Will There Ever Be a Treatment For Rabies?
Key takeaways:
Rabies in people is preventable with prompt medical care.
Without prompt treatment, rabies can reach the brain and be fatal.
Finding an effective treatment for rabies once it reaches the brain has been difficult, but there’s hope that one day a treatment will be available.
Rabies is a viral disease transmitted through direct contact with the saliva or brain tissue of an infected animal. It’s rare in humans in the U.S., but it causes nearly 60,000 deaths every year across the world.
Time is of the essence with rabies. If someone is bitten by a rabid animal and prompt medical care isn’t available, it can spread in the body. Rabies infects the central nervous system (CNS), and — if left untreated — it can be fatal if it reaches the brain. Once it reaches the brain, there’s currently no treatment available.
Researchers are still trying to find ways to treat rabies once it reaches the brain. Thankfully, rabies in people is preventable with prompt medical care. For this reason, most efforts against rabies are currently focused on prevention.
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In this article, we’ll discuss what rabies is and how it’s transmitted. We’ll also review prevention measures and look at potential treatments, including learning why treating clinical rabies — or rabies affecting the brain — is so difficult.
How do you get rabies?
Rabies is transmitted through direct contact with the saliva or brain tissue of an infected animal.
Wild animal bites are the most common way people in the U.S. get infected with rabies — more than about 90% of U.S. rabies cases occur in animals. In the U.S., rabies is most often transmitted by bats, raccoons, foxes, and skunks. The most common cause of human death in the U.S. from rabies is exposure to an infected bat.
Livestock and pets — especially dogs — can also have rabies. Worldwide, the leading cause of human death from rabies is a dog bite. This is much rarer in the U.S. due to laws requiring dogs to be regularly vaccinated against rabies.
Other than an animal bite, how can rabies be contracted?
Getting rabies from something other than an animal bite is rare, but it can happen. For example, it’s possible for scratches or open wounds to be exposed to saliva or other tissue from an infected animal. This could also lead to rabies infection.
But, according to the Centers for Disease Control and Prevention (CDC), rabies isn’t transmitted through contact with the blood, feces, or urine of an infected animal. You can’t get rabies from petting an infected animal, but it’s still recommended to keep your distance.
In theory, being bitten by someone with rabies could also cause you to develop it. However, there are currently no recorded cases of rabies being transmitted from one person to another.
Is a rabies vaccine available for humans?
Yes, rabies vaccines (RabAvert, Imovax) are available for humans. The vaccine is given by an injection into the muscle, and it consists of four shots. Most people only need the rabies vaccine if they’ve had exposure to a rabid animal.
The first dose should be given as soon as possible after potential exposure to rabies. You’ll get your other three doses on days 3, 7, and 14 after your first dose.
How do you prevent rabies from becoming an infection?
Prompt medical attention is vital for preventing a rabies infection. If you’ve been bit by a rabid animal — or even an animal that might have rabies — you’ll need post-exposure prophylaxis (PEP) to help protect yourself. About 55,000 people in the U.S. get PEP every year.
General PEP components
PEP differs slightly depending on whether you’ve previously had the rabies vaccine. In general, rabies PEP consists of:
Human rabies globulin (HRIG): This is a medication that is given once on the day of being exposed to rabies.
The rabies vaccine: Like mentioned, this vaccine series — used in addition to HRIG — consists of 4 total doses. The first dose is given preferably on the day of exposure, and then it’s repeated on days 3, 7, and 14 after the first dose.
HRIG provides an immediate source of antibodies to help your body fight the rabies virus. An antibody is an immune system chemical that recognizes and helps get rid of foreign substances, like bacteria and viruses. This is especially important as it takes some time for your body to start making its own antibodies after getting the vaccine.
What does PEP look like if I’ve never been vaccinated against rabies?
Rabies PEP for people who have never gotten a rabies vaccine consists of:
Wound cleaning: It’s recommended to immediately clean the wound with soap and water. You can also use a skin disinfectant like povidone-iodine, if available, in addition to soap and water.
HRIG: One dose of human rabies globulin (HRIG) on the day of exposure.
The rabies vaccine: People who have never received a rabies vaccine should receive the full four-dose series.
What does PEP look like if I’ve already been vaccinated against rabies?
Rabies PEP for people who have had the rabies vaccine in the past consists of:
Wound cleaning: It’s recommended to immediately clean the wound with soap and water. You can also use a skin disinfectant like povidone-iodine, if available, in addition to soap and water.
The rabies vaccine: People who have had a rabies vaccine in the past typically only need two rabies vaccine doses — one on the day of the exposure and one on day 3.
Can I get a rabies vaccine before being exposed to a rabid animal?
Unless you work with rabies in a laboratory or work as an animal or wildlife control officer, you likely don’t need a preventive rabies vaccine.
That said, if you’re traveling to a location where rabies is widespread, your healthcare provider can tell you if you should get the rabies vaccine before you travel. But remember — people who have had the rabies vaccine still need PEP if they’re bitten or scratched by a potentially rabid animal.
Can you treat rabies once symptoms of an infection develop?
After being exposed to rabies, it takes time for rabies to travel to your brain. This is known as the incubation period and can last weeks to months. This time can vary depending on the initial location of exposure.
The first symptoms are similar to those of the flu and other illnesses and include fatigue, fever, headache, and weakness. Eventually, anxiety, confusion, and agitation can develop. This is followed by symptoms of clinical rabies, such as hallucinations, fear of water, delirium, and insomnia.
Once certain symptoms of a rabies infection develop, it’s almost always fatal. To date, there have been fewer than 20 cases of humans surviving a symptomatic rabies infection.
Thankfully, there’s some good news — research is underway to find effective treatments for rabies infections. There are promising medications — such as favipiravir and bufotenine — which have shown potential effectiveness in animal studies. But it’s still not known whether these will work to treat rabies in people.
Treating rabies infection once it reaches your brain is difficult. One reason is that your brain maintains a barrier from the rest of the body that regulates what comes in and out. This is why rabies can have a long incubation period — giving a person valuable time to receive PEP. But, this brain barrier is also the reason why it’s difficult to treat — it makes it hard to get medications into the brain.
Is rabies fatal?
Once symptoms of rabies infection appear, no treatment has been found to be effective. Rabies is inevitably fatal unless you receive appropriate and prompt PEP therapy. Clinical rabies has a 100% fatality rate in people who don’t receive rabies vaccination after being exposed.
Is there any ongoing research for rabies treatments?
Recently, the FDA released guidance for drug manufacturers to use to help develop monoclonal antibody cocktails — a type of new anti-rabies treatment. Monoclonal antibodies are biologic medications that act as artificial antibodies. The term cocktails refers to multiple monoclonal antibody medications being used at the same time.
These treatments are meant to replace HRIG in PEP, which is sometimes in short supply and carries risk for transmitting blood-borne pathogens. A pathogen is an organism that causes illness or disease, and blood-borne pathogens are disease-causing organisms found in blood, such as the hepatitis C virus.
Other recent research found a combination of two monoclonal antibodies could cure rabies in preliminary animal studies, even after they showed symptoms of rabies in their brains. If this medication combination shows the same results in humans, it would be a breakthrough for treating people with rabies infection even after it reaches the brain.
The bottom line
Rabies is a disease that is preventable with prompt medical care, but it’s almost always fatal when it reaches your brain. Treating rabies once it reaches your brain is difficult because it’s hard to get medications into your brain. Recent research has shown promise with new medication combinations for treating rabies in the brain in animals, but more research is needed to determine if they’re effective in treating infected people.
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