Rabies is a rare but very serious infection of the brain and nerves. It's usually caught from the bite or scratch of an infected animal, most often a dog. Rabies is found throughout the world, particularly in Asia, Africa, and Central and South America. It's not found in the UK, except in a small number of wild bats. Rabies is almost always fatal once symptoms appear, but treatment before this is very effective. There's also a vaccine for people at risk of being infected.

Rabies vaccination You should consider getting vaccinated against rabies if you're travelling to an area of the world where rabies is common and: you plan to stay for a month or more, or there's unlikely to be quick access to appropriate medical care

you plan to do activities that could put you at increased risk of exposure to animals with rabies, such as running or cycling Visit a GP or travel clinic if you think you may need the vaccine. Most people will have to pay for the rabies vaccine if it's needed for protection while travelling. Even if you have been vaccinated, you should still take precautions to avoid coming into contact with rabies if you're travelling in an area where rabies is found, and get medical advice straight away if you have been bitten or scratched. Some people may need the rabies vaccine because they could come into contact with rabies through their work. If you think this applies to you, speak to your employer or occupational health provider. Find out more about the rabies vaccination

How to avoid being bitten or scratched All mammals (including monkeys) can carry rabies, but it's most common in: dogs

bats

raccoons

foxes

jackals

cats

mongooses Animals can spread the infection if they bite or scratch you or, or in rare cases, if they lick an open wound or their saliva gets into your mouth or eyes. Rabies is not spread through unbroken skin or between people. While travelling in an area where rabies is a risk: avoid contact with animals – some infected animals may behave strangely, but sometimes there may be no obvious signs they're infected

avoid touching any dead animals If you're travelling with a child, make sure they're aware of the dangers and that they should tell you if they have been bitten, scratched or licked by an animal. Check them for any wounds if they come into contact with an animal. Public Health England has produced a leaflet with more information about rabies risks for travellers. For information about areas where rabies is a risk, see: TravelHealthPro: rabies information

fitfortravel: country information

What to do if you have been bitten or scratched If you have been bitten or scratched by an animal in an area with a risk of rabies: immediately clean the wound with running water and soap for several minutes

disinfect the wound with an alcohol- or iodine-based disinfectant and apply a simple dressing, if possible

go to the nearest medical centre, hospital or GP surgery as soon as possible and explain that you have been bitten or scratched If this happens while you're abroad, get local medical help immediately. Do not wait until you have returned to the UK. If you have already returned to the UK without getting medical advice, it's still a good idea to get help, even if it's been several weeks since you were bitten or scratched. It's unlikely you have been infected with rabies, but it's best to be safe. Post-exposure treatment is nearly 100% effective if it's started before any symptoms of rabies appear.

Treatment after a bite or scratch If you have been bitten, scratched or licked by an animal that might have rabies, you may need specialist medical treatment to stop you getting rabies. This is called post-exposure treatment. Post-exposure treatment involves: cleaning and disinfecting the wound

a course of the rabies vaccine – you'll need to have 4 doses over a month if you have not been vaccinated against rabies before, or 2 doses a few days apart if you have

in some cases, a medicine called immunoglobulin is given into and around the wound – this provides immediate but short-term protection if there's a significant chance you have been infected The post-exposure treatment you need may be slightly different if you have a weakened immune system. Treatment should be started quickly, ideally within a few hours of being bitten or scratched. But it's often safe to delay treatment until the next day if the vaccine or immunoglobulin need to be ordered in by your doctor.

Symptoms of rabies Without treatment, the symptoms of rabies will usually start after 3 to 12 weeks, although they can start sooner or much later than this. The first symptoms can include: a high temperature

a headache

feeling anxious or generally unwell

in some cases, discomfort at the site of the bite Other symptoms start a few days later, such as: confusion or aggressive behaviour

seeing or hearing things (hallucinations)

producing lots of saliva or frothing at the mouth

muscle spasms

difficulty swallowing and breathing

inability to move (paralysis) Once symptoms appear, rabies is almost always fatal. In these cases, treatment will focus on making the person as comfortable as possible.