This information is intended for public health professionals, healthcare providers, and veterinarians. Please visit our rabies webpage for general information or our rabies activity webpage for data on rabid bats found in Washington State.
- Bats in the Bedroom
- Protocol for Animal Bites
- Bats and Rabies Prevention
- Rabies Frequently Asked Questions
- Rabies Activity in Washington State
- Instructions to safely capture a bat for rabies testing (PDF)
- Local Health Jurisdictions
- Specimen Submission Forms
- Rabies Incidence Rates – Communicable Disease Report (PDF)
- NASPHV Rabies Compendium
- CDC Rabies Vaccine Recommendations
Public Health and Healthcare Providers
- Legal Requirements for Reporting
- Reporting and Surveillance: Suspected Rabies Human Exposure Page
- Reporting and Surveillance: Human Rabies Page
- Reporting Form – Suspected Rabies Exposure (PDF)
- Reporting Form – Human Rabies (PDF)
- Surveillance and Reporting Guideline – Suspected Rabies Exposure (PDF)
- Surveillance and Reporting Guideline – Human Rabies (PDF)
- Assessment of Rabies Exposures and Guidance on Rabies PEP (PDF)
- CDC – Rabies Information for Healthcare Providers
- CDC – Rabies PEP
- CDC – Rabies Biologics
- CDC – Programs for Uninsured and Underinsured Patients
- Rabies Titers: Kansas State University
- Rabies Titers: Atlanta Health Associates
- Rabies specimen submission and testing (human): consult your local health jurisdiction.
Rabies Frequently Asked Questions for Healthcare Providers
What is rabies?
Rabies is a viral disease that infects the central nervous system. If a person does not receive the appropriate medical care after a potential rabies exposure, infection with the virus is almost always fatal. All warm-blooded mammals including humans are susceptible to rabies.
What is rabies post-exposure prophylaxis (PEP)?
Rabies in humans is 100% preventable through prompt, appropriate medical treatment, known as post-exposure prophylaxis. Begin treatment following potential rabies exposure as soon as possible after the exposure occurs. First, immediately wash all bite wounds and scratches with soap and water.
PEP consists of a dose of human rabies immune globulin (HRIG) and four total rabies vaccinations, given on days 0, 3, 7, and 14. People with weakened immune systems will need a fifth dose of vaccine and a blood test to check that the vaccine worked. People who have been previously vaccinated against rabies should only receive vaccine (no HRIG), on days 0 and 3 after a rabies exposure.
When should post-exposure prophylaxis for rabies be considered?
Local health jurisdictions in Washington can assist in determining whether PEP administration is warranted, and/or facilitate animal testing. When assessing whether to administer PEP following a suspected rabies exposure, consider:
- the type of animal
- the nature of the exposure
- the geographic area where exposure occurred
- whether the animal is available for testing
Type of Animal:
In Washington State, bats are the only known reservoir for rabies; however, the virus can be transmitted from bats to other mammals. Wildlife or animals that spend unsupervised outside are more likely to come into contact with bats.
Nature of Exposure:
Rabies virus is found in the saliva and brain tissue of a mammal infected with rabies. It is usually spread to people by animal bites. Rabies could be spread if the virus comes into contact with mucous membranes (eye, nose, and respiratory tract), open cuts, or wounds.
Other animal contact, such as petting a mammal infected with rabies or contact with its blood, urine, or feces does not result in infection. For healthy adults, bats found indoors with no known contact represent a very low risk of rabies exposure. Person-to-person transmission of rabies has occurred only through tissue transplantation.
Geographic Area where Exposure Occurred:
In the continental United States, rabies virus is adapted to various animal species. Some states have raccoon, skunk, or fox variant rabies, in addition to bat variant rabies. Other countries may have canine variant rabies present.
Whether the Animal is Available for Testing:
When rabies exposure is suspected and the animal is available and in good condition for testing, local health jurisdictions may approve testing the animal for rabies. If the test returns negative, PEP can be avoided, or discontinued if treatment has been started.
For more detailed information on the assessment of rabies exposures, see: Assessment of Rabies Exposures and Guidance on Rabies PEP (PDF)
What are the symptoms of rabies in people?
Human rabies is a rare disease in the United States. Symptoms normally appear two to eight weeks after exposure, but this period may vary up to months or years.
Early symptoms include headache, fever, and sometimes pain at the site of the exposure (bite). Symptoms may include agitation, confusion, paralysis, and difficulty swallowing. The disease rapidly progresses into a severe nervous system (neurologic) illness. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive.
Local Health Jurisdictions can facilitate human rabies testing at CDC if recommended.
When is it too late to start rabies vaccinations after an exposure?
Administration of rabies PEP following exposure to a rabid animal is considered a medical urgency, not an emergency. Local health jurisdictions can consult with healthcare providers and can facilitate testing the animal for rabies if recommended.
It may be appropriate to initiate PEP prior to receiving animal test results depending on:
- the behavior and appearance of the animal
- the severity and location of the bite
- whether the exposure was provoked
- the species of the animal
PEP can be delayed when a dog, cat, or ferret is currently healthy, and can be observed for 10 days. Likewise, PEP can be delayed up to 5 days while an animal is being tested if the appearance/behavior of the animal, bite severity and bite location are not high risk. Assess each exposure situation to determine timing of PEP in relation to animal testing results.
Initiate PEP immediately for bat bites to the head or neck or severe bites from a wild carnivore. If PEP is started prior to the availability of animal testing results, PEP can be discontinued if the animal is later found to be negative for rabies virus. If PEP has not been started and test results indicate the animal was rabid, start PEP immediately. Since incubation periods of more than one year have been reported for human rabies cases, PEP should be administered regardless of the time interval since exposure to rabies occurred.
Where can I get more information?
- Rabies (human)
- For more information call your local health department or Communicable Disease Epidemiology 206-418-5500 or toll-free 877-539-4344.
- Report suspected human rabies exposure
- Report human rabies
- Rabies Resources
- Guide for Veterinary Offices - Handling Calls about Bat Encounters (PDF)
- CDC – Rabies Information for Veterinarians
- Washington Animal Disease Diagnostic Laboratory, Rabies Submissions
- Oregon State University, Veterinary Diagnostic Laboratory, Rabies Submissions
- Report suspected or confirmed cases of rabies in animals to the Washington State Department of Agriculture.
Local health jurisdictions should contact veterinarians in their jurisdiction to solicit assistance with animal euthanasia.
The Michigan Rabies Working Group and the Bat World Sanctuary maintain lists of acceptable means of bat euthanasia, to be performed by vaccinated personnel with appropriate personal protective equipment, including: inhalant anesthetics and injectable anesthetics.
Physical methods of euthanasia such as cervical dislocation or decapitation are not acceptable for the euthanasia of bats due to concern for rabies exposure. Freezing is never an acceptable means of attempting euthanasia.
- Humane Euthanasia of Bats for Public Health Rabies Testing (Michigan Rabies Working Group) (PDF)
- Insectivorous Bat Euthanasia (Bat World Sanctuary) (PDF)