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; recovery has been well-documented in fewer than 10 cases worldwide.  

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 (e.g. mongoose) are the main reservoirs (see https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/high-risk.html). The main mode of rabies transmission is through the bite of an infected animal; however, other exposure types are possible such as a scratch or saliva or CNS tissue contaminating broken skin or mucosa. Rabies is not transmitted from viral contact with intact skin. 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 or wild animals, and keep bats out of the home.

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

Rabies is almost invariably fatal once a person is symptomatic; post-exposure prophylaxis (PEP) should be given for exposed individuals to prevent fatal disease.

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 and Health care facilities: immediately notifiable to local health jurisdiction
  • Laboratories: immediately notifiable to local health jurisdiction; submission required – clinical specimen associated with positive result, within 2 business days.
  • Veterinarians: 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) (206-418-5500 or 1-877-539-4344).
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