We use the term 'rabid' as a byword for madness and extremely violent behaviour. The very word rabies – Latin for 'rage' – conjures horror images of wide-eyed insanity, victims foaming at the mouth and a prolonged excruciating death – all caused by a single bite from an infected dog.
But just how true is this picture of the disease, and what is the reality of rabies in the modern world?
What is rabies?
Rabies is a very serious disease that affects the brain and central nervous system. It is caused by a zoonotic virus, which is a virus than can be transmitted between mammals and humans. According to the World Health Organisation (WHO), it causes tens of thousands of deaths worldwide each year. The US Centre for Disease Control estimates an average of 59,000 deaths a year.
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Where is rabies most common?
Rabies is most common in Asia, Africa and Central and South America and is more virulent in poor rural communities with limited access to routine medical treatment.
There are some fears, as reported in the journal Ecography in 2024, that climate change may be enabling the common vampire bat of South America, a major carrier of rabies, to expand its range to southern USA. Though bats seldom bite humans, they can spread the disease to animals such as dogs. Other rabies carrying animals may also be affected by climate change in Africa and Asia.
How do you catch rabies?
Rabies is spread via saliva, usually through bites or licks (especially of an existing open wound) from an infected animal. All mammals can carry rabies but the WHO states that over 99 per cent of infections are caused by dogs.
Other major carriers include foxes, coyotes, raccoons and bats. There have been some claims that rabies can be spread through unpasteurised milk though no scientific study has confirmed this. There is also no evidence that the diseases can be passed from human to human, such as through kissing.
What are the symptoms of rabies?
The WHO lists early symptoms that include “fever, pain and unusual or unexplained tingling, pricking, or burning sensations at the wound site.”
As the virus infects the central nervous system, the brain and spinal cord become inflamed.
Some four out of five cases result in hyperactivity and hallucinations and can include hydrophobia (fear of water) and aerophobia (fear of drafts or of fresh air). This is called 'furious rabies' and accounts for the idea that rabies causes a ravening madness. The WHO says that “death occurs after a few days due to cardio-respiratory arrest” .
In 20% of the total number of human cases rabies runs a less dramatic and usually longer course than the furious form. Muscles gradually become paralysed, starting from the wound site. A coma slowly develops and eventually death occurs. This is called paralytic rabies and, according to the WHO “is often misdiagnosed, contributing to the under-reporting of the disease”.
Can it be treated?
Once symptoms appear, rabies is fatal, which is why it is feared so greatly. However, victims of dog bites or other potential rabies infections can avoid contracting the disease through 'post-exposure prophylaxis' (PEP), so long as it is treated immediately. PEP includes cleaning the wound fully then applying human rabies immune globulin (HRIG) to the wound site. This acts by flooding the wound with antibodies and may be bolstered by an injection. At the same time, the patient will need a course of rabies vaccines.
Rabies vaccines can also be taken before entering rabies hotspots – especially for vets who may be treating infected animals. For example, some 100,000 Americans are given rabies vaccines each year. Rabies vaccines are highly effective.
