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You dropped your compass near a fallen tree. Absentmindedly, you reach under the decaying log to retrieve it,  and a guttural growl is followed by a stinging bite. You jerk back your bloody hand to discover six puncture marks and a small flap of torn skin gushing blood. lacking a proper first aid kit, you wrap the wound in a scrap of a torn t-shirt and quickly start back to camp. You don’t know it now, but you have rabies… if you don’t get help soon, you will painfully slip into a coma and eventually die.

WHAT IS RABIES?

Popular culture suggests rabies is the harbinger of the zombie hoard, as a bite from an infected person will quickly spread the virus to others…which is sort of true. All it takes is a single bite where infected saliva gets into a new host’s blood stream; however, it is extremely rare for humans to contract rabies from other humans (the only known cases have involved cornea transplant patients). Rabies is generally a zoonotic virus—meaning it is only transmitted from animals to humans— and it attacks the central nervous system, causing acute encephalitis (inflammation of the brain).

Diseases are classified the same way animals are (genus, family, order, etc.). The rabies virus is classified as part of Group V of the RNA-type viruses in the Rhabdoviridae family, which include vesicular and encephalitis-related diseases. It resides in the Lyssavirus genus of diseases, which gets its name from Lyssa, the Greek goddess of madness and rage. In fact, rabies means “madness” in Latin.

There are two types of rabies, furious rabies and paralytic rabies, that can occur together, by themselves or in stages (usually furious develops into paralytic when untreated). Furious Rabies is the stereotypical type of rabies, where infected animals (and people) will be easily excitable, hyperactive, erratic, foaming at the mouth, and experience hallucinations that may lead to aggressive behavior.

“…if you don’t get help soon, you will painfully slip into a coma and eventually die.”

Paralytic Rabies is slow to take effect but just as serious as Furious. As the name suggests, those infected slowly become paralyzed from the bite location outwards. They will be unable to move or control their muscles. They will eventually slip into a coma and die.

HOW CAN YOU GET RABIES?

Rabies is transmitted through the bite or scratch of an affected animal. Where you are in the world determines the primary animal of transmission. In Asia and parts of northern Africa, rabid dogs are the primary source of the rabies virus because of the lack of animal vaccines and the prevalence of keeping animals as pets without proper preventative medical care, while in the United States, it is the bat that most spreads the virus to humans.

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However, from 1995 to 2013, the Centers for Disease Control (CDC) reported only 49 deaths nationwide due to rabies, and all but 15 of those cases were because of a bat (there were 12 dogs — none contracted inside the U.S. —one fox, one mongoose, and one unknown). According to the World Heath Organization (WHO), over 14 million people contract rabies every year, and before Louis Pasteur and Emile Roux developed the vaccine in 1885, all human cases of rabies were painfully fatal.

Today, an average of only 55,000 people die of rabies worldwide, and most of those are due to lack of proper treatment and misdiagnosis of the disease. Ninety-nine percent of these deaths are in developing countries, mostly in India, Southeast Asia and Central Africa. From WHO: “Poor people, especially children, are at highest risk of dog rabies. About 30 to 60 percent of the victims of dog bites (the primary mode of virus transmission) are children less than 15 years of age. Children often play with animals and are less likely to report bites or scratches.”

Animals That Host Rabies

Most wild and domestic mammals are able to host and transmit the rabies virus, while some are more prevalent than others. The rabies virus is available in several distinct strains that populate certain animals, making them more or less potent when affected. Squirrels, hamsters, guinea pigs, rats, mice, and other small rodents, for example, are almost never infected with rabies and there has never been a case of them transmitting rabies to humans.

Bats: In the United States, the bat is the leading cause of the spread of rabies since it was discovered they carry the disease in 1931. It was also noted that the rabies virus could be transmitted through the air in heavily populated caves. In 2006, 950 Girl Scouts were given vaccinations after reports of bats flying in their cabins during a camp in Virginia. GSA paid for the vaccines, costing nearly $2 million.

Cats: They are more likely to contract rabies than are dogs (three to one), as they are usually given free reign to travel in and out of their owner’s yard, thereby putting themselves in a higher risk to come into contact with wild animals that carry the disease.

Raccoons, Skunks, Opossums: There is currently no USDA-approved vaccine for the strain of rabies that affects skunks, for example, so a bite from a skunk must be treated with urgency (capturing the skunk so it can be tested is very important). Infected raccoons, on the other hand, have been growing in numbers on the East Coast and account for 50 percent of all animal rabies cases in the U.S. since 1990, peaking in 1992 with nearly 6,000 infections reported.

Other animals in the United States that may have rabies are: cows, ferrets, goats, horses, rabbits, beavers, coyotes, foxes, monkeys, and woodchucks.

In the United States, death by rabies is a very rare occurrence. For example, the Maryland Department of Health and Mental Hygiene reported in March 2013 of the first death from rabies in its state since 1976, while in August 2011, a U.S. Army soldier in New York complained of arm and shoulder pain, nausea, anxiety, and dysphagia and later died of rabies (from a dog bite while he was stationed in Afghanistan), the first U.S. soldier to do so since 1974 (and that was in Vietnam).

While dogs are historically associated with the rabies virus, there are more cats afflicted with rabies in the U.S. each year than dogs (three times more) because of their proclivity to wander in and out of wildlife zones. More than 90 percent of the rabid animals reported to the CDC are from wildlife such as raccoons, skunks, foxes and bats. There is an estimated 40,000 Americans who receive a rabies prevention treatment called Post-Exposure Prophylaxis (PEP) due to a potential exposure to rabies.

Rabies by the Numbers
 

40,000
People in the U.S. treated for rabies each year

55,000
People who die from rabies worldwide

20,000
Annual deaths in India alone

$300 MILLION
Cost to treat rabies in the U.S.

99
Percentage of deaths in Asia and Africa

92
Percentage of rabid animals that are wild

303
Number of rabid cats reported in 2010 in the U.S.

69
Number of rabid dogs reported in 2010 in the U.S.

8,000
Number of rabid animals found annually in the U.S.

$1,500
Cost of a rabies PEP treatment after exposure

2010 
Reported Cases of Rabies in Animals  

SPECIES

NUMBER

Raccoons

2,246

Skunks

1,148

Bats

1,430

Foxes

429

Cats

303

Cattle

71

Dogs

69

Groundhogs

32

Bobcats

30

Coyotes

11

Fishers

3

Opossums

3

Beavers

2

White-tailed Deer

2

River Otters

2

Squirrels

2

Cougars

1

Muskrats

1

Rabbits

1

Ringtail Cat

1

Wolf

1

HOW RABIES AFFECTS YOU

A small bite by an infected animal releases a virus into your bloodstream that quickly gets to work attacking your nervous system in a very methodical way. The symptoms are slow in showing themselves, and the virus can incubate for up to a year. Long after you’ve returned home, days, months, sometimes even years, you might begin to display an erratic behavior that even you don’t understand.

Once inside a muscle or nerve cell, the virus begins to quickly replicate itself in a way that goes mostly unnoticed by the nervous system (near the bite area). Since the rabies virus is neurotropic, it finds and travels along the nervous system pathways until it reaches the central nervous system. There it causes encephalitis, a swelling of the brain, which is the first noticeable symptom.

You’ll become irrational, confused, delusional, hyperactive. You’ll have a sudden fear of water, but can’t stop salivating a foamy spit that’s dribbling down your chin. From the burning sensation at the bite mark will spread a tingling numbness. Shortly, your throat will becomes paralyzed and you can no longer swallow. You will have trouble walking, keeping your balance, and your muscles begin to throb in a twitching ache with even the slightest movement. You’ll soon lose muscle control.

“You’ll become irrational, confused, delusional, hyperactive. “

You’ll experience headaches, seizures, confusion, and paralysis. After the brain is infected, the virus travels to the salivary glands, where it is poised to be transmitted to its next victim.

WHAT CAN YOU DO (ONCE YOU ARE BITTEN)?

Because of the rabies vaccination and Americans’ socio-economic ability to vaccinate their pets, the rabies virus has been secluded into the wilderness. The odds of you getting rabies is extremely remote, but there are thousands of cases of suspected rabies that are treated each year from Americans travelling abroad, costing around $300 million in health costs.

Because the disease is very hard to diagnose without symptoms and once symptoms have appeared it is too late to treat, it is important to contact a doctor immediately after any animal bite, even from a pet, but especially from a wild animal.

Thoroughly washing the wound with soap and warm water for at least 10 minutes might reduce the virus in the wound and around the bite mark. Like a snake bite, stay calm to keep your heart rate to a minimum. Get to an emergency room as quickly as possible. Once there, they will administer a series of post-exposure prevention shots, repeated injections of the rabies vaccine and immunoglobulin, an antibody.

Symptoms to be looking for are fever, muscle weakness, tingling and burning at the bite mark, but remember that once you see these symptoms, there is very little chance you will survive.

The Milwaukee Protocol

In 2004, Jeanna Giese contracted rabies when she was 15 years old after picking up a bat found outside her church in Fond du Lac, Wisconsin. Lacking education about rabies, her parents washed the wound and did nothing else. Three weeks later, Jeanna was experiencing the symptoms of rabies (she couldn’t speak, stand, or walk), and it was too late to administer the anti-rabies vaccine. She was going to die. However, her doctor decided to induce her into a coma to stall the rabies from attacking her body and allow her immune system to build up its own antibodies. They had no idea if it would work or not, but after a week, tests showed that her body was beginning to fight the rabies.

Jeanna Giese is the first person in the world to have survived the rabies virus; since 2004, there have been four others. The procedure is called the Milwaukee Protocol and was developed by Dr. Rodney Willoughby Jr., Jenna’s doctor. Further tests and evaluations of the controversial procedure suggest that the survivability rate is very low, as only five out of 36 people have survived post-symptomatic rabies under the Milwaukee Protocol.

PREVENTIVE MEASURES

Like any potential survivor’s situation, it is always a good idea to be proactive when you are bitten or scratched by any wild animal, regardless if you think it has rabies or not, especially avoiding raccoons, bats, foxes, and skunks. Several animals can be a host of the virus but not display any of the characteristics of having it.

When in an area where wild animals are prevalent, avoid coming into contact with them. If you see one acting strangely, contact the authorities.

Editor’s note: A version of this article first appeared in the October 2015 print issue of American Survival Guide.