Rabies, Human

Cause: Rabies virus.

Illness and treatment: Initial neurologic symptoms include abnormal skin sensation or pain, often affecting the site of the bite, and subtle personality changes. Later neurologic symptoms include seizures, excess salivation, fear of water, delirium, agitation, and paralysis. Symptomatic illness is considered to be universally fatal with a few notable exceptions: experimental treatment in this country saved one young girl in Wisconsin (2005); Texas reported a case of presumptive abortive human rabies (2009); and a California girl survived a presumptive rabies illness with experimental treatment (2011).

Sources: In Washington, bats are the primary reservoir. Skunks, raccoons and foxes are additional reservoirs elsewhere in this country. In some countries, dogs and other carnivores are the main reservoirs. Rabies is transmitted when saliva or brain tissue contaminates the skin or mucosa. Person to person transmission is documented only by tissue/organ transplantation.

Prevention: Obtain post-exposure prophylaxis for exposure to a rabid or potentially rabid animal. Certain high risk groups should have pre-exposure vaccination. Keep vaccinations up-to-date for all dogs, cats and ferrets, avoid contact with unfamiliar animals, and keep bats out of the home.

Recent Washington trends: Two human cases due to infection with the bat rabies variant of rabies virus were reported in the past 50 years, one in 1995 and one in 1997.

Rabies is almost invariably fatal despite treatment; post-exposure prophylaxis (PEP) should be considered for exposed individuals.

Purpose of Reporting and Surveillance

  • To assist in the diagnosis of human cases of rabies.
  • To identify persons potentially exposed to a human rabies patient and provide counseling about post-exposure prophylaxis (PEP).
  • To offer PEP to others who may have been exposed to the same source as the patient.

Legal Reporting Requirements

  • Health care providers: immediately notifiable to local health jurisdiction
  • Health care facilities: immediately notifiable to local health jurisdiction
  • Laboratories: Rabies virus immediately notifiable to local health jurisdiction; specimen submission required - clinical specimen associated with positive result (2 business days)
  • Veterinarians: Suspected human or animal cases immediately notifiable to the local health jurisdiction; animal cases notifiable to Washington State Department of Agriculture (see: https://app.leg.wa.gov/wac/default.aspx?cite=16-70).
  • Local health jurisdictions: suspected and confirmed cases are immediately notifiable to the Washington State Department of Health (DOH) Communicable Disease Epidemiology (CDE) (1-877-539-4344).
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