Rabies in Children

Rabies is a viral infection that affects certain warm-blooded animals. It's caused by a virus in the Rhabdoviridae family and attacks the nervous system. Once symptoms develop, it is 100% fatal in animals if left untreated.

In North America, rabies occurs mainly in skunks, raccoons, foxes, coyotes, and bats. In some areas, these wild animals infect domestic cats, dogs, and livestock. In the United States, cats are more likely than dogs to be rabid. However, rabbits, squirrels and rodents are very unlikely to be infected with the rabies virus.

Individual states maintain information about animals that may carry rabies. It is best to check for region-specific information if you are unsure about a specific animal.

Patients can be seen by Texas Children's experts in Infectious Disease.

Causes & Risk Factors

How does rabies occur?

The rabies virus enters the body through a cut or scratch, or through mucous membranes (such as the lining of the mouth and eyes), and travels to the central nervous system. Once the infection reaches the brain, the virus travels into the nerves and multiplies in different organs.

The salivary glands are most important in the spread of rabies from one animal to another. When an infected animal bites another animal, the rabies virus is transmitted through the infected animal's saliva. Scratches by claws of rabid animals are also dangerous because these animals lick their claws.

Humans with open scratches or sores may be exposed to rabies when these areas are licked by an animal infected by rabies. Humans also can be infected if secretions from an infected bat land on a mucus membrane (as when an infected bat is found in a room when the person is asleep).

Symptoms & Types

The time of exposure to the onset of illness can range anywhere from 5 days to more than a year, although the average incubation period is about 2 months. The following are the most common symptoms of rabies:

Rabies: Stage 1

• Initial period of vague symptoms, lasting 2 to 10 days
• Vague symptoms may include:
  • Fever
  • Headache
  • Malaise
  • Decreased appetite
  • Vomiting
• Pain, itching, or numbness and tingling at the site of the wound may occur

Rabies: Stage 2

• Children often develop difficulty in swallowing (sometimes referred to as "foaming at the mouth") due to the inability to swallow saliva -- even the sight of a glass of water may terrify the child.
• Some children become agitated and disoriented, while others become paralyzed.
• Immediate death, or coma resulting in death from other complications, may result.

The symptoms of rabies may look like other conditions or medical problems. Always consult your child's health care provider for a diagnosis.

Diagnosis & Tests

In animals, a test called direct fluorescent antibody test (dFA) is often used to detect rabies. Test results are usually known within a few hours. Knowing these results may save a child from undergoing treatment if the animal is not rabid.

In humans, a number of tests are needed to confirm or rule out rabies, as no single test can be used to rule out the disease with certainty. Tests are done on samples of serum, saliva, spinal fluid, and skin biopsies taken from the nape of the neck.

Treatment & Care

Your child's health care provider will determine specific treatment for rabies. Unfortunately, there is no known, effective treatment for rabies once symptoms of the disease occur. However, there are effective vaccines (HDCV, PCEC) that provide immunity to rabies when given soon after an exposure. Treatment for suspected exposure to rabies includes one dose of immune globulin and a series of shots of rabies vaccine over a 2-week period. Vaccination may also be used for protection before an exposure occurs, for persons such as veterinarians and animal handlers.

How can animal bites and rabies be prevented?

Being safe around animals, even your own pets, can help reduce the risk of animal bites. Some general guidelines for avoiding animal bites and rabies include the following:

• Keep pets in a fenced yard or on a leash when out in public.
• Select family pets carefully.
• Never leave a young child alone with a pet.
• Have your pets immunized against rabies and all shots kept current.
• Supervise pets so they do not come into contact with wild animals. Call your local animal control agency to remove any stray animals.

If a person is bitten by a domestic animal that can be observed for 10 days (the period during which the infected animal will become obviously ill) prophylaxis to the person can be delayed until this time period is over. In cases of exposure from a bat or other wild animal, if the animal can be caught and tested to determine if it is infected. If the animal has rabies, prophylaxis for the person should be started.

Teaching your child about animal safety may also help to prevent animal bites. Some things to remember include the following:

• Do not try to separate fighting animals.
• Avoid any strange or sick animals.
• Leave animals alone when they are eating.
• Do not approach or play with wild animals of any kind.

What facts need to be reported to your health care provider?

If you or someone you know has been bitten or scratched by an animal, remember to report the following facts to your health care provider:

• Location of the incident (backyard, forest, etc.)
• Type of animal involved (domestic pet or wild animal)
• Type of exposure (cut, scratch, licking of open wound)
• Part of the body involved (hand, leg, face, etc.)
• Number of exposures
• Whether or not the animal has been immunized against rabies (if known)
• Whether or not the animal is sick or well - if "sick," what symptoms were present in the animal
• Whether or not the animal is available for testing or quarantine

Do not attempt to capture a wild or sick-appearing animal that has bitten your child; animal control officers should be notified.