Rabies Symptoms

Symptoms depend on the stage of the disease

Early rabies symptoms may only include mild fever and headache. As it progresses, severe symptoms like confusion, excessive salivation, seizures, paralysis, delirium, and coma occur. Once this happens, death is almost inevitable.

The rabies virus, a member of the Lyssavirus genus, moves through the network of nerve cells, causing progressive symptoms as it gradually infiltrates the brain and central nervous system. Despite being rare in the United States, rabies remains a frightening prospect due to the speed at which this occurs.

This article walks you through a timeline for rabies symptoms during each phase of infection. These phases are known as the incubation, prodromal, and acute neurologic periods.

However, it’s critical that you do not wait for rabies symptoms or signs to appear to seek treatment. You must get medical attention the moment you are bitten or scratched by an animal that has or is suspected to have rabies.

rabies symptoms
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Incubation Period for Rabies

The incubation period is the time between exposure to the virus and the first appearance of symptoms. The period can run anywhere 30 to 90 days on average but may be shorter or longer based on the host and viral factors.

How Many Years Later Can Rabies Take Effect?

Incubation periods longer than one year are exceptionally rare, but it can happen. There have been reports of rabies symptoms beginning years after exposure, including one case of a man who developed symptoms more than 20 years after a dog bite.

Prodromal Period

The prodromal period is described by the first appearance of symptoms. This is when the virus first enters the central nervous system and begins to cause damage.

The prodromal phase tends to run from two to 10 days on average and may cause such symptoms as:

  • Fever
  • Itching (pruritus)
  • Tingling or burning sensation at the site of the exposure (known as paresthesia)
  • Fatigue
  • Headache
  • Anxiety
  • Irritability
  • Chills
  • Insomnia
  • A general feeling of unwellness (malaise)
  • Loss of appetite (anorexia)
  • A sore, swollen throat (pharyngitis)

Acute Neurologic Period

The acute neurologic period lasts anywhere from two to ten days and will almost invariably end in death. The types and characteristics of symptoms can vary, depending largely on how severe or mild the initial exposure was.

Furious rabies is the type most people with experience. As its name suggests, this form of rabies is characterized by violent physical and neurologic symptoms. Symptoms may come and go, and will often be interspersed with moments of calm and lucidity. Death will most often be caused by cardiorespiratory arrest.

Paralytic rabies accounts for about 20% of cases and will cause muscles to gradually weaken, starting from the site of the exposure and expanding outward. Paralysis and death will eventually ensue (usually by respiratory failure).

Atypical rabies is a type most often associated with bat bites. It may involve symptoms from both furious and paralytic forms of the disease. The variations in symptoms and severity can often make it hard to recognize a case as rabies.

Symptoms of rabies occurring during the acute neurologic period may include:

  • Agitation
  • Hyperactivity
  • Hyperventilation
  • Excessive salivation
  • Hydrophobia (a distressing symptom characterized by an unquenchable thirst, an inability to swallow, and panic when presented with fluids to drink)
  • Partial paralysis
  • Confusion
  • Vomiting blood
  • Aggression (including thrashing and biting)
  • Hallucinations
  • Seizures
  • Priapism (persistent and painful erection of the penis)

These symptoms will soon to lead to a coma as the rabies infection causes massive brain inflammation. Without intensive supportive care, death will usually occur within hours or days.

Why Are Rabies Patients Afraid of Water?

Hydrophobia results from intense pain and muscle spasms in the throat that make it difficult for a person with rabies to swallow. This may cause avoidance of water, and even the sight or sound of water may come to trigger spasms.

When to See a Doctor

Once rabies symptoms begin to appear, the infection is almost always fatal. To this end, you need to seek care the moment you are bitten by a wild animal—or even a domestic one.

Start by washing the wound thoroughly with soap and warm water. While a doctor should be seen as a matter of urgency, the condition is not considered to be a medical emergency at this stage. It is simply important to see a physician, ideally on the same day, and to provide as much information as you can about the attack. Even if you’ve been previously vaccinated for rabies, you should still have your wound looked at.

Rabies Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Man

If the animal has been captured (or the suspected pet quarantined), tests can be performed to determine whether it has rabies. But, even then, treatment wouldn’t necessarily be delayed pending the results. This is because the only sure way to confirm rabies is to euthanize the animal and obtain two tissue samples from the brain. Clearly, with a domestic animal, this may be less of an option if the symptoms are vague, non-specific, or nonexistent.

Whatever the circumstance, if there is a genuine suspicion of exposure, treatment should be started without delay.

On the other hand, if you have been scratched by a suspicious animal or have come into contact with body fluids from a sick or dead animal, you should still see a doctor if only for your peace of mind. This is especially true if you live in an area where animal rabies has been identified.

While rabies can only be transmitted through saliva or brain/nerve tissues, any potential exposure, however small, should be taken seriously. If anything, it may provide you the impetus to get the rabies vaccine and reduce your future risk.

Frequently Asked Questions

  • What is the timeline for rabies in humans?

    The timeline for rabies in humans starts with the incubation period after infection (30 to 90 days), then moves to the prodromal phase where symptoms start (2 to 10 days), then finishes with the acute neurologic period (2 to 10 days) which usually ends with death.

  • Can rabies be cured after initial symptoms appear?

    Once clinical symptoms start, rabies is almost always fatal, which is why it is important to get vaccinated as soon as you think you are exposed, and always vaccinate household pets.

  • What are the signs of a rabid animal?

    Rabid animals may shows signs of fear, aggression, salivating, difficulty swallowing, paralysis, and seizures. Animals may also exhibit uncharacteristic behaviors such as wandering around in daylight hours when the animal is typically nocturnal.

  • How quickly do you need to get a rabies vaccine after a bite to avoid being infected?

    Get the rabies shot as soon as possible, but ideally within 24-48 hours of exposure. If you have previously been vaccinated against rabies, you will need a second dose on 7 days after the first.

    If you have never been vaccinated against rabies, additional doses will also be needed on days 3, 7, and 14. You will also need an injection of rabies immunoglobulin (rabies antibodies) when you get the first dose of the vaccine.

  • How many people get rabies every year?

    Rabies is very rare in the United States, with only one to three cases a year.

    According to the World Health Organization, the virus causes approximately 59,000 deaths worldwide each year, with 95% of them in Africa and Asia.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Rod Brouhard, EMT-P
Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.