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SHAH ALAM – A dog bite or scratch may look like a minor injury, but when the animal is infected with rabies, getting medical attention quickly can be the difference between life and death.
Malaysia recorded a human rabies death in Kedah this month involving a 31-year-old man who was bitten by a stray dog in August.
The man sought treatment after the incident but did not receive rabies post-exposure prophylaxis (PEP). He later developed symptoms including weakness, numbness, difficulty swallowing, fear of water and behavioural changes before he died on Sept 27.
With rabies, waiting for symptoms before seeking treatment can be extremely dangerous. Here is what you need to know.
WHAT IS RABIES?
Rabies is a viral disease that affects the central nervous system and can infect both animals and humans.
The disease is transmitted mainly through the saliva of an infected animal. Once clinical symptoms appear, rabies is virtually 100 per cent fatal.
However, rabies is preventable if a person receives appropriate treatment promptly after exposure.
HOW DOES RABIES SPREAD?
Rabies is usually spread when the saliva of an infected animal enters the body through a bite, scratch or an open wound.
It can also be transmitted when infected saliva comes into contact with mucous membranes, such as the eyes or mouth.
This means a person should not wait for an animal to show obvious signs of illness before seeking medical advice after a possible exposure.
WHICH ANIMALS CAN TRANSMIT RABIES?
Rabies affects mammals.
Dogs are responsible for up to 99 per cent of human rabies cases globally, but other mammals, including cats, livestock and wildlife, can also carry and transmit the virus.
In Malaysia, animal-bite risk assessments may therefore involve dogs, cats and other potentially infected animals.
WHY IS RABIES SO DANGEROUS?
The virus can travel through the nervous system towards the brain and spinal cord.
Once clinical symptoms develop, the disease causes progressive and fatal inflammation of the brain and spinal cord. There is no reliably effective cure once clinical rabies has developed.
The important point is that rabies is preventable before symptoms appear.
WHAT ARE THE SIGNS AND SYMPTOMS?
Early symptoms of rabies can be non-specific and may include fever, pain, weakness, headache and unusual tingling, prickling or burning sensations around the bite or wound.
As the disease progresses, patients may develop difficulty swallowing, fear of water (hydrophobia), fear of air or drafts (aerophobia), agitation, confusion, abnormal behaviour, paralysis and eventually coma.
Not everyone develops the same symptoms, and rabies can also cause a paralytic form of the disease, in which muscle weakness and paralysis gradually develop.
HOW LONG DOES IT TAKE FOR SYMPTOMS TO APPEAR?
The incubation period is usually around one to three months, although it can vary considerably.
Health Ministry guidelines note that symptoms can appear in less than a week or more than a year after exposure, depending on factors including the location of the exposure and the amount of virus involved.
This is why feeling well immediately after a bite does not mean a person is safe.
WHAT SHOULD YOU DO IMMEDIATELY AFTER A BITE OR SCRATCH?
Do not wait for symptoms.
The first step is to wash the wound thoroughly with soap and running water for at least 15 minutes.
After washing the wound, seek medical attention as soon as possible for a rabies risk assessment and to determine whether PEP is required. WHO specifically recommends immediate wound washing followed by medical assessment after a potential rabies exposure.
Do not simply cover the wound and wait to see whether the animal becomes sick.
IS RABIES PREVENTABLE?
Vaccinating dogs is one of the most effective ways to prevent human rabies because it stops transmission at its source. Responsible pet ownership and avoiding contact with stray or unfamiliar animals also reduce the risk.
People whose work or activities put them at higher risk of exposure can also receive pre-exposure prophylaxis (PrEP), or rabies vaccination before exposure. This may be relevant to certain animal health workers, wildlife workers and others who regularly handle animals at risk.
WHAT TREATMENT IS AVAILABLE AFTER EXPOSURE?
Treatment after a possible rabies exposure is known as PEP, which may include thorough wound washing, a course of rabies vaccine and for certain severe exposures, rabies immunoglobulin (RIG) or other recommended rabies antibodies.
According to the World Health Organisation (WHO), minor scratches or abrasions without bleeding require wound washing and vaccination, while bites or scratches that break the skin and certain exposures involving saliva may require both vaccination and rabies immunoglobulin or monoclonal antibodies.
The Health Ministry (MOH) similarly has different PEP requirements depending on the type of exposure and whether the person has previously received rabies vaccination.
People should not decide on their own whether they need the vaccine, as a healthcare professional should assess the animal, the type of contact and the wound before determining the appropriate treatment.
WHEN SHOULD YOU SEEK MEDICAL ATTENTION?
People should seek medical attention as soon as possible after being bitten or scratched by an animal that could potentially carry rabies, particularly if the animal is stray, unknown or cannot be observed, behaves unusually or aggressively, or has an unknown vaccination status.
Medical attention is also important if the bite or scratch breaks the skin, causes bleeding, or if saliva comes into contact with an open wound, the eyes or mouth. People should not wait for symptoms to appear before seeking treatment.
In the latest Kedah case, the victim developed symptoms weeks after being bitten and subsequently tested positive for rabies. Health authorities have urged anyone bitten or scratched by an animal to wash the wound with soap and running water for at least 15 minutes and seek medical attention for a risk assessment and appropriate treatment.
WHAT ARE SOME COMMON MISCONCEPTIONS ABOUT RABIES?
“A small scratch cannot transmit rabies.”
A scratch can still pose a risk, especially if infected saliva contaminates the wound. Seek medical advice after any possible exposure.
“I only need treatment if the animal looks sick.”
Not necessarily. An infected animal may not appear obviously ill, so do not rely on its appearance to assess the risk.
“If I feel fine, I do not need the vaccine.”
Feeling well does not rule out rabies, as symptoms can take weeks or months to appear.
“Once someone is bitten, rabies cannot be prevented.”
Rabies can be prevented through prompt PEP before symptoms develop.
“Rabies only comes from dogs.”
Dogs cause most human rabies cases globally, but other mammals can also transmit the virus.
“I should wait and see what happens to the animal.”
Do not wait. Wash the wound immediately and seek medical attention for a risk assessment.
WHAT IS THE SITUATION IN MALAYSIA?
Malaysia continues to strengthen rabies surveillance and prevention through cooperation between human health and veterinary authorities.
In August 2026, Kedah recorded 502 animal-bite and scratch cases, with dogs accounting for 65.3 per cent, cats 23.1 per cent and other animals 11.6 per cent.
Sarawak has also continued animal vaccination and surveillance efforts, with dogs required to receive anti-rabies vaccination and annual booster doses.
THE MOST IMPORTANT THING TO REMEMBER
If an animal bites or scratches you, do not wait for symptoms.
Wash the wound with soap and running water for at least 15 minutes, then seek medical attention promptly so healthcare professionals can assess your risk and determine whether rabies vaccination, immunoglobulin or other treatment is needed.
