Rabies (dog bite)
Also called: rabies after dog bite, hydrophobia, dog bite rabies, animal bite rabies
Rabies is a virus spread mainly by dog bites and scratches. Once symptoms start it almost always kills, but it can be prevented. After any bite, wash the wound well with soap and water and go to a rabies or dog bite centre the same day.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Rabies is an infection caused by a virus that attacks the brain and nerves. It is spread through the saliva (spit) of an infected animal, usually by a bite or a scratch, or when saliva gets into an open wound, the eyes or the mouth. Dogs cause up to 99 out of 100 human cases. Cats, farm animals, monkeys and wild animals can also carry it. Most deaths happen in Asia and Africa, and many of those who die are children.
The virus moves slowly along the nerves towards the brain. This waiting time (incubation period) is usually two to three months, but it can be as short as a week or as long as a year. Once symptoms begin, rabies is almost always fatal. There is no cure at that stage.
The good news is that rabies can be prevented after a bite. Treatment given soon after the exposure, before any symptoms, is called post-exposure prophylaxis (PEP). It has three parts: washing the wound well, a course of rabies vaccine, and, for deeper or more serious wounds, rabies immunoglobulin (ready-made antibodies) given into and around the wound. Started early and given in full, it works almost every time. Vaccinating dogs is the best way to protect whole communities.
In Pakistan
A study at six dog bite centres in Karachi, Hyderabad, Mirpurkhas and Peshawar found that dogs caused almost all bites, only about a quarter of patients had washed the wound with soap and water, many had used healers or put chillies, spices or oil on the wound, and most arrived late. Only about one in five patients received rabies immunoglobulin, which was costly and not supplied to hospitals.
Symptoms
- Early on: fever, headache, tiredness and feeling generally unwell
- Pain, tingling, burning or itching at the place of the old bite or scratch
- Anxiety, restlessness and trouble sleeping
- Confusion, agitation, aggression or seeing things that are not there (hallucinations)
- Fear of water (hydrophobia): painful throat spasms when trying to drink
- Fear of moving air or a breeze on the face (aerophobia)
- Trouble swallowing and a lot of saliva or drooling
- Weakness or paralysis, often starting near the bite (the slower, paralytic form)
- Fits (seizures), then coma
Causes and risk factors
Causes
- Infection with the rabies virus, which lives in the saliva of infected animals
- A bite from an infected dog, which causes almost all human cases
- Scratches that break the skin, or licks on broken skin
- Saliva getting into the eyes, mouth or nose (mucous membranes)
- Bites or scratches from cats, monkeys, livestock, bats or other wild animals
What makes it more likely
- Living in an area where dogs are not vaccinated and many stray dogs roam
- Being a child, as children are bitten more often, often on the head and face, and may not tell an adult
- Not washing the wound and not getting post-exposure treatment quickly after a bite
- Living in a rural or poor area far from a rabies treatment centre
- Work with animals, such as vets, animal control staff, wildlife rangers and laboratory staff handling the virus
- Travel to or living in remote places where rabies is common and treatment is hard to reach
Complications
Rabies itself is the main danger. Once the virus reaches the brain and spinal cord, it causes worsening swelling of the brain (encephalitis). In the furious form, death usually follows within a few days from heart and breathing failure. The paralytic form, seen in about one in five people, moves more slowly through paralysis and coma before death, and it is often mistaken for another illness. Very few people have ever survived, and survivors usually have severe brain damage. Dog bites can also become infected or cause tetanus, and bites to the head and face in children are more serious.
When to see a doctor
- Any bite or scratch from a dog, cat, monkey or wild animal that breaks the skin: wash it and go to a rabies or dog bite centre the same day
- Several bites, deep puncture bites, or bites on the head or face (especially in children): seek care at once
- Animal saliva in the eyes, mouth or an open wound
- Any direct contact with a bat
- A dog that was acting strangely, was very aggressive, or died or disappeared after the bite
- After a past bite: fever with tingling or pain at the old wound site, fear of water, confusion or weakness (emergency, go to hospital now)
Are you a PMDC-registered doctor who treats Rabies (dog bite)? List your profile free.
Diagnosis
After a bite, the doctor does not wait for a test. No test can show rabies infection before symptoms start, so treatment is decided from the type of contact. WHO groups exposures into three categories. Touching or feeding an animal, or licks on unbroken skin, need only washing. Nibbles on bare skin or small scratches without bleeding need wound washing and the vaccine straight away. Bites or scratches that break the skin, saliva on broken skin, eyes or mouth, and any contact with bats need washing, vaccine and rabies immunoglobulin. Where possible, the biting dog is kept and watched under a vet, or tested, but treatment is started anyway.
When someone already has symptoms, rabies can be hard to recognise, especially if the bite is forgotten. Special tests on saliva, spinal fluid (from the back), blood and a small skin sample from the back of the neck can confirm it.
Treatment
- Straight away, wash the bite or scratch with soap and plenty of running water for at least 15 minutes; an antiseptic such as povidone-iodine can be used after washing if available
- Go to a rabies or dog bite centre the same day, even if the wound looks small; do not wait to see if the dog becomes ill
- The doctor checks the wound category and starts a course of rabies vaccine; your doctor decides the schedule, so complete every injection on the dates given
- For bites or scratches that break the skin, or saliva on the eyes, mouth or broken skin, rabies immunoglobulin is also given into and around the wound if you have never had rabies vaccine before
- People who were fully vaccinated against rabies before still need wound care and vaccine after a bite, but usually not immunoglobulin
- The doctor also cleans the wound, may delay stitching, gives a tetanus vaccine if you are not up to date, and may give antibiotics for high-risk wounds
- Once symptoms of rabies have started, treatment can only ease suffering (comfort or palliative care) in hospital
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Rabies vaccine | main post-exposure treatment, started as soon as possible after any bite or scratch that needs it; also used before exposure for people at high risk; safe in pregnancy; your doctor decides the schedule | Rabies vaccine, inactivated (purified Vero cell) (10 brands), Rabies vaccine, inactivated (purified chick embryo cell culture) (1 brand) |
| Rabies immunoglobulin | ready-made antibodies given into and around serious wounds in people never vaccinated before, together with the vaccine; human immunoglobulin is often scarce, and equine (horse-derived) immunoglobulin is better than none | Equine rabies immunoglobulin (1 brand) |
| Tetanus vaccine | given after a bite to people whose tetanus vaccination is not up to date | Tetanus toxoid (2 brands), Tetanus toxoid vaccine, adsorbed (1 brand), Diphtheria + Tetanus toxoid vaccine, adsorbed (Td) (1 brand) |
Also used (not yet in our price list): Human rabies immunoglobulin, Rabies monoclonal antibodies (an alternative to immunoglobulin), Antibiotics for high-risk bite wounds or people with weak immunity (doctor chooses)
Self-care and prevention
Self-care
- Wash every bite or scratch at once with soap and running water for at least 15 minutes
- Do not put chillies, spices, oil, chemicals or other home remedies on the wound; wash it and get medical care
- Go to a rabies centre the same day; do not go to a traditional healer instead
- Finish the full vaccine course, even if you feel well and even if the dog seems healthy
- Tell the doctor about the animal: whether it was a stray, how it behaved, and whether it has been vaccinated
- Keep your vaccine card and bring it if you are ever bitten again
- Tell an adult if a child has been bitten, scratched or licked on broken skin, and check children for bites they may hide
Prevention
- Vaccinate pet dogs and cats, including puppies, and support dog vaccination drives in your area
- Keep away from stray dogs and unknown animals; do not feed or touch monkeys or wild animals, and never handle bats
- Never leave a young child alone with any dog, and teach children not to tease, chase or touch strange dogs
- If a dog threatens you, stay still, avoid eye contact and back away slowly instead of running or shouting
- People at high risk, such as vets and animal workers, can have the rabies vaccine before any exposure; they still need care after a bite
- After any bite or scratch, wash it well and get post-exposure treatment quickly
Common questions
Can rabies be cured?
Once symptoms of rabies begin, it is almost always fatal and there is no proven cure. That is why treatment must start soon after the bite, before any symptoms. Given early and completed, post-exposure treatment prevents rabies in almost everyone.
Do I need injections if a dog only licked or scratched me?
A lick on unbroken skin needs only washing. A lick on broken skin, or a scratch that breaks the skin, can pass the virus and needs to be checked by a doctor the same day. The doctor decides whether you need the vaccine alone or the vaccine plus rabies immunoglobulin.
The dog looks healthy. Should I wait and watch it before starting treatment?
No. Wash the wound and start treatment straight away. The doctor and the local vet may arrange for the dog to be watched or tested, and this can help the doctor decide later, but it should not delay the first injections.
Is the rabies vaccine safe in pregnancy?
Yes. Pregnancy is not a reason to avoid rabies treatment after a bite, because rabies is almost always fatal. Tell the doctor you are pregnant, and they will plan your care.
Is the bite of a monkey or cat also a risk?
Yes. Cats, monkeys, farm animals, bats and other wild animals can also carry rabies, although dogs cause almost all cases. Any bite or scratch that breaks the skin should be washed and checked at a rabies centre the same day.
Sources
- WHO (fact sheet). Rabies (2026).
- WHO (fact sheet). Animal bites (2024).
- CDC. Rabies Post-exposure Prophylaxis Guidance (n.d.).
- CDC. Rabies | CDC Yellow Book (n.d.).
- CDC. About Rabies | Rabies | CDC (n.d.).
- CDC. Clinical Features of Rabies | Rabies | CDC (n.d.).
- MedlinePlus. Rabies: MedlinePlus (n.d.).
- Journal of the College of Physicians and Surgeons Pakistan. Awareness about Rabies Post Exposure Prophylaxis in Pakistan Among Patients and Health Care Workers: Results from an Asian Rabies Expert Bureau Study (2011).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.