- Rabies is caused by infection with rabies virus, or other lyssaviruses including Australian bat lyssavirus (ABLV), and is acquired from animals.
- Rabies and ABLV may be transmitted by the bite or scratch of an infected animal, but may result from licks to broken skin, saliva on mucous membranes and through organ transplantation.
- People should avoid potential exposure by avoiding contact with domestic and wild animals, particularly bats anywhere in the world, and dogs, cats and monkeys overseas.
- People who are planning long term travel to areas where rabies is known to occur, or people whose occupation or activities puts them at high risk of exposure (such as veterinarians or wildlife carers) should consider vaccination and discuss with their doctor.
- If potentially exposed to rabies or ABLV, it is extremely important that appropriate treatment commences immediately. Incorrect or incomplete treatment can be fatal.
- There may be limited supplies of some components of the treatment overseas and in Australia, so it is much safer to avoid animal contact.
What are rabies virus, ABLV and other lyssaviruses?
Rabies virus and ABLV belong to a group of viruses called lyssaviruses. All lyssaviruses cause a similar illness known as rabies, which affects the central nervous system and is usually fatal.
Rabies virus does not currently occur in land dwelling animals in Australia but ABLV does occur in bats in Australia, and can be transmitted from bats to humans and to other animals. Only three cases of human infection with ABLV have been recorded since the virus was first identified in 1996. All cases were in Queensland and all died as a result of ABLV infection after being bitten or scratched by bats.
Rabies is most frequently associated with canid animals; dogs, foxes and related species, but monkeys can also be infected, and an outbreak has recently been reported amongst ferret badgers in Taiwan.
What are the symptoms of rabies?
There is a wide variability in the time it takes for symptoms to appear following exposure to an infected animal (from several days to several years) and treatment with post-exposure prophylaxis comprising rabies immunoglobulin (RIg) and/or vaccine can prevent the illness.
Once symptoms begin, rabies and ABLV are almost invariably fatal. The early symptoms of rabies are flu-like, including headache, fever and fatigue. The illness progresses rapidly to paralysis, delirium, convulsions and death, usually within a week or two of the onset of illness.
How are rabies virus and other lyssaviruses spread?
Rabies virus and other lyssaviruses (including ABLV) are spread from infected animals to people through bites or scratches, or by being exposed to infected animals’ saliva through the eyes, nose or mouth. Only mammals can be infected. Dogs are the main source of human cases of rabies. Other animals that transmit rabies include bats, foxes, cats, raccoons, skunks, jackals and mongooses. Monkeys may be able to transmit rabies, but the risk is low. Rabies has also been spread through organ transplantation.
In Australia, evidence of ABLV infection has been found in various species of flying foxes/fruit bats and insect-eating microbats. It is assumed that any bat in Australia could potentially carry ABLV. The behaviour or appearance of a bat is not a readily interpreted guide as to whether it is carrying the virus.
Contact or exposures to bat or other animal faeces, urine or blood do not pose a risk of exposure to lyssaviruses, and nor do living, playing or walking near bat roosting areas.
Who is at risk?
People who handle bats in Australia or overseas, and people who come into contact with wild or domestic land dwelling mammals (especially dogs, cats and monkeys) in a country where there is a rabies virus risk, are at increased risk of rabies.
How is rabies prevented?
The best protection against being exposed to rabies or other lyssaviruses (including ABLV) is to avoid handling any bat in Australia or overseas, or any wild or domestic land dwelling mammal in a country where there is a rabies virus risk:
- Do not feed, pat or play with animals while overseas, especially in areas where rabies is known to occur.
- In particular, avoid contact with stray dogs and cats while overseas.
- Avoid contact with bats anywhere in the world, including Australia, even if you want to help a sick or injured bat.
- It is not safe to handle bats unless you are properly trained, vaccinated and equipped.
- Injuries often occur when untrained and unvaccinated people attempt to aid a bat that may be injured or on the ground for some reason.
- Do not carry food, and do not feed or pat monkeys, even in popular markets, tourist destinations and sanctuaries where tourists may be encouraged to interact with monkeys.
- Preferably avoid venues where monkeys are known to have direct access to people.
- Monkeys may bite or scratch without warning in their search for food.
If you intend to work in or travel to a country or countries where there is a rabies virus risk, or if you are likely to come into contact with bats in Australia, you should discuss the need for vaccination with your doctor.
What is the treatment for people who may have been exposed?
If you are bitten or scratched by a bat anywhere in the world or by a land dwelling mammal overseas, you should:
- immediately wash the wound thoroughly with soap and water for at least five minutes. Proper cleansing of the wound reduces the risk of infection.
- apply an antiseptic with anti-virus action such as povidone-iodine, iodine tincture, aqueous iodine solution or alcohol (ethanol) after washing.
- seek medical attention as soon as possible to care for the wound and to assess whether you are at risk of infection.
If you may have been exposed to rabies or ABLV and have not been vaccinated previously, you will require an injection of RIg as soon as possible and a series of rabies vaccine injections. RIg is a preparation containing antibodies from people who have previously been vaccinated. As much as possible of the required RIg dose is injected into the wound, and the remainder in a muscle elsewhere in the body. You will require two booster doses of vaccine even if you have previously been vaccinated.
Shortage of RIg for treating possible exposures
RIg and rabies vaccine are in short supply globally. The number of Australians potentially exposed both at home and overseas that require treatment has increased markedly in recent years, creating the need to ration limited supplies from time to time when demand exceeds supply.
It is important to reduce the number of potential exposures to avoid the risk of infection, and to ensure that there are sufficient supplies of RIg to treat everyone who needs it. More than half of all exposures overseas occur in the tourist destination Bali where Australians frequently travel. Bites or scratches from monkeys are a low risk for disease transmission, but comprise nearly 50% of all potential exposures of Australians that require treatment with RIg. Australians travelling to Bali are frequently exposed to monkey bites and scratches. Exposures involving bats, dogs and cats occur less frequently but are considered a higher risk for transmitting the disease.
How is rabies diagnosed?
Diagnosis requires confirmation by laboratory tests for the presence of lyssaviruses.
How is rabies treated?
There is no available treatment for rabies once symptoms have started.
What is the public health response?
Public health units in the states and territories will help arrange vaccination following exposure and rabies immunoglobulin where required. Public health unit staff will investigate the likely source and the circumstances of the exposure and determine whether others may be at risk of infection.
Doctors should contact their local public health unit for advice on people who may have been exposed. Hospitals and laboratories will notify cases of rabies to the local public health unit.
The rabies and ABLV Series of National Guidelines document developed by the Communicable Diseases Network of Australia provides information guidance for health professionals in responding to possible exposures to rabies/ABLV, and is available from The rabies and ABLV Series of National Guidelines (http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-abvl-rabies.htm).
The Australian Immunisation Handbook provides further information on vaccine and RIg. For more information visit The Australian Immunisation Handbook (http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home).
For further information, please contact your local doctor or nearest public health unit.