Rabies is an almost invariably fatal viral infection of the brain and spinal cord. The virus inhabits the nervous system of infected animals and humans and is shed in saliva.
So a bite, lick, or scratch by a rabid animal is the means of transmission.
In the U.S., principal vectors are wild animals, especially skunks, raccoons, coyotes, foxes, and bats. Domesticated animals, like cats and dogs, can carry rabies, but are usually vaccinated against it (and so not a risk). Dogs are the major vector in foreign countries. Any unvaccinated or sick animal lick, bite, or scratch, including from livestock and rodents warrants medical evaluation.
Post-rabies exposure treatment with injection of human rabies immunoglobulin (antibody), called HRIG, and a 4-dose series of rabies vaccine is nearly 100% successful in preventing rabies infection.
The average incubation period from contact with the virus is 2-8 weeks (range is 5 days to 7 years) and treatment to prevent it should be started as medically urgent (though not emergent).
Rensimer and Associates is one of only two practices and 9 facilities in Harris County where HRIG and rabies vaccine and the expertise to appropriately consider their use post-exposure to a rabid animal or pre-exposure (occupational and travel) are available. Medical insurance payors are increasingly denying payment for these services provided through hospital emergency rooms (and so hospitals are getting out of this business) because of the extreme charges for any ER visit and they do not consider this situation a legitimate medical emergency. These treatments are stocked here and our organization is trained to operationally expedite their application, including evaluating to what extent medical insurers will cover their expense. Because we daily immunize to rabies (80 – 100 individuals/year), it is highly unlikely an insurer will decline or otherwise contend with our position on the medical necessity of rabies immunization.