Hidden deadly threat: how to recognize rabies and save lives

What's the problem?

Stories about soldiers on the front lines rescuing animals and sheltering them in trenches and bunkers have been widespread in Ukraine since the full-scale war started. Every time you see a video online of a terrified dog or cat finding safety in the caring hands of a soldier, it fills your heart with warmth and pride — even in the harshest conditions, Ukrainian people hold on to their humanity.

However, a recent video circulating on social media gives reason to worry. It shows a soldier exhibiting signs of hydrophobia — one of the classic symptoms of rabies. He explains that a few months ago, a cat bit him.

We won't share the video out of respect for ethics, but the realization is chilling: the man in the footage is, tragically, beyond help.

What's the solution?

Rabies is a fatal, incurable disease, and we need to talk about it openly. Spreading awareness can save lives, especially in the chaos of war.

Together with epidemiologist and infectious disease specialist Yuliia Boiko, we'll discuss rabies, how it spreads, what symptoms to watch for, and, most importantly, how timely action after an animal bite can prevent a tragic outcome.

How does it work?

Every year, rabies kills around 59,000 people worldwide. Children under 15 make up 40% of those bitten by animals suspected of carrying the virus. Rabies exists in over 150 countries, and according to the World Health Organization, Ukraine is one of the regions where the disease is widespread among wild animals. That means rabies is very much present here. Before the full-scale war, travelers to remote areas of Ukraine and those working with wild animals were advised to get preventive vaccinations.

Now, the situation has only gotten worse. The war has devastated veterinary and epidemiological services, disrupted vaccination efforts for wild animals, and left thousands of pets homeless, forcing them into contact with wild and feral animals. This has created the perfect conditions for rabies to spread. Meanwhile, rescue operations and increased human-animal interactions in front-line and combat zones have further raised the risk of infection — for both animals and people.

According to Ukraine's Center for Public Health, 1,845 people sought medical help in 2023 after being bitten or exposed to saliva from rabid animals — that's 4.5 cases per 100,000 people. Preliminary data for 2024 shows that the number has already risen to 2,427 cases (5.86 per 100,000 people).

"In 2023, one person in Ukraine died from rabies. In 2024, that number has already doubled to two — including one soldier," says epidemiologist Yuliia Boiko.

Rabies is a deadly viral disease that attacks the central nervous system in both humans and animals. The most dangerous thing about it is that symptoms don't appear right away — they can take weeks or even months to show. Once symptoms start, survival is almost impossible. Rabies has a nearly 100% fatality rate.

Any mammal can carry rabies, but the most common carriers are foxes, raccoon dogs, wolves, bats, hedgehogs, rodents, dogs, and cats. Wild animals that behave strangely — approaching humans without fear, for example — are especially dangerous.

"This kind of behavior is unusual for wild animals. The virus actually changes their brain function, making them act in a different way so it can spread more easily. Nature is clever that way! Stray animals and pets that have been in contact with wild or infected animals are also a risk," says Yuliia Boiko, an epidemiologist.

She lists the early and often overlooked signs of rabies in animals:

• Behavior changes: sudden aggression (biting multiple people, animals, or even objects without reason) or, on the other hand, extreme affection.
• Excessive licking of a bite wound, caused by inflammation and pain, can happen if a wild animal has bitten a pet.
• Unusual vocalizations: dogs may have a hoarse bark, or an infected animal may lose its ability to make sounds.

As the disease progresses, more severe symptoms appear:

• Trouble swallowing
• Excessive drooling (not just foaming at the mouth)
• Fear of light, noise, or water
• Uncontrollable movements, pacing in circles
• Paralysis

"Hydrophobia isn't just an unwillingness to drink. It's painful throat spasms that make swallowing impossible. This is a key symptom in the late stage of rabies," adds Boiko.

The most common way rabies spreads is through an animal bite. But even a scratch can be enough, especially if infected saliva gets into a wound, broken skin, or the eyes or mouth.

You can get rabies from a pet if:

• It hasn't been vaccinated
• It has had contact with infected animals
• It's in the early stages of rabies before symptoms appear

Since the virus spreads through the nervous system, it isn't found in an infected animal's blood or feces. However, studies have shown that it can sometimes be present in their tears.

Cases of rabies spreading from human to human are extremely rare. Still, people caring for someone with rabies must be careful to avoid contact with their saliva.

Once the virus enters the body, it travels along nerve pathways to the brain, causing inflammation (a condition known as viral encephalitis).

The closer the bite is to the head, the faster the disease develops. The incubation period (the time between infection and the first symptoms) ranges from seven days to a year, but in most cases, symptoms appear within one to three months.

Several factors affect how fast rabies develops:

• Type of wound: scratch, shallow bite, deep bite, multiple bites
• Amount of virus that entered the body
• The type of animal that bit the person, the specific rabies strain, and whether the animal showed symptoms
• Immune system strength of the infected person
• Location of the bite: bites on the head, neck, or fingers are more dangerous because these areas have many nerve endings, allowing the virus to reach the brain faster

If an animal bites you, scratches you, or you come into contact with its saliva:

1. Wash the wound immediately with soap and water for at least 10 minutes.
2. Disinfect the area with an antiseptic like alcohol, hydrogen peroxide, or iodine.
3. Seek medical help right away, even if it's just a tiny scratch or contact with saliva.
4. Only a doctor can determine if you need a rabies vaccine.
5. If possible, the animal should be isolated and monitored by a vet for 10 days to check for symptoms of rabies.

What you should never do

• Don't ignore even minor scratches.
• Don't assume an animal is healthy just because it looks fine.
• Don't delay seeing a doctor.
• Don't hope that "it's probably nothing."

"Ukraine has seen an increase in rabid cat bites. Foxes remain the most common carriers among wild animals, but I want to highlight bats. They are especially risky when it comes to rabies. In the US, most human rabies deaths are linked to bats. Very few people in Ukraine know this. Last year, a bat flew into our apartment building, and the kids wanted to catch it. No adults even realized that bats can carry rabies," warns epidemiologist Yuliia Boiko.

What to do if you've had contact with a bat:

• If you or your pet has touched a bat, wash the contact area thoroughly with soap and water, then go to a doctor immediately.
• Contact local health authorities to have the bat tested for rabies.
• Never touch a bat, especially with your bare hands.
• If you think a bat bit your pet, take your pet to the vet immediately.
• Make sure your dogs, cats, and ferrets are vaccinated against rabies on time.

The infectious disease specialist adds that bats can also carry other dangerous diseases. If you come into contact with a bat, seeing a doctor is important to determine if you need any preventive treatment. In some cases, a bat bite may leave no visible marks at all. Because of this, whenever you're in areas where bats might be present, you should stay alert and be extra cautious to avoid contact with them.

However, you need to remember that bats are usually shy and non-aggressive creatures and play a crucial role in our ecosystems. You cannot get rabies just by seeing a bat or being near one. But if you pick up a bat, it may bite in self-defense.

If a bat is lying on the ground, crawling, or unable to fly, it's likely sick, injured, or rabid. Do not touch it. Instead, call a local wildlife or animal control service.

According to Boiko, mice and rats usually don't spread rabies. However, if a rodent bites you, treat the wound properly just like you would for any animal bite — clean it thoroughly and see a doctor. You may need additional care, such as a tetanus shot.

No. Once symptoms appear, rabies is always fatal. Getting a rabies vaccine right after a bite or scratch is the only way to stay safe. The vaccine works 100% of the time, but only if given before symptoms start.

How does rabies vaccination work? Forget the old myth about "40 shots in the stomach." Modern rabies vaccines are just a series of injections in the upper arm given on Day 0 (the day you seek treatment), Day 3, Day 7, Day 14, and Day 28.

You must follow the schedule exactly to ensure full protection. If the bite is severe (deep wounds, multiple bites, or a bite from a wild animal), doctors may also give rabies immune globulin (RIG). This provides instant protection while your body builds immunity from the vaccine.

Don't wait! You need to start the vaccination no later than 14 days after exposure, but the sooner, the better.

It happens sometimes. If a doctor refuses, Boiko advises:

"If they won't vaccinate you, demand a written refusal and take it to the hospital's chief doctor. In Ukraine, rabies vaccines are widely available in ERs and regional hospitals."

Yes. Preventive rabies vaccination is recommended for people at high risk, including:

• Veterinarians
• Animal shelter workers
• Hunters
• Slaughterhouse workers
• Taxidermists
• Military personnel
• According to the World Health Organization (WHO), children living in areas with a high risk of rabies can also receive the vaccine as a precaution — if cost and logistics allow.

Preventive vaccination consists of three shots on Day 0, Day 7, and Day 28. The first booster shot is given one year later and every five years after.

Even if you've had a preventive rabies vaccine, you still need two more shots if bitten — on Day 0 and Day 3.

Yes. There are no lifestyle restrictions after rabies vaccination.

"You often hear that alcohol is banned after the rabies vaccine. But this rule was invented to ensure people don't forget their next dose. Alcohol does not affect the vaccine's effectiveness. The key is getting all five doses so your body develops enough antibodies to fight the virus," says Boiko.

Even more helpful solutions!

• Vaccinate your pets every year.
• Avoid contact with wild or stray animals. They can carry dangerous diseases that spread to humans, like hantavirus, plague, toxoplasmosis, and rabies.
• Stay away from packs of stray dogs — it's better to take a detour than to risk an encounter.
• Don't pick up wild animals, even if they look cute (yes, that includes hedgehogs).
• Teach kids how to behave around animals to prevent bites and scratches.

The American Academy of Pediatrics advises on safe animal interactions:

• Don't tease or provoke animals. Many bites happen because people play too rough. Teach kids not to pull a pet's tail, take away its toy, or bother it while it's eating.
• Never pet a strange dog or cat.
• Warn children to stay away from yards with aggressive or overly excited dogs.
• Teach kids to recognize the warning signs of a dangerous dog: stiff posture, a low tail, frantic barking, or an intense stare.
• Teach them how to interact with dogs safely:
  • Always ask the owner for permission before petting a dog.
  • Let the dog sniff first. Stand still while it gets used to you.
  • Gently extend your hand and pet the dog slowly.
  • Avoid touching the dog's face or tail.
  • Never disturb a dog while sleeping, eating, or caring for puppies. Even friendly dogs can become aggressive in these situations.
  • Don't put your face close to an animal's face.

• Never leave a small child alone with a dog — even if it's your pet or a familiar, well-behaved dog. Any dog can bite.

These simple steps can help prevent injuries and keep people and animals safe!