‘What are the chances that I may get rabies?‘
A careful search of peer-reviewed scientific literature suggests that the chances are very low (see figure below from 1).
- ‘Although human-to-human rabies transmission in a health-care setting is theoretically possible, no such occurrence has been documented‘ (2).
- ‘Apart from corneal transplants, bite and nonbite exposures inflicted by infected humans could theoretically transmit rabies, but no laboratory-diagnosed cases occurring under such situations have been documented‘ (3).
- ‘There has never been a documented case of human-to-human transmission in hospital settings. Casual contact, such as touching a person with rabies or contact with urine, blood, and stool does not constitute an exposure. Practically, there is no risk to other humans from a patient with rabies unless it is by mucous exposure to saliva or a bite‘ (4).
One reported case of possible mother and child rabies transmission:
- ‘Two non laboratory-confirmed cases of human-to-human rabies transmission in Ethiopia have been described. The reported route of exposure in both cases was direct salivary contact from another human (a bite and a kiss)‘ (3).
- ‘Two non-laboratory-confirmed cases of humanto-human rabies transmission in Ethiopia have been described. The reported route of exposure in both cases was direct salivary contact from another human infected with rabies‘ (4).
- ‘Two nonlaboratory confirmed cases of human-to-human transmission were described in the year 1996 in Ethiopia. The route of exposure was direct salivary contact from another human – a kiss and a bite.‘ (5).
- ‘The contact with infected people could be a potential risk for their relatives and health workers when unprotected direct contact with secretions from a patient containing viable virus occurs ‘ (6).
- These papers refer to the only reported possible but unproven human-to-human case of mother and child in Ethiopia in 1996 (7).
One reported case of possible mother-to-child rabies transmission:
- ‘A nine-month pregnant woman entered the Infectious Diseases Clinic of Numune Hospital-Ankara (10.5.1981). She was bitten 34 days ago by a baby dog. On the second day, the birth of a boy was realized by induction. The baby was taken to the Sami Ulus Children Hospital-Ankara, where he was normally fed. After 40 hours and 30 minutes, the baby died suddenly. The autopsy, macroscopic and microscopic examinations confirmed the diagnosis of rabiesin both the mother and the baby. To our knowledge this is the first case reported of human Rabies acquired by placental transmission‘ (8).
Organ Transplant rabies transmission:
- ‘How is rabies transmitted?…Humans are an end host; anecdotal cases of transmission from human to human have not been confirmed outside of transplantation, including transmission from patients to healthcare workers.’ (1).
- ‘Human-to-human transmission has occurred among eight recipients of transplanted corneas. Investigations revealed each of the donors had died of an illness compatible with or proven to be rabies. The eight cases occurred in five countries: Thailand (two cases), India (two cases), Iran (two cases), the United States (one case), and France (one case). Stringent guidelines for acceptance of donor corneas have been implemented to reduce this risk‘ (3).
- ‘there are only eight well-documented reports of human to human transmission in corneal transplant recipients‘ (5).
- ‘There are many reports of organ transplantation involved in the transmission of rabies. The most frequent cases have been observed in corneal transplantation. The most recent case reported was of a German patient and occurred in 2005.‘ (6).
- ‘To date, the only medically verified cases of human-to-human rabies transmission are the cases infected through organ transplantation from undiagnosed rabies patients’ (9).
- ‘Theoretically, nosocomial transmission could occur following contact with saliva from an infected individual; however, to date this has not occurred, and the only reports of nosocomial transmission have been for two patients who received corneal grafts from donors with “obscure neurological conditions”; one had a Guillain-Barre-type syndrome, and the other had flaccid paralysis‘ (10).
Thus, documented human-to-human rabies transmission is so far confined to organ transplants (see figure below from 11).
- Your friend doesn’t have rabies.
- He’s already getting post-exposure treatment, which greatly reduces his risk of getting and spreading rabies.
These minimize even further your risk of getting rabies from him.
‘What should I do?‘.
Given how deadly rabies is, I can well imagine your anxiety. I suggest to consult a doctor, preferably the same doctor who is treating your friend for the dog bite since he’s already familiar with the situation.
- Crowcroft, Natasha S., and Nisha Thampi. “The prevention and management of rabies.” bmj 350 (2015): g7827.
- Arguin, Paul M. “Human rabies prevention–United States, 1999: recommendations of the Advisory Committee on Immunization Practices (ACIP).” Morbidity and Mortality Weekly Report: Recommendations and Reports (1999): i-21.
- Gongal, Gyanendra. “What is the risk of rabies transmission from patients to health care staff?.” Asian Biomed 6.6 (2013).
- Stantic-Pavlinic, Mirjana. “Rabies treatment of health care staff.” Swiss medical weekly 132.11/12 (2002): 129-131.
- Consales, C. A., and V. L. Bolzan. “Rabies review: immunopathology, clinical aspects and treatment.” Journal of Venomous Animals and Toxins including Tropical Diseases 13.1 (2007): 5-38.
- Fekadu, M., et al. “Possible human-to-human transmission of rabies in Ethiopia.” Ethiopian medical journal 34.2 (1996): 123-127.
- Sipahioğlu, U., and S. Alpaut. “[Transplacental rabies in humans].” Mikrobiyoloji bulteni 19.2 (1985): 95-99.
- Takayama, Naohide. “Rabies: a preventable but incurable disease.” Journal of Infection and Chemotherapy 14.1 (2008): 8-14.
- Aitken, Celia, and Donald J. Jeffries. “Nosocomial spread of viral disease.” Clinical Microbiology Reviews 14.3 (2001): 528-546.
- Helmick, Charles G., Robert V. Tauxe, and Andrew A. Vernon. “Is there a risk to contacts of patients with rabies?.” Review of Infectious Diseases 9.3 (1987): 511-518.