Animal & Insect-Borne Diseases

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.  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. Is a human able to spread rabies?

A. While person-to-person transmission has never been documented, precautions should be taken to prevent exposure to the saliva of a diseased person. Very rarely, rabies has been transmitted when infected tissue was transplanted into an uninfected person. 

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.) 

Q.  How is rabies diagnosed in humans and animals?

A.  In humans infected with rabies, diagnosis is made based on a history of exposure to animals, symptoms, and a several lab tests. In animals, rabies is diagnosed by identifying the virus in brain tissue.

Q. What happens if rabies exposure goes untreated?

A. A human who is exposed to a rabid animal does not always contract rabies, but there’s no way to know before symptoms occur (and then it’s too late to prevent).  If treated promptly, nearly all cases of rabies can be prevented. However, if treatment is delayed until signs of rabies develop, the disease is nearly always fatal. All animal incidents should be evaluated by a health professional to determine if treatment is necessary. 

Q. What can be done to prevent the spread of rabies when deployed?

A. Exposure to rabies may be minimized by eliminating or avoiding contact with dogs, cats, and staying away from all wild animals. Follow General Order 1: Do not keep mascots or wild animals as pets, regardless of how young or cute they are. Keep bats out of living quarters by keeping screens in good repair and by closing up any small openings that could allow them to enter. Do not make outside areas inviting to wild animals.  Secure trash and fasten trash can lids tightly. Report unknown and strangely behaving animals to animal control personnel.  

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. Can working dogs carry rabies?

A.  NATO working dogs, military working dogs and therapy dogs are vaccinated against rabies and pose little risk.

Q.  What is the protocol for a military provider treating patients suspected of having had contact with a rabid animal?

A.  Initial treatment by military providers is the same as that followed in the civilian community per CDC guidance. Treatment includes cleansing of the wound with large amounts of soap and water, administration of rabies immune globulin, and a series of injections with rabies vaccine.  When a patient seeks care for an animal bite from a military provider, a special animal bite report is completed.  The report is sent to a veterinarian who then attempts to locate the animal.  If the animal can be found, it may be held for observation (to see if the animal becomes sick with rabies) or euthanized to allow testing of the brain for the virus. The bite reports are also forwarded to preventive medicine personnel to ensure appropriate treatment is provided to the patient.  If rabies vaccination is indicated, medical personnel ensure the patient completes the series of shots.   

Q.  How common is rabies in the theater of operations?

A. Rabies is much more common in the developing world, including countries like Afghanistan, than in the U.S. or other developed nations.  Unlike in developed countries, domestic animals in Afghanistan and similar countries are not immunized against rabies, and rabies is especially common in dogs.  The Army’s veterinary lab in Germany performs all rabies testing on animals submitted from theater; Four of 44 (~10%) animals tested during from January 2010 to August 2011, were positive for rabies.  Despite the tragic death of a Soldier in August from rabies, cases of the disease in Service members remain rare. 

Q.  What guidance or policy has been issued to prevent other incidents from animals at forward operating bases?

A. MOD 10 of the CENTCOM Individual Protection and Individual/Unit Deployment Policy, states that local animals are carriers of multiple diseases, to include rabies, and that deployed personnel will avoid contact with local animals and are not to feed, adopt or interact with them in any way.
Subordinate commanders have issued feral animal policies that reinforce this policy. Afghanistan Policy Letter 25, Feral Animal Control on FOBs/COBs, provides guidance to all personnel assigned to U.S. Forces in Afghanistan and directs commanders at all levels to enforce General Order 1B, which prohibits adoption of pets and mascots, implements animal control practices, requires proper procedures to prevent animal access to sources of food waste, and forbids compassionate feeding of animals in the deployed environment.

Q: Where should members of the Active-Duty or Reserve Components of the Army seek care and medical evaluation for rabies treatment and evaluation?

A.  Both members of the Active Duty and Reserve Components of the Army should contact their unit healthcare professional for medical evaluation and treatment if they feel they have been exposed to the rabies virus while deployed.

Q: I am no longer in the military, but I think I may have been exposed to rabies while I was deployed. Where can I go to receive a medical evaluation?

A: For information about a military medical provider near you, please call the Wounded Soldier and Family Hotline at (800) 984-8523.  They will take your contact information and get some details about your concern.  A military representative will contact you within 24 hours to properly direct your care.  

Q. I am a civilian or contractor who has redeployed from Iraq/Afghanistan and believe I may have been exposed to rabies while deployed. Where can I go to receive a medical evaluation?

A: For information about a military medical provider near you, please call the Wounded Soldier and Family Hotline at (800) 984-8523.  They will take your contact information and get some details about your concern.  A military representative will contact you within 24 hours to properly direct your care.  

Q. What should I do to an animal that bites me or if I have contact with the animal’s saliva?

A. Do not attempt to trap, injure or kill animals.  Capturing animals is best performed by qualified, vaccinated, pest control personnel.  Failure to follow proper procedures can result in greater exposure to rabies.

Q: If a Family Member was told stories of, or shown pictures of their Soldier interacting with an animal during a deployment within the past year, what should the family member do?

A. If the Soldier was bitten or if the animal’s saliva or other fluids came into contact with an open wound, eyes, or mouth, encourage the Soldier to be evaluated by a healthcare professional for possible rabies exposure as soon as possible.

Q: What are my actions if I identify a stray animal on my FOB/COB or post?

A. Notify your chain of command; they will inform the proper authorities. Do not attempt to trap, injure or kill animals. Capturing animals is best performed by qualified, vaccinated, pest control personnel.  Failure to follow proper procedures can result in greater exposure to rabies.

Q. Can a Soldier get screened for rabies “just to be safe?”

A.  There is no screening test for rabies.  This is why anyone who may have been bitten or who suspects they have been exposed to rabies should seek medical evaluation as soon as possible after thoroughly cleaning the exposed area.  If you were exposed, starting treatment as soon as possible after the incident will prevent the disease.