Answer:

The rabies virus enters the body through bites, scratches, or licks on open wounds. From the site of injury, the virus multiplies and travels along nerve pathways to the spinal cord and brain. Its slow movement and minimal inflammatory response make it difficult for the immune system to detect. The incubation period typically ranges from two to eight weeks, though it can be as short as a few days or extend beyond one year.

Rabies manifests in two forms: furious rabies (80%) and paralytic rabies. Patients initially experience fever, headache, and numbness at the wound site. In furious rabies, symptoms include restlessness, hallucinations, hydrophobia (fear of water), aerophobia (fear of drafts), autonomic nervous system dysfunction, and spasms of the pharyngeal and respiratory muscles. This rapid progression often leads to death from cardiac arrest, seizures, and exhaustion. Between episodes of fury, patients may appear lucid and cooperative, yet their condition is untreatable. In paralytic rabies, patients remain conscious but experience progressive paralysis, starting from the wound and spreading to the limbs, eventually leading to coma and death.

According to the World Health Organization (WHO), approximately 59,000 deaths occur annually due to rabies, with 40% being children under 15 years old. In Vietnam, WHO reports over 70 rabies fatalities each year, primarily from dog bites, though cat scratches and bites also pose a risk. Notably, in recent years, the number of rabies deaths has increased to over 80 cases. For example, there were 82 deaths in 2023, 84 in 2024, and 73 in 2025. While the 2025 figure shows a slight decrease compared to the two preceding years, the number remains high.

Wounds from dog or cat bites, where the rabies virus can enter. Illustration: Vecteezy

To prevent rabies, individuals must properly manage dog or cat bites and scratches. First, wash the wound under running clean water and soap for at least 15 minutes. Next, disinfect the wound with alcohol or iodine solution to reduce the viral load. Afterward, visit the nearest vaccination center for a medical assessment and to receive a rabies vaccine. Depending on the situation, anti-rabies serum and tetanus vaccine may also be administered.

The rabies vaccination schedule consists of five intramuscular doses on days 0, 3, 7, 14, and 28, or eight intradermal doses on days 0, 3, 7, and 28. It is crucial not to squeeze, vigorously rub, or apply leaves to the wound. Suturing the wound should only be considered if more than five days have passed since the bite.

Additionally, people can proactively get pre-exposure rabies vaccination. Modern vaccines are safe and do not harm health. The pre-exposure schedule involves three doses on days 0, 7, and 21 or 28, which helps the body develop protective antibodies. If bitten or scratched by an animal after pre-exposure vaccination, only two additional vaccine doses are needed, eliminating the need for serum, even for severe or dangerous wounds.

Doctor Pham Dinh Dong

Medical Manager, VNVC Vaccination System

Readers can submit vaccine-related questions for doctors to answer here.