Rabies

In this episode of Current Vet, Dr. Lottie explains rabies, how it causes disease, the 3 phases of clinical signs and what we should do if we suspect a case

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Timeline:
00:00 Intro
00:31 Case
03:15 Aetiology & Pathogenesis
07:18 Clinical Signs
10:14 Diagnosis
13:15 Treatment
15:53 Prevention
20:11 Key Points
21:48 Outro

Recommended reading

• National Association of State Public Health Veterinarians (2016). Compendium of Animal Rabies Prevention and Control. Public Veterinary Medicine: Public Health.
• Small Animal Internal Medicine, Chapter 64 – Encephalitis, Myelitis, and Meningitis (pp. 1125–1126).
• WHO (2024). Expert Consultation on Rabies: Third Report (Technical Report Series No. 1012). Geneva: World Health Organization.
• WOAH (2023). Manual of Diagnostic Tests and Vaccines for Terrestrial Animals, Chapter 3.1.18 – Rabies
• Global Alliance for Rabies Control website. https://rabiesalliance.org

References

• Balcha, C. (2017) ‘Review of rabies preventions and control’, International Journal of Public Health Science (IJPHS). doi: 10.11591/IJPHS.V6I4.10781
• Coleman, P.G. and Dye, C. (1996) ‘Immunization coverage required to prevent outbreaks of dog rabies’, Vaccine, 14 (3), pp. 185–186. doi: 10.1016/0264-410x(95)00197-9
• National Association of State Public Health Veterinarians Compendium of Animal Rabies Prevention and Control Committee (2016) ‘Public veterinary medicine: public health — Compendium of animal rabies prevention and control’, Journal of the American Veterinary Medical Association, 248 (5), pp. 505–517. doi: 10.2460/javma.248.5.505
• Singh, R., Singh, K.P., Cherian, S., Saminathan, M., Kapoor, S., Reddy, G.B.M. et al. (2017) ‘Rabies – epidemiology, pathogenesis, public health concerns and advances in diagnosis and control: a comprehensive review’, Veterinary Quarterly, 37(1), pp. 212–251. doi: 10.1080/01652176.2017.1343516
• Rupprecht, C.E., Hanlon, C.A. and Hemachudha, T. (2002) ‘Rabies re-examined’, The Lancet Infectious Diseases, 2 (6), pp. 327–343. doi: 10.1016/S1473-3099(02)00287-6
• Small Animal Internal Medicine (2020) Chapter 64: Encephalitis, myelitis, and meningitis, pp. 1125–1126. 6th edn. St Louis: Elsevier Saunders.
• The Ecologist (2025) ‘Rabies in sea mammals (Cape fur seals, South Africa)’, The Ecologist, 14 July 2025. Available at: https://theecologist.org/2025/jul/14/rabies-sea (Accessed: 27 October 2025).
• U.S. Centers for Disease Control and Prevention (2025) ‘Rabies: Information for Veterinarians’. Available at: https://www.cdc.gov/rabies/hcp/veterinarians/index.html (Accessed: 27 October 2025).
• U.S. Centers for Disease Control and Prevention (2025) ‘Rabies Post-exposure Prophylaxis Guidance’. Available at: https://www.cdc.gov/rabies/hcp/clinical-care/post-exposure-prophylaxis.html (Accessed: 27 October 2025).
• Bautista-Alejandre, A. (2025) ‘CDC warns of rabies risks following Maryland feral cat outbreak’, DVM360. Available at: https://www.dvm360.com/view/cdc-warns-of-rabies-risks-following-maryland-feral-cat-outbreak (Accessed: 27 October 2025).
• World Health Organization (2018) WHO Expert Consultation on Rabies: Third Report (Technical Report Series No. 1012). Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/WHO-TRS-1012
• World Organisation for Animal Health (WOAH) (2023) *Manual of Diagnostic Tests and Vaccines for Terrestrial Animals,*Chapter 3.1.18 – Rabies. Available at: https://www.woah.org/fileadmin/Home/eng/Health_standards/tahm/3.01.19_RABIES.pdf.
• World Organisation for Animal Health (WOAH) (2025) ‘Rabies’. Available at: https://www.woah.org/en/disease/rabies/ (Accessed: 27 October 2025).
• World Health Organization and Global Alliance for Rabies Control (2025) ‘Global Alliance for Rabies Control’. Available at: https://rabiesalliance.org (Accessed: 27 October 2025)

Current Vet is an educational podcast intended for veterinary students, veterinary professionals, and individuals with an interest in veterinary medicine.

All content provided in this podcast and its associated materials is for educational and informational purposes only. It is not intended as, and must not be considered a substitute for, professional veterinary advice, diagnosis, or treatment.

Any clinical cases discussed in this podcast are fictional, and are designed to reflect typical or likely clinical scenarios for educational purposes. They do not represent specific real-life cases, clients, or animals.

While every effort is made to ensure accuracy and alignment with current evidence at the time of publication, veterinary medicine is a rapidly evolving field, and recommendations may change over time.

Creators and Guests

Host

Dr. Lottie Wilkinson

Creator and host of the Current Vet podcast

What is Current Vet?

The podcast that makes veterinary medicine simple.

In each episode, Dr. Lottie breaks down clinical conditions, cases, and concepts across species, focusing on pathophysiology, decision-making, diagnostics, and what actually matters in practice. It’s the kind of context that makes your knowledge finally click.

Every month, we’ll also have honest conversations with guests about the incredible variety of veterinary medicine, what you can do with a vet degree and how to think bigger about your career.

Whether you’re cramming for exams or looking for a soundtrack for your dog walk, Current Vet will make veterinary medicine simple

Intro

[00:00:00]

Hello, hello, and welcome back to a brand new episode of Current Vet. This is the podcast that makes veterinary medicine simple. I'm your host, Dr. Lottie, and today we're talking about one of the oldest known diseases, but one that still doesn't actually have a cure, and that is rabies. While it's close to being eradicated in a lot of countries, it still causes thousands of human and animal deaths every year, and it is a major public health concern.

Case

So definitely a condition we must be hot on as vets. So let's jump straight into our case. It is 10 45 on a Saturday night, and you are the vet on call when your phone rings. The owner says that she's really worried about her dog cocoa. She's never paved like this before, and she just bit her. You tell the owner to take a breath and explain what happened.

So basically, [00:01:00] cocoa is a 5-year-old female chocolate Labrador. She's usually very friendly and gentle, but the owner explains that. A couple of hours ago she started acting really oddly. She was pacing, whining, barking at nothing, and then suddenly growling and lunging when she tried to touch her. You ask if there's been any known trauma or toxin exposure. The owner says that she stays indoors except for when they're out on their walks. And about a month ago, she did actually get a small bite on her leg when she ran off in the woods. She says that they let cocoa off lead while on the walk and she disappeared into the trees for about 15 minutes. When she came back, she was limping slightly with a tiny puncture wound on her for they never saw what caused it.

No sign of another dog, a fox or wild animal. So they cleaned it at home and thought nothing of it because it healed over and everything seemed fine. Now, a month later, [00:02:00] cocoa is showing these behavioral changes, aggression and neurological signs. You ask if cocoa is up to date on her vaccines, and the owner says that she is not.

They meant to do it, but they didn't think it was important as that she doesn't really see any other animals. So you now have an unvaccinated dog showing acute neurological signs with a history of an unexplained bite wound and possible exposure to wildlife. And you must treat this as a suspected RA's case until proven otherwise.

You calmly explain to the owner what needs to happen next. So do not approach or attempt to restrain cocoa. Keep her confined in a secure room away from all other people and animals. Do not try to feed, touch or move her. Wash any bite wounds that you've sustained thoroughly and with soap and water for at least 15 minutes.

And then seek immediate [00:03:00] medical attention even if they think it's a minor bite. Make sure to explain to the doctor that there is a possible rabies exposure. You explain that this is a notifiable disease and that you'll need to report it immediately to the local health authorities.

Aetiology & Pathogenesis

So rabies is caused by the rabies virus, which is actually a member of the Rhabdo IDE family. And in the Lisa virus genus, it is an enveloped single stranded negative sense, RNA virus that is neurotropic, which means specifically targets nervous tissue and it can infect any warm-blooded species. So not just cats, dogs and wildlife.

It is most commonly transmitted via bites from infected animals and saliva containing the virus. Infect the bitten animal.

It can technically enter through mucus membranes, open [00:04:00] wounds, or actually really rarely aerosol exposure if you're in like a lab setting or like a really dense populated back cave. But these are obviously very rare. So bites are gonna be the main one to be aware of. Once inside the body, the virus initially replicates locally in the bitten tissue, and while this goes on, the animal will not show clinical signs of rabies.

The incubation period typically lasts two to eight weeks in dogs, but it can actually range from anywhere from a couple of days to months, depending on a couple of factors. So for example, how far away from the. Central nervous system, the bite is so bites closer to the central nervous system, leads to generally quicker progression to clinical disease.

The viral load transmitted from the bite, and then of course the host's immune response.
After replicating locally, the virus then spreads into peripheral [00:05:00] nerves via the neuromuscular junction. And once inside the neuronal axons, the virus is going to travel towards the spinal cord and brain. Once inside the central nervous system, the virus replicates causing encephalitis, which is inflammation of the brain.

After it's replicated in the central nervous system, the virus then kind of spreads outward again through the nerves to various tissues and especially the sali glands. So this is crucial because it enables that viral transmission. In saliva. There are three stages to disease progression with rabies. We have the

prodromal phase, the furious phase, and the paralytic phase, and we'll come onto the signs scene during each phase in a moment, but in a nutshell. Prodromal is the mild early signs furious phase is that classic aggressive [00:06:00] phase that we associate with rabies often, and paralytic is the final phase when the muscles start to become paralyzed, and we see that kind of characteristic frothy ruling, gross skunk.

once clinical signs have developed though rabies is almost invariably fatal in any species infected. Although many countries like the UK, Australia, parts of North America are considered rabies free, the disease remains endemic across a lot of the world, and infection persists in reservoir populations which maintain the infection in the environment.
So in developing countries, dogs are still big reservoirs of rabies and pose a risk to humans living alongside them. In North America, animals like raccoons, skunks, foxes, and bats are the key reservoir species. And in Europe it's foxes and bats. So this is why [00:07:00] rabies can be controlled, but eradication is really difficult.

'cause unless these reservoir populations are either immunized or controlled in some other way, the virus is always gonna have somewhere to hide and somewhere to spread from.
So next, let's talk about the clinical signs that we might see and how we're gonna recognize different stages of infection. So recognizing rabies in animals can be really challenging, especially in the early stages when signs are a bit vague and might be mistaken for other behavioral or neuro conditions.

But as we said before, there are gonna be those three phases of infection. So prodromal, the furious and paralytic Prodromal phase is gonna be the first couple of days of clinical signs. We might see subtle behavioral changes. Things like anxiety, restlessness, irritability, , pyrexia, we can see licking or [00:08:00] chewing at the bite site and kind of apprehension might be seen as well.

This is obviously different to the outright aggression that we're gonna see in the later phase. So the furious phase also called the. Encephalitic phase reflecting that, inflammation of the brain is gonna cause heightened aggression, snapping, unprovoked attacks. We're gonna see hypersensitivity to light, sound, and touch.

They have difficulty swallowing. We see drooling or apparent choking. And this can be due to pharyngeal paralysis. And then we often see things like wandering and vocalization, and there can be changes to the tone of the vocalization as the muscles of the larynx start to become paralyzed as well.

The third phase is the paralytic or dumb phase,

and this is when we're gonna see progressive paralysis, [00:09:00] weakness of limbs that. Dropped jaw, the characteristic frothy rule and voice changes. So for example, with dogs, we might hear a difference in the bark. Eventually the animal dies of cardiac arrest or respiratory failure.

When the respiratory muscles become paralyzed, and this usually occurs within seven to 10 days of the onset of clinical signs. It is important to note though that not all animals show every single stage. Some may skip directly to the paralytic phase and others show only subtle signs.

Cats tend to be a bit more intense, a bit more aggressive, hyperactive.

They can be hissing, attacking, and hiding away for no reason. Large animals like cows and horses often show more subtle or paralytic signs. In cows we can also see bellowing, excessive vocalization, and then ataxia and [00:10:00] weakness

wild animals actually often present with a kind of loss of fear of humans. They appear a bit disorientated. Or for example, we might see diurnal activity in a nocturnal species.

Diagnosis

Diagnosing rabies is not like diagnosing almost any other infectious disease in Vet Med because it is a potential public health emergency. So if rabies is suspected. Safety reporting and containment are gonna be the main priorities. It's not gonna be taking samples and running diagnostics, so let's walk through what a vet would have to do if they suspect a case of rabies.

The first steps are gonna be do not touch, do not examine, do not approach the animal, isolate them, report the case, and the authorities will coordinate the situation, advise next steps on quarantine, and determine which [00:11:00] testing or euthanasia procedures should be followed.

Unfortunately, definitive diagnosis of rabies can only be made postmortem. There are no reliable antimortem tests to confirm or rule out infection. So for definitive lab tests, this is traditionally done by authorities.

But the gold standard is the direct immunofluorescent antibody test, and that is gonna be done on fresh brain tissue. So this test is gonna detect the rabies viral antigen using fluorescent labeled antibodies that are specific to the antigen.

Other confirmatory tests that could be done are R-T-P-C-R to detect the viral RNA immunohistochemistry or histopathology to identify neg bodies. Samples are always collected by trained, authorized personnel using really [00:12:00] strict biosecurity protocols. And you should never be taking these samples yourself.

You should only ever do so if instructed to do it by the authorities. So step three is gonna be the human exposure assessment If in a case. A person has been bitten, scratched, licked on broken skin or mucus membranes by a suspected infected animal. The situation basically becomes a medical emergency.

The vet's role is to document the event. Including the vaccination status of the animal and details of exposure, notify the public health authorities immediately and advise the person to seek medical care urgently for post-exposure prophylaxis. This has to be started before symptoms appear in order to be effective.

So this is something we need to be able to explain well to our clients if there is a risk of exposure. For humans that [00:13:00] PEP is gonna include thorough wound cleaning for at least 15 minutes with soap and water. The rabies vaccine series is gonna be started as soon as possible, and the rabies immunoglobulin is gonna be infiltrated in and around the wound,

Treatment

so the reality rabies is that once clinical signs appear, there is no effective treatment for animals or for humans. So that's why that early identification, strict biosecurity, and good prevention, so especially our vaccinations are gonna be absolutely essential.

The priority is to protect human and other animals' health. By reporting the case, isolating the animal, and avoiding all contact

official authorized personnel will assess the situation. And decide between euthanasia and postmortem testing or strict quarantine under official supervision.

Okay. Let's quickly [00:14:00] talk through some of the other kind of monitoring options for animals in different situations. So obviously cocoa is unvaccinated, is showing signs and has bitten her owner. So euthanasia is the only option in that case. But if any animal is suspected to have rabies and is showing clinical signs, they must be euthanized.

And this is for public health reasons, for animal welfare. The condition is. Invariably fatal once they have started showing clinical signs, and that is gonna be a really horrible death for the animal. So obviously, not only is it public health concerns, but it is also animal welfare. If the animal is unvaccinated, but not yet showing signs and has potentially been exposed to rabies euthanasia, or a four to six month quarantine in an authorized facility is gonna be required.

The owner can request quarantine over euthanasia, but can't opt out of both of these options. [00:15:00] If an animal is vaccinated and bites a human attend, 30 day quarantine is required to monitor for clinical science developing. If a vaccinated animal is bitten, scratched, or potentially exposed to rabies, then around 30 day quarantine is recommended just to monitor for any clinical signs developing.

So depending on the case, the authorities will assess the situation and decide between euthanasia and postmortem testing or strict, strict quarantine If the animal is healthy, not showing clinical signs and the risk is deemed low.

So for cocoa, as an unvaccinated dog showing neurological aggression where the history of an unknown bite, and now having bitten her owner euthanasia and post-mortem testing are gonna be the required course of action.

Prevention

So what can we do to [00:16:00] prevent infections in animals? First up is of course, vaccination vaccine requirements are gonna vary across the world depending on how much of a risk rabies poses to pets. So for example, in the United States, rabies is a required vaccine for all cats and dogs. But in the United Kingdom, there is no requirement for pets to be vaccinated as it is classed as a rabies free country.

However many animals traveling into or out of the UK must have the rabies vaccine before traveling so the country can maintain its rabies free status. So for countries where rabies vaccines are required. Dogs and cats should receive their first rabies vaccine at 12 to 16 weeks old, followed by a booster at 12 months.

They then receive another booster every one to three years depending on the the vaccine type and local regulations. Ferrets, horses, and [00:17:00] livestock in at-risk regions should also be vaccinated, especially if they have outdoor access or any possible contact with wildlife. In endemic regions, mass community vaccination campaigns are extremely effective.

Herd immunity can be achieved by vaccinating at least 70% of the population. So this is gonna break the cycle of transmission, both for animals and for people.

Some countries have now started programs for mass immunization of wildlife with an oral vaccine. So this is only available currently for government organizations and programs, not regular vets, but these vaccines are hidden in. Baits and have been very successful in several wildlife species. So species like foxes, coyotes, and raccoons.

And this is a really wonderful advancement in rabies control. As before these oral vaccines were used, a lot of limiting transmission from wildlife [00:18:00] reli on population control and culling. So an oral vaccine is a much, much better option compared to those.

in addition to vaccines, we're gonna avoid contact with wildlife. So make sure owners know to keep their pets on, lead in a high risk area. Avoid contact with. Species like bats, foxes, raccoons, and definitely stray dogs. Also to report any abnormal wildlife behavior. So we use that example of a nocturnal species being active during the day.

Um, any species showing unusual aggression, reporting those to authorities can really help.

For humans, we need to be making sure that we get pre-exposure vaccines for anyone working high risk jobs, so. As vets and vet students, we should be vaccinated. People like animal control offices, lab staff, those who handle wildlife, and people living or traveling to countries where rabies is [00:19:00] endemic should be vaccinated as well.

And then any person who's potentially infected or has had contact with a suspected rabies animal, They must undergo post-exposure prophylaxis. So there are three components to this. As we said before, that wound cleansing, the immunoglobulins and the vaccination schedule as well.

Although we have had a lot of really great developments with mass vaccination campaigns, there has been one kind of concerning development in South Africa, and that is that we've got confirmed rabies cases in Cape First Seals, and this is the. Actually the first confirmed rabies outbreak in marine mammals, and these cases were detected along the Western Cape in South Africa back in 2024.

And necropsy and PCR did confirm rabies virus. So this just kind of highlights the adaptability that [00:20:00] these viruses have and the importance of good surveillance even in. Species and ecosystems that we thought were quite low risk.

Key Points

Before we finish, let's quickly go through the key points that you have to know about rabies. So rabies is caused by a neurotropic lists of virus that infects almost all mammal species. And once clinical signs appear, it is pretty much a hundred percent, it's 99.99. Nine nine 9% fatal.

So it's called a hundred percent. It's fatal transmission occurs primarily through bites and transfer of saliva. The virus then travels along the nerves to the brain and the sali glands. Clinical signs are gonna vary depending on the stage of disease, but generally progress from subtle behavioral [00:21:00] changes into aggression, and then eventually to paralysis and death.

There is no treatment , and control relies on good vaccination. Rapid reporting of suspected cases and good coordination between public health authorities and that any suspected cases must be reported immediately. Do not handle the animal, report them to the relative authorities isolate the animal, and prevent all contact with them. For humans who have potentially been exposed they must immediately go and get post-exposure prophylaxis, which is very effective if given before symptoms start.

And then for prevention, vaccination is going to be the key

Outro

and that is rabies. So even though many of us will. Fingers crossed, hopefully never see a case. Understanding rabies and how to handle different situations is [00:22:00] essential so we can play our role in protecting one health.

thank you so much for listening to this episode of Current Vet. If you found it helpful, please follow or subscribe wherever you get your podcasts. It's gonna really help us reach more people. Share it with any friends or colleagues who might need to hear this episode.
You'll find all our references, any further reading linked in the show notes. And if there's a topic you'd like me to cover next, then let me know in the comments or find us on Instagram and TikTok at Veterinary Vista. See you next time.