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People usually get rabies from the bite of a rabid animal. It is also possible, but quite rare, that people may get rabies if infectious material from a rabid animal, such as saliva, gets directly into their eyes, nose, mouth, or a wound.
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Non-bite exposures to rabies are very rare. Scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or other potentially infectious material (such as brain tissue) from a rabid animal constitute non-bite exposures. Occasionally reports of non-bite exposure are such that post-exposure prophylaxis is given.
Inhalation of aerosolized rabies virus is also a potential non-bite route of exposure, but other than laboratory workers, most people are unlikely to encounter an aerosol of rabies virus. Other contact, such as petting a rabid animal or contact with the blood, urine or feces (e.g., guano) of a rabid animal, does not constitute an exposure and is not an indication for prophylaxis.
Medical assistance should be obtained as soon as possible after an exposure. There have been no vaccine failures in the United States (i.e., someone developed rabies) when post-exposure prophylaxis (PEP) was given promptly and appropriately after an exposure.
One of the most effective methods to decrease the chances for infection involves thorough washing of the wound with soap and water. Specific medical attention for someone exposed to rabies is called post-exposure prophylaxis or PEP. In the United States, PEP consists of a regimen of one dose of immune globulin and five doses of rabies vaccine over a 28-day period. Rabies immune globulin and the first dose of rabies vaccine should be given by your health care provider as soon as possible after exposure.
Additional doses or rabies vaccine should be given on days 3, 7, 14, and 28 after the first vaccination. Current vaccines are relatively painless and are given in your arm, like a flu or tetanus vaccine.
Adverse reactions to rabies vaccine and immune globulin are not common. Newer vaccines in use today cause fewer adverse reactions than previously available vaccines. Mild, local reactions to the rabies vaccine, such as pain, redness, swelling, or itching at the injection site, have been reported. Other symptoms more rarely reported include:
Local pain and low-grade fever may follow injection of rabies immune globulin.
Consult with your doctor or state or local public health officials for recommended times if there is going to be a change in the recommended schedule of shots. Rabies prevention is a serious matter and changes should not be made in the schedule of doses.
The only well-documented documented cases of rabies caused by human-to-human transmission occurred among 8 recipients of transplanted corneas, and recently among three recipients of solid organs (see MMWR article). Guidelines for acceptance of suitable cornea and organ donations, as well as the rarity of human rabies in the United States, reduce this risk. In addition to transmission from cornea and organ transplants, bite and non-bite exposures inflicted by infected humans could theoretically transmit rabies, but no such cases have been documented.
Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue (urine, blood, feces) does not constitute an exposure and does not require post-exposure prophylaxis. In addition, contact with someone who is receiving rabies vaccination does not constitute rabies exposure and does not require post-exposure prophylaxis.
For more information on person-to-person transmission of rabies, see: Fekadu, M., Endeshaw, T., Alemu, W., Bogale, Y., Teshager, T., and Olson, J. G. (1996). Possible human-to-human transmission of rabies in Ethiopia. Ethiopia Medical Journal, 34, 123-127.