Rabies symptoms: the first signs, when they appear, and why you must not wait

Rabies is a virus that attacks the brain and nerves. The first signs can feel like the flu: fever, headache, weakness, sore throat or vomiting. A key clue is tingling, itching, burning, numbness or pain where you were bitten or scratched, even if the wound healed long ago.

Then the brain is affected. Most people in the Philippines get the "furious" form:

• restlessness, anxiety, confusion, or seeing things that are not there (hallucinations)
• fear of water (hydrophobia), the most common sign: drinking causes painful throat spasms, so the person refuses water even when thirsty
• fear of moving air (aerophobia): a fan or a breeze can set off the spasms
• drooling, trouble swallowing or breathing, and seizures

In the less common paralytic form, weakness starts in the bitten arm or leg and slowly spreads until the person falls into a coma.

Death usually follows within days. Only a doctor can say what is causing someone's symptoms.

The time from the bite to the first symptom (the incubation period):

• is usually 2 to 3 months, but can be as short as about a week (WHO). Sometimes it is more than a year, and rarely several years.
• can be shorter after bites on the face, head or neck, deep bites or many bites.

At San Lazaro Hospital, more than 1 in 5 patients got sick within a month of the bite, and almost 1 in 10 more than a year later. The longest wait was 10 years.

Counting days will not tell you that you are safe. No test can find rabies before symptoms start, and feeling well weeks or months later proves nothing.

If you were bitten or scratched and never got the vaccine, go to an animal bite treatment center now, even if weeks or months have passed. The staff will decide what you still need.

Once symptoms appear, rabies is fatal in virtually all cases (WHO). Before symptoms, it can almost always be prevented by washing the wound and getting the vaccine, plus rabies immunoglobulin (RIG) for serious exposures. This is called post-exposure prophylaxis (PEP).

Waiting costs lives here:

• In 2024, the DOH recorded 426 human rabies cases, and all of them died.
• Of the San Lazaro patients with a known animal exposure (2006 to 2015), 90 in 100 never got any vaccine or RIG. Most were adult men, who may be less likely to go to a bite center.
• Only 2 had received full treatment (vaccine and RIG). Both were small children bitten on the face, where rabies can develop very fast.

The virus is in the saliva (laway) of an infected animal. It enters through a bite, a scratch that breaks the skin, a lick on broken skin, or saliva in the eyes, nose or mouth.

Dogs cause up to 99% of human cases. Cats, livestock, monkeys and bats can carry it too, and so can puppies. In 2024, 45% of Filipinos who died of rabies had been bitten by a pet, and for more than half of those pets no one knew if they were vaccinated.

Bites from rats and mice are not known to spread rabies, but wash any bite and have it checked. Passing rabies from one person to another by a bite or saliva has never been confirmed. Getting it from the raw meat of an infected animal is extremely rare, but the DOH chart still counts handling the body or eating its raw meat as a serious exposure.

Many people ask about rabies from a cat scratch (kalmot ng pusa). Cats can carry rabies, and a scratch that breaks the skin is treated like a dog bite. Among San Lazaro rabies patients who recalled the animal, about 4 in 100 named a cat. Wash the scratch and go to a bite center the same day.

A cat scratch can also cause cat-scratch disease, a usually mild infection with bacteria. A small bump forms at the scratch, then nearby glands (kulani) swell, sometimes with fever. See a doctor if glands swell.

Children get the same signs as adults. WHO says about 40% of people who die of rabies are children under 15. They are bitten more often than adults, and they may not tell anyone about a small bite or scratch, or may be too young to explain what happened.

• Ask your child after they play with animals, and tell them they won't be scolded for reporting a bite.
• If a small child may have been bitten or scratched but cannot explain, take them to a bite center anyway.

A child with fever and pain at an old wound, who refuses to drink, or who is very restless or confused needs the emergency room now. Ask a doctor before giving a child any medicine. See also our guide to fever in babies and children.

1. Hold the wound under running water and wash it with soap for a full 15 minutes, as soon as you can. No first aid matters more.
2. After washing, you can apply an antiseptic such as povidone-iodine. Leave closing the wound to the health worker.
3. Go to an animal bite treatment center (ABTC) the same day, with an ID and your PhilHealth number. Tell the staff about the animal and the wound.
4. Start the vaccine if the staff say so, and return on every date on your card.
5. Keep an eye on the dog or cat for 14 days, from a safe distance. Tell the center at once if it falls sick, dies or goes missing.

A lick on healthy skin needs only washing. Bites or scratches that bleed, licks on broken skin and any exposure on the head or neck are the most serious. For the schedule and where to get it free, see our anti-rabies vaccine guide.

• A tandok (traditional healer) instead of the bite center. In a survey in three provinces, almost a third of bite victims who skipped medical care saw a tandok. No healer, herb or Palawan's "rabies tree" has been shown to prevent rabies. See a healer only after the bite center, the same day.
• Garlic, herbs or other remedies on the wound. None is known to stop the virus. Use soap and running water.
• Squeezing the wound to make it bleed is not part of the recommended first aid.
• "We'll see if the dog gets sick first." The DOH chart says to start the vaccine and watch the animal at the same time. If it is still healthy after 14 days, the doctor may stop the shots early.
• "Our dog had its shots" or "it's just a puppy." Go anyway and let the staff decide.

Before symptoms, treatment works very well: wound care, the rabies vaccine and RIG. Antibiotics do not kill the rabies virus.

After symptoms start, there is no cure. Very few people have ever survived, and not without lasting brain damage. Doctors give comfort care to ease fear, pain and spasms.

If someone shows signs of rabies, bring them to the nearest emergency room or call 911, and tell the doctors about any bite, even an old one. Avoid their saliva, and tell health workers if it got into your eyes, mouth or a wound.

Fear after a bite is common and understandable.

• If you finished the vaccine on time, rabies is very unlikely. In the United States, no one who got the vaccine promptly and correctly has developed rabies.
• If you missed a date, or never got the vaccine, go to a bite center now.

If the worry keeps you from sleeping or working, talk to our wellbeing guide or ask a nurse. If you feel overwhelmed or think of harming yourself, call 1553, the mental health crisis line.

Animal bite treatment centers are in many government hospitals, rural health units (RHUs) and health offices. Your barangay health worker or PhilHealth YAKAP clinic can point you to the nearest one. Find a health center or find a hospital.

PhilHealth's Animal Bite Treatment package. As of March 2025, it pays ₱5,850 per case (up from ₱3,000) at more than 700 accredited centers, for members and their dependents. It covers the vaccine, RIG, wound care, tetanus shots, antibiotics and supplies. Under its rules it is for serious exposures, including any on the head and neck. Ask the center if your case qualifies.

Since 2016, government bite centers have aimed to give the vaccine free, though stock can run out; private clinics set their own prices. See what PhilHealth covers and our Malasakit Center guide for help with hospital bills.

Not sure how serious your bite is? Ask Joy, our AI symptoms guide or book a call. More on infections: Infections and fever.

• Get every dog and cat its rabies shot, puppies too, and keep the vaccine card. WHO says vaccinating dogs protects people at the lowest cost. Ask your barangay about pet vaccination days.
• Don't let pets roam. Avoid stray and wild animals, even friendly-looking ones.
• Teach children never to tease dogs and to tell you about every bite or scratch.

You often cannot tell by looking whether an animal has rabies. Watch out for a dog or cat that turns aggressive or vicious, or is unusually tired and weak. Keep people away, report it to your barangay or municipal veterinary office, and never touch a dead animal with bare hands.

Culling stray dogs does not stop rabies, WHO says.