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If Cute, Why Dangerous?

Written by Kaja Carlsen-Brown, Edited by Olivia McCollum

Introduction - What is rabies?

It may be tempting to pet the adorable, tail-wagging dog on the side of the street that appears to be completely harmless. However, there is a possibility that the dog has been infected by the dangerous rabies virus. Rabies is a zoonotic virus, meaning transmission to humans comes from animals. The time from exposure to symptoms, the incubation time, is unpredictable and the symptoms of rabies vary between infected individuals.1 The virus can be lethal, and thus taking precautions against contracting the virus, knowing how to approach a potential infection, and being aware of the signs and symptoms of rabies in animals are vital to saving your life.  


Symptoms and disease 

Rabies is a deadly virus with a fatality rate of 100% once it reaches the central nervous system.2 New research suggests that the rabies virus targets neurons by entering the cells and disrupting normal neuron function to promote cell death.3 Rabies usually enters the body when saliva comes in contact with skin ruptures, primarily caused by bites or scratches from an infected animal.2 The incubation period varies between locations of infection on the body and from person to person, as some show symptoms after a couple of weeks and for others it can take years.4 However, by the time the virus reaches the central nervous system, it will be too late to attempt treatment and the typical rabies symptoms begin to appear.2 After an asymptomatic incubation period, caused by the ability of rabies to avoid detection by the immune system, flu-like symptoms emerge.5,2 Thereafter, severe symptoms that are more commonly associated with rabies, such as hydrophobia and muscle spasms, begin. There are two common severe symptom categories that can occur, found in both humans and animals. These are quiet, and excited, depending on the immune response, infection site and virus quantity in the central nervous system.6 Patients with the excited form of symptoms typically have a weaker immune response, infection site close to the central nervous system, or a higher viral abundance, leading to more severe symptoms, compared to those with the quiet form of symptoms.6 Humans and animals with quiet rabies symptoms often experience paralysis, weakened muscles and eventually coma, whereas those with the excited type of rabies experience symptoms more commonly associated with the virus, including hallucination, frothing at the mouth, aggression, drooling, and fear, especially of water. The final symptom of rabies for both categories is death.2  


Rabies worldwide 

Most cases of rabies infections in humans globally are caused by dogs.7 Any warm-blooded animal can transmit the virus, and the main reservoirs of the disease vary between geographical areas.4 An animal that harbors the pathogens, with or without experiencing symptoms but still able to infect others, is known as a reservoir. Rabies has a wide variety of reservoirs, which contributes to spreading and spillover to humans. Dogs are the main reservoirs of rabies in northern Africa and Asia, whereas bats, foxes, skunks, and jackals dominate the rest of the world with exception of Western Europe, which is considered rabies-free.7 This discrepancy is due to the strict regulations and vaccination programs of both domesticated and wild dogs, raccoons and foxes in the European Union.8 The rabies virus thrives in environments with lower altitude, higher humidity, and higher temperatures allowing greater spread.9 In these environments people wear less clothing and show more bare skin, which also increases the transmission risk for rabies from animal to human.9 Due to historical and social connections between humans and dogs, people are often more comfortable with interacting with dogs, leading to increased rabies transmission. This is why areas with these types of climates and a high abundance of stray dogs, such as Africa and South Asia, are places with the most reported cases. The World Health Organization (WHO) estimates that 95% of rabies cases occur in Africa and Asia where almost all cases are reported to originate from dogs.10 This is directly related to optimal environments for rabies, high abundance of stray dogs as well as less stringent regulation of vaccinations.10


Precautions, preventive measures and treatment 

There are several approaches to prevent a potential rabies infection. The most important method is vaccination of dogs, both stray and domesticated. Therefore, in many countries vaccination is mandatory.11 For humans, pre-exposure prophylaxis (PrEP) is highly recommended before entering a high rabies risk area, especially if there are limitations in getting rapid treatment in the area, such as in remote locations. PrEP is administered as a set of injections with inert viral components, much like a vaccine. This controlled repeated exposure creates an immune response within the body that reduces the likelihood of rabies infection should that person be exposed.12 While vaccination and PrEP can be helpful in avoiding the disease, the best way to avoid contracting rabies is to avoid any contact with unknown animals.


After a bite or a scratch from an animal, it is important to be treated as soon as possible. This treatment is post-exposure prophylaxis (PEP), which is an effective treatment provided by the closest health department.13 The appropriate PEP treatment is determined by the severity of the bite or scratch in the given situation. Regardless of severity and access to medical providers, the first step is to administer first aid and disinfect the wound, by thoroughly flushing and washing the wound for at least 15 minutes with soap and water or an antiviral agent, such as detergent or povidone iodine.13 This has to be done immediately after the bite or scratch has occurred. In case of an affected skin breach a medical provider will give the rabies vaccine, which allows the body to make a stronger defense against the virus by producing rabies-specific antibodies. If the scratch or bite is severe, there will be a need for an injection of prepped antibodies that can fight the virus before it reaches the central nervous system.14 The WHO suggests that over 15 million people receive PEP annually and 55,000 people die from rabies infections.10 Almost all patients who receive PEP survive, depending on how far the virus has reached in relation of the central nervous system.15 The unpredictable incubation time demonstrates therefore the importance of rapid PEP treatment for an increased chance of survival. 


Conclusion 

Being aware of the dangers of rabies and the symptoms is crucial as it can save your life. This includes researching high risk areas for rabies infections and the availability of PEP in that area when planning a foreign trip. Even though PrEP and PEP are proven to be effective treatments, recovery is not guaranteed. Considering the lethal and severe consequences of a rabies infection the wisest thing to do is to avoid contact with all unknown animals, especially in areas with endemic rabies. As you now approach the adorable, tail-wagging dog on the side of the road with your knowledge and observe it, you step aside and call animal control because this dog is frothing at the mouth and has muscle spasms, meaning it could be infected by rabies.

References 

  1. Anderson S, Manikkavasagan G, Roberts D. Definitions including: incubation, communicability and latent period; susceptibility, immunity, and herd immunity. Faculty of Public Health. Published 2016. Accessed April 6, 2026. https://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2g-communicable-disease/definitions-disease-control 

  2. Chen SJ, Rai CI, Wang SC, Chen YC. Infection and Prevention of Rabies Viruses. Microorganisms. 2025:13(2):380. doi: 10.3390/microorganisms13020380. 

  3. Yu D, Jin R, Liu J, Zhang C, Duan C, Luo X, Yang W, Liu C, Liang J, Li X, Luo T. Rabies Virus Infection Causes Pyroptosis of Neuronal Cells. International Journal of Molecular Sciences. 2024;25(11)5616. doi: 10.3390/ijms25115616.

  4. Singh R, Singh K, Cherian S, Saminathan M, Kapoor S, Reddy GBM, Panda S, Dhama K. Rabies – epidemiology, pathogenesis, public health concerns and advances in diagnosis and control: a comprehensive review. Veterinary Quarterly. 2017;37(1):212-251. doi: 10.1080/01652176.2017.1343516. 

  5. Ito N, Moseley GW, Sugiyama N. The importance of immune evasion in the pathogenesis of rabies virus. The Journal of Veterinary Medical Science. 2016;78(7):1089-1098. doi: 10.1292/jvms.16-0092. 

  6. Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, Shuangshoti S, Laothamatas J. Human rabies: neuropathogenesis, diagnosis, and management. The Lancet Neurology. 2013;12(5):498-513. doi: 10.1016/S1474-4422(13)70038-3.   

  7. U.S. Centers for Disease Control and Prevention. Global Rabies: What You Should Know. U.S. Centers for Disease Control and Prevention. Published July 1, 2025. Accessed March 10, 2026. https://www.cdc.gov/rabies/around-world/index.html 

  8. Müller FT, Freuling CM. Rabies control in Europe: an overview of past, current and future strategies. Scientific and Technical Review. 2018;37(2):409-419. doi: 10.20506/rst.37.2.2811.

  9. Subedi D, Chandran D, Subedi S, Acharya KP. Ecological and Socioeconomic Factors in the Occurrence of Rabies: A Forgotten Scenario. Infectious disease reports. 2022:14(6):979-986. doi: 10.3390/idr14060097. 

  10. Strand P. The Global Stray Dog Population Crisis. National Animal Interest Alliance. Published November 17, 2011. Accessed March 16, 2026: https://www.naiaonline.org/articles/article/the-global-stray-dog-population-crisis-and-humane-relocation

  11. California Department of Public Health. Rabies. California Department of Public Health. Last updated February 11, 2025. Accessed April 6, 2026. https://www.cdph.ca.gov/Programs/CID/DCDC/pages/rabies.aspx 

  12. Kessels JA, Recuenco S, Navarro-Vela AM, et al. Pre-exposure rabies prophylaxis: a systematic review. Bulletin of the World Health Organization. 2016:95(3):210-219C. doi: 10.2471/BLT.16.173039.

  13. World Health Organization. Control of Neglected Tropical Diseases. World Health Organization. Date unknown. Accessed March 16, 2026. https://www.who.int/teams/control-of-neglected-tropical-diseases/rabies/vaccinations-and-immunization

  14. World Health Organization. Rabies vaccines: WHO position paper – April 2018. World Health Organization. Published April 20, 2018. Accessed March 16, 2016. https://iris.who.int/server/api/core/bitstreams/b3f08b00-3107-4643-a0b2-b473f9599540/content   

  15. U.S. Centers for Disease Control and Prevention. About Rabies. U.S. Centers for Disease Control and Prevention. Published January 27, 2026. Accessed April 6, 2026. https://www.cdc.gov/rabies/about/index.html.

This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research are constantly evolving. This post contains information that was last updated in May 2026.


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