bit you. 

• If bitten, scratched or exposed to a wildlife, do not release the animal. The animal can be tested for the presence of the rabies virus. 
• Try to trap the animal if it can be done so, safely.  Wildlife, including bats, can be captured safely by a wildlife cooperator or trapper. If the animal is killed, try not to damage the brain.  
•  If the animal has an owner, get the owner’s name, address, telephone number, and ask if the animal is vaccinated against rabies. 
• Call Animal Control at 410-396-4689 or dial 311. Let Animal Control know of the rabies exposure, so that they can test for rabies virus or quarantine the animal. If the situation is an emergency, dial 911. 

1. Clean the wound. 

• Wash the wound with soap and water for 15 minutes soon after exposure. Use an antiseptic (like povidone-iodine), if available. 

1. Seek medical treatment. 

• Get prompt medical attention.  
• Discuss with your health care provider whether you should start rabies post-exposure prophylaxis (PEP). 
• You should consider medical attention if a bat was present and exposure cannot be ruled out (e.g., a sleeping person awakens to find a bat in the room, or an adult sees a bat in the room with a previously unattended child or incapacitated person). 

1. Contact the Baltimore City Health Department. 

• Contact the Baltimore City Health Department Acute Communicable Diseases Bureau (410-396-4436) for information about rabies, rabies treatment, or a potential rabies exposure. 

Risk Table

*The guidance for rabies treatment is based on the status of the animal. The Acute Communicable Disease team will determine whether the animal can be placed in quarantine, or if rabies testing can be conducted in conjunction with Animal Control. 

**This table does not substitute medical advice. Concerned individuals should still contact their medical provider or the Acute Communicable Disease team. 

Rabies Symptoms

If infected, symptoms may occur from days to weeks after exposure to the virus. Initial symptoms may include confusion, flu-like symptoms, abnormal behavior, weakness, discomfort, fever or headache. There also may be a prickling, or an itching sensation at the site of the bite. These symptoms may last for several days. Additional symptoms may include one or more of the following: 

• Anxiety 
• Insomnia 
• Agitation 
• Delirium 
• Hallucinations 
• Hydrophobia (fear of water) 
• Hypersalivation 
• Seizures 

How to Prevent Rabies

1. Vaccinate your dogs, cats and ferrets regularly.  
2. Do not let your pets roam free. 
3. Baltimore City requires that all cats and dogs over age four months be licensed.  

• Pet licensing is extremely important as a means of confirming that pets have been inoculated against Rabies.  
• To apply for a Baltimore City pet license, call 855-328-1399 or visit the website. 

1. Teach children to stay away from animals they don't know. 
2. Stay away from any animals who appear sick, stagger when walking, drool heavily or suffer from paralysis. Domestic animals may act unusual or aggressive. 
3. Cover garbage cans securely and do not leave pet food outside. 
4. Prevent bats from entering your home. 
5. Report animal bites, bat sightings, and other animal exposures to Animal Control by calling 311, or unless it’s an emergency situation dial 911. 

About Rabies Treatment

What is PEP? 

Rabies post-exposure prophylaxis (PEP) is highly effective in preventing rabies in humans after a confirmed or suspected exposure to the rabies virus (e.g. contact with saliva from rabid animals by bite or scratch, or exposure to a bat).  

PEP involves the following steps: 

1. Clean the wound with soap and water for 15 minutes after exposure. If available, use a disinfectant, such as povidone-iodine, to flush the wound.  
2. For persons who have not been previously vaccinated against rabies, immunization includes: 
   1. Administration of a single dose of human rabies immunoglobulin (RIG),
   2. A 4-dose course of rabies vaccination given over a 14-day period. 
   3. Note - Persons with a weakened immune system may need an additional (5th) dose and should talk to their health care provider before getting vaccinated. 
3. For persons who have previously received pre-exposure rabies vaccination, or the full course of PEP after a prior rabies exposure, immunization includes:
   1. A 2-dose course of rabies vaccination given soon after exposure. 
4. Note – RIG is not recommended for persons who have received pre-exposure rabies vaccines or rabies PEP. 

If you or someone you know has questions about getting rabies post-exposure prophylaxis, call the Acute Communicable Diseases during normal business hours at 410-396-4436, or after-business hours call the Baltimore city operator at 410-396-3100. 

Other Times to Consider a Rabies Vaccination

Other times to consider a rabies vaccination include if you:

• Have frequent contact with potentially rabid animals or rabies vectors; or occupations that interact with wildlife or rabies vectors, such as veterinarian technicians 
• Plan on international travel where you are likely to encounter animals in an area where dog rabies is common and prompt access to appropriate medical care may be limited. Review the rabies status in the country and discuss with your health care provider whether you should get the rabies vaccine prior to international travel. 

Consult your health care provider if considering pre-exposure rabies vaccination.  

Role of the BCHD Acute Communicable Disease Team

The Baltimore City Health Department Acute Communicable Disease team conducts risk assessments, provides technical assistance, and tracks disease patterns for communicable diseases in Baltimore City. For rabies, the ACD team conducts risk assessments to all potentially exposed or injured victims to determine the level of exposure to rabies.

For Providers

Reporting 

Animal bites are a reportable disease in Maryland. Immediately report any patient with an animal bite/scratch/exposure by completing the Health Care Provider Animal Bite/Exposure Report form and fax the form to 410-396-7332 or call 311.  

For questions on the administration of rabies post-exposure prophylaxis, call Acute Communicable Diseases during normal business hours at 410-396-4436 or after business hours call the Baltimore City operator at 410-396-3100. 

Rabies Virus Incubation Period 

The incubation period for the rabies virus after exposure varies from weeks to months, based on the following factors: 

• The location of the exposure site (how far away it is from the brain), 
• The severity of exposure (how much virus entered the body), 
• The age of the patient (younger children may have shortened incubation periods), and 
• whether the person had ever received a rabies vaccine. 

Symptoms 

The first symptoms of rabies, called prodrome, can feel like the flu, including weakness, discomfort, fever, or headache. There also may be  a prickling, or an itching sensation at the site of the bite. These symptoms may last for several days. 

Usually, severe disease appears within two weeks of the first symptoms, when the rabies virus causes brain dysfunction. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive.  

Additional rabies symptoms in humans may include one or more of the following: 

• Anxiety 
• Insomnia 
• Confusion 
• Agitation 
• Delirium 
• Hallucinations 
• Hydrophobia (fear of water) 
• Hypersalivation 
• Seizures 

It is critical to administer rabies PEP as soon as possible after exposure.

Pre-exposure rabies vaccinations should be considered for individuals who: 

• Have frequent contact with potentially rabid animals or rabies vectors; or  
• Occupations that interact with wildlife or rabies vectors, such as veterinarian technicians; or 
• Plan on international travel where you are likely to encounter animals in an area where dog rabies is common and prompt access to appropriate medical care may be limited. Review the rabies status in different countries and discuss with your health care provider whether you should get the rabies vaccine prior to international travel. 

Additional Resources

• Maryland Department of Health - Rabies
  • The MDH Rabies PEP Training module online course designed to educate health care providers
• Maryland Rabies Fact Sheet
• WHO Rabies Fact Sheet
• Rabies Ready: What to Know Before a Bite
• Rabies Pre-exposure Prophylaxis | Rabies | CDC
• Rabies Post-Exposure Prophylaxis (PEP)
• Bats and Rabies
  • Bats and Rabies at Schools (courtesy of Arizona Department of Health Services)
  • Bats in Houses (maryland.gov)
• For information on vaccination protocols visit: 
  • Rabies Vaccination: For Healthcare Providers | CDC 
  • Rabies Status by Country | Rabies | CDC
• Low-Cost Vaccines and Microchips — Baltimore Animal Rescue and Care Shelter (BARCS)