Animal & Insect-Borne Diseases
Rabies 

 

Key facts about rabies 

·      Rabies is a viral infection that can be transmitted to humans through the saliva of infected animals. 

 

·      Animals present in deployment settings are not vaccinated against rabies as pets are in the United States.

 

·      Humans can be infected with rabies if bitten by an infected animal or if the saliva of an infected animal contacts broken skin, eyes or mouth. 

 

·      You cannot always tell if an animal has rabies. 

 

·      Once the signs and symptoms of rabies develop, the disease is almost always fatal. 

 

·      Rabies is preventable. Treatments for rabies are available at medical treatment facilities in theater and in the U.S. 

 

Soldier with two puppies
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How to prevent rabies       

·      Follow General Order 1: Do not keep mascots or pets when deployed!  

·      Do not approach, feed, or handle animals. 

·      If you are bitten or if an animal's saliva contacts your broken skin, eyes or mouth, immediately wash the area with soap and water and seek medical attention right away—rabies is preventable if exposed individuals receive prompt medical care after being exposed. 

·      Report animal exposures immediately.

·      Capturing animals is best performed by qualified, vaccinated, pest control personnel.  Failure to follow proper procedures can result in greater exposure to rabies and other diseases.

 Medical treatment 

·      It is important to have a medical evaluation for all animal exposures regardless of how the animal was behaving.  Animals can be infected with rabies while still appearing healthy. 

·      Treatments for rabies are available at medical treatment facilities in theater.

·      Rabies vaccines, for both animals and humans, must be stored and handled correctly to be effective and must only be given by authorized personnel.

 

·      Medical treatment may include what is known as post-exposure prophylaxis (PEP).  PEP includes wound care, injection of human rabies immune globulin (HRIG) and a series of 4 or 5 rabies vaccinations (doses may be reduced if the individual was vaccinated before the exposure). 

 

·      If complete preventive treatment is obtained promptly following a rabies exposure, nearly all cases of rabies will be prevented. All individuals who may have been exposed should seek immediate medical evaluation and treatment.

 

 

If you have questions about animal exposures, rabies treatment, or access to medical care:

  • Review the Frequently Asked Questions below or
  • Call the Wounded Soldier and Family Hotline at (800) 984-8523

 



Frequently Asked Questions

Q.  What is rabies?

A.  Rabies is a viral disease that affects the central nervous system. It is transmitted from infected mammals to humans and, if untreated, is almost always fatal.

Q. How do people get rabies?

A. People get rabies from contact with  a rabid animal. The exposure is nearly always through a bite, but rabies can also be transmitted if a rabid animal’s saliva comes into contact with a person’s broken skin, eyes or mouth.  It is important to note that in developing countries, dogs are the main source of the rabies virus.  In the U.S. and other developed nations where pets are vaccinated, bats and wild animals become the major concern.

Q.  Can all animals transmit rabies?

A.  No.  Only mammals (warm-blooded animals with fur) carry rabies.  Dogs, cats, bats, foxes, skunks, raccoons, and jackals are among the most likely mammals to transmit the virus.  Small rodents, such as mice and rats, rarely transmit the disease.  Outside of the U.S. and other developed countries, dogs are by far the most common source of rabies.

Q. How can I tell if an animal has rabies?

A. Often you cannot.  Despite the common belief that rabid animals are easily identified by foaming at the mouth and aggressive behavior, infected animals may not look sick or act strange.  All bites or contact with saliva from animals should be evaluated by a qualified medical provider in consultation with a veterinarian.

Q.  What are the symptoms of rabies?

A. Early symptoms may include irritability, headache, fever and itching or pain at the exposure site. The disease eventually progresses to spasms of the throat and the muscles used for breathing, convulsions or seizures, confusion, paralysis and death. Once symptoms appear, rabies is nearly always fatal.  

Q. How soon after exposure do symptoms appear? 

A. The time between exposure and the onset of symptoms—the incubation period—varies but averages two to twelve weeks in humans. In rare cases, symptoms may not appear for over one year. 

Q. What is the treatment if I’m bitten by an animal or exposed to its saliva or other body fluids?  

A. To prevent rabies from an animal bite or exposure to its saliva, immediately wash the area thoroughly with soap and water and report to the nearest medical provider. ALL animal bites should be evaluated by a health care provider to assess risk of rabies exposure.  A physician may order an injection of rabies immune globulin and a series of four or five injections of a rabies vaccine to the arm to prevent the disease.  This treatment is extremely effective and should be initiated as soon after the bite as possible.  (Individuals who were previously vaccinated against rabies do not require rabies immune globulin and need fewer doses of the vaccine following an exposure.) 

More Frequently Asked Questions

 

More information:

Government

USAPHC Rabies Fact Sheet

Redeployment Medical Threat Briefing  external link (Password protected - AKO) 

Pre-deployment Medical Threat Briefing for Afghanistan  external link (Password protected - AKO) 

MILVAX Rabies Webpage

Centers for Disease Control and Prevention (CDC) Rabies Webpage 

Non-Government

World Health Organization Rabies Webpage 

 

Additional information for health care providers: 

Person-to-person transmission of rabies is extremely rare; however, medical personnel should use contact precautions to prevent exposure to the saliva of the infected person.

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 postexposure prophylaxis.

Government

 USAPHC Rabies Prevention Outreach Program: Information for Providers  - This is a toolkit for healthcare providers that contains each of the next five items on this list.

 Rabies Prevention and Post-Deployment Assessment Information for Providers

 USAPHC Rabies Outreach Program: Algorithm for Potential Deployment-Related Rabies Exposure

 USAPHC Rabies Outreach Program: Rabies Fact Sheet for Health Care Providers

 USAPHC Rabies Outreach Program: Animal Exposure Questionnaire

 USAPHC Provider Training - Evaluating Rabies Risk Exposures

USAPHC How to Access and Use the Rabies AHLTA Template/AIM Form (RB_BITE_LATE)

USAPHC How to Access and Use the Acute Potential Rabies Exposures AHLTA Template/AIM Form

MILVAX Project Immune Readiness - An online course on rabies vaccine administration courses.  Covers rabies, the vaccine, dosage, and administration details, indications and contraindications/ precautions, patient education, and resources related to immunization, including the VIS.

CDC - Recommendations of a national working group on prevention and control of rabies in the United States 

CDC - Morbidity and Mortality Weekly Report: Human Rabies --- Wisconsin, 2010

CDC - Human Rabies Prevention - United States, 1999 Recommendations of the Advisory Committee on Immunization Practices (ACIP)

CDC - Compendium of Animal Rabies Prevention and Control, 2005*

DA PAM 40–11 - Preventive Medicine  - see paragraph 2-9

Human Rabies Prevention – United States, 2006  - Rabies Working Group, Advisory Committee on Immunization Practices
October 2006  external link (Password protected - AKO) 

Rabies Postexposure Prophylaxis (PEP) Basics (State of Maryland)

Non-Government

Control of Communicable Disease Manual - see page 498

Compendium of Animal Rabies Prevention and Control, 2011   - National Association of State Public Health Veterinarians, Inc. 

Additional information for leaders:

ALARACT 352/2011 - Rabies exposure, identification, notification, evaluation, and treatment program  external link (Password protected - AKO) 

Department of Defense General Order 1A -- Prohibited Activities for U.S. Department of Defense Personnel Present Within the United States Central Command Area of Operations, December 2000

US Forces Afghanistan Policy Letter 25 – Feral Animal Control on Forward Operating Bases, June 2010

Warning Order 11-56 - Public Health Response to Rabies Risk during Overseas Contingency Operations

 

World Rabies Day Information

Government

CDC World Rabies Day 

Non-Government

World Rabies Day Organization

American Veterinary Medical Association - World Rabies Day

World Health Organization  - World Rabies Day

 

 World Rabies Day logo