Rabies

Transmitted through saliva of infected mammals, usually via bites or scratches. Dogs are the most common source in endemic countries.

Symptoms

Initial: fever, headache, malaise. Progressive: anxiety, confusion, hydrophobia, paralysis. Once symptomatic, rabies is nearly always fatal.

Treatment

Post-exposure prophylaxis (wound washing + rabies immunoglobulin + vaccine series) is effective if given promptly before symptoms. No treatment once symptomatic.

Endemic regions

Highest risk in Asia (especially India) and Africa. Present on all continents except Antarctica. Rural areas with limited access to PEP are highest risk.

Prevention & prophylaxis

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Pre-exposure prophylaxis (PrEP)

3-dose series on days 0, 7, and 21–28. Recommended for travelers to endemic areas with limited PEP access, extended rural stays, or high animal contact risk. Simplifies post-exposure management — eliminates need for rabies immunoglobulin (which may be unavailable).

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Post-exposure prophylaxis (PEP)

After a bite or scratch: immediately wash wound with soap and water for 15 minutes. Seek medical attention urgently. Unvaccinated individuals need rabies immunoglobulin + 4-dose vaccine series. Previously vaccinated individuals need only 2 booster doses. PEP is nearly 100% effective if given promptly.

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Animal avoidance

Do not touch, feed, or approach stray dogs, cats, monkeys, or bats. Even apparently healthy animals can carry rabies. Children are at highest risk — educate them before travel. Know the location of the nearest PEP facility at your destination.