Unlike most other vaccine-preventable diseases though, unless you are at high risk for getting rabies, you don’t typically get the rabies vaccine unless you have already been exposed to rabies.
How does one get exposed to rabies?
Now that most people get their pets vaccinated against rabies, these exposures typically come from wild animals, including:
While any mammal can be susceptible to rabies, small mammals, including squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, rabbits, and hares, rarely get rabies and aren’t usually thought to be a risk for humans.
Your other pets, including dogs, cats, and ferrets, are though. They should be vaccinated against rabies. As should other domestic animals, including cows, goats, sheep, and horses.
It is also important to teach your kids to avoid wild animals. While most kids won’t go out of their way to pet a coyote, they might try to feed a racoon or skunk, and they might pick up a bat they find on the ground.
Kids should also avoid cats and dogs that they don’t know. Your kids should not just walk up and pet unfamiliar dogs and cats.
What to Do If Your Child Is Exposed to Rabies
Unfortunately, you won’t always know if an animal has rabies, although an animal acting strangely can be a tip off that they might have rabies.
That bat your kids found on the ground could definitely have rabies, especially if they found it during the day. And the bat doesn’t even have to obviously bite your child. For example, if you find a sick or dead bat in your child’s room in the morning when he wakes up, you should consider that a possible exposure to rabies.
Many other exposures happen when kids are bitten by stray cats or dogs.
What do you do?
According to the CDC, if your child is bitten by any animal or has any possible exposure to rabies, you should:
immediately wash the wound well with soap and water, also using a povidone-iodine solution (Betadine Antiseptic Solution) to irrigate the wound if it is available
see a healthcare provider
call your local animal control for help in capturing the animal for observation or rabies testing
Animal control can also help in verifying a pet’s rabies vaccination status if your child was bitten by a neighborhood cat or dog.
“A healthy domestic dog, cat, or ferret that bites a person should be confined and observed for 10 days. Those that remain alive and healthy 10 days after a bite would not have been shedding rabies virus in their saliva and would not have been infectious at the time of the bite.”
CDC on Human Rabies Prevention — United States, 2008
In general, unless they already appear rabid, dogs, cats, and ferrets can be quarantined and observed for 10 days to see if they develop signs of rabies before your child begins post-exposure prophylaxis.
Other animals, including skunks, raccoons, foxes, coyotes, and bats should be considered rabid, with a quick start of post-exposure prophylaxis, unless the animal can be quickly tested (brain material) for rabies. And of course, you would be more considered about rabies if the animal was acting strangely, looked sick, or if it was an unprovoked attack.
What if you can’t find or capture the animal?
Depending on the circumstances, your pediatrician, with the help of your local or state health department, can determine if your child needs rabies post-exposure prophylaxis with rabies immune globulin and a 4 dose series of the rabies vaccine over 2 weeks.
“The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful.”
CDC on Rabies in the U.S.
About 40,000 to 50,000 people in the United States get rabies post-exposure prophylaxis each year. That works to keep the number of rabies cases and rabies deaths in people very low.
And it is not probably not at the top of your list of things to think about at a time like this, but animal bites can also be a risk for tetanus. Make sure your child doesn’t need a tetanus shot.
What to Know About Getting Exposed to Rabies
Keep your kids safe from rabies by vaccinating your pets and teaching them to avoid wild animals, but also know what to do if your child is exposed to rabies.
Unlike most other infections though, tetanus isn’t contagious. Instead, spores of Clostridium tetani get into dirty wounds and then begin to grow into active bacteria.
The now “awake” Clostridium tetani bacteria then begin producing exotoxins that cause the symptoms of a tetanus infection.
In the pre-vaccine era, there were about 500 to 600 cases of tetanus in the US each year and about 165 deaths.
Fortunately, tetanus is rare now, as most folks are vaccinated, but we do see some cases in kids who are intentionally not vaccinated or in seniors who haven’t gotten a tetanus booster in a long while.
The unvaccinated child with the toe nail injury?
“A 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration… Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection… The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved.”
Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report
He was unvaccinated “based on religious grounds” and had recently injured his toe, resulting “in a small local hematoma and loose toenail.” It also resulted in his getting tetanus and a 30 day stay in the hospital.
What Are the Symptoms of Tetanus?
Unvaccinated children can develop symptoms of tetanus two days to two months (average incubation period is two weeks) after getting a wound that is contaminated by tetanus spores.
“It was hideous. He was spasming every three minutes. He was biting his tongue and bleeding. His arms were spasming and he was arching his back and his whole face and jaw was completely locked.”
Linda Williams on her unvaccinated 7-year-old son’s bout of tetanus
The most characteristic symptoms are painful muscle spasms that gradually get worse over a week, including:
spasms of the muscles around their mouth, giving the typical “lockjaw” appearance of tetanus
spasms of the muscles around the throat, which can make it hard to swallow
spasms of the chest muscles, making it difficult to breath
spasms of the muscles in the neck, back, arms, legs, and abdomen
Other associated symptoms can include fever, headache, irritability, tachycardia (high heart rate), urinary retention (secondary to bladder muscle spasm), low blood pressure or high blood pressure.
How Do You Diagnose Tetanus?
Tetanus is usually diagnosed in someone with painful muscle spasms and history of a dirty wound.
It is important to keep in mind that your child is not only at risk for tetanus following the classic case of stepping on a rusty nail – a classic myth about tetanus.
Tetanus spores live in the soil and so almost any dirty wound can lead to tetanus infections. Although puncture wounds are the most common that lead to tetanus, scrapes, burns, snake bites, dog bites, and even spider bites can also cause tetanus if the wounds becomes contaminated with dirt or feces.
Testing for the Clostridium tetani in the original wound is sometimes possible, but is not necessary for a diagnosis of tetanus, since it is technically difficult to do.
Neonatal tetanus can occur in newborns if their mother isn’t immunized against tetanus and their umbilical cord stump gets contaminated.
How Do You Treat Tetanus?
The treatments for tetanus can include sedation and mechanical ventilation and:
human tetanus immunoglobulin (TIG) to try and neutralize the tetanus toxin
antibiotics, such as penicillin G, metronidazole, erythromycin, or tetracycline
muscle relaxants, such as diazepam, magnesium sulfate, midazolam, and baclofen
neuromuscular blocking agents, such as vecuronium and pancuronium, which cause paralysis
If you have ever read a story about a child who has needed treatment for tetanus, you will likely opt for a tetanus shot instead.
Do I Need a Tetanus Shot?
Like other vaccine-preventable diseases, keeping up-to-date on your child’s immunizations can help to prevent your child from ever getting tetanus.
One thing that complicates tetanus is that your child may still need a tetanus shot, even if they are fully vaccinated, if it has been five or more years since his last tetanus shot and he has:
a wound that is contaminated with dirt, feces, or saliva
a puncture wound
an avulsion wound, in which part of the wound is pulled away from the other part
a wound caused by crush injury, burn, or frostbite
So if your child had a tetanus shot at age four (the DTaP vaccine kids get before starting kindergarten), then he may need a tetanus shot if he gets a dirty wound before he gets a tetanus booster when he is 11 or 12 years old (the Tdap vaccine).
And yes, a tetanus shot will work in these situations, even if you have already been exposed to the tetanus spores. But no, letting a wound bleed a lot won’t flush out the spores. These are other myths about tetanus and tetanus shots that you might hear.
What to Know About Tetanus and Tetanus Shots
See your pediatrician as soon as possible if your child needs a tetanus shot after getting a dirty wound.