In the United States, human rabies is rare but probably underdiagnosed. Rabies should be included in the differential diagnosis of any case of acute, rapidly progressing encephalitis, even if the patient does not recall being bitten by an animal. In addition to situations involving an animal bite, a scratch from an animal, or contact of mucous membranes with infectious saliva, postexposure prophylaxis should be considered if the history indicates that a bat was physically present, even if the person is unable to reliably report contact that could have resulted in a bite. Such a situation may arise when a bat bite causes an insignificant wound or the circumstances do not allow recognition of contact, such as when a bat is found in the room of a sleeping person or near a previously unattended child.

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Thirty-nine dogs were injected intramuscularly with either an Ethiopian strain or a Mexican strain of rabies virus. The excretion of rabies virus in the saliva was studied before and during illness. Nine of 17 dogs that died after injection with the Ethiopian strain had virus in the submaxillary glands. Four of these dogs excreted virus in the saliva up to 13 days before signs of disease were observed. Sixteen of 22 dogs that died after injection with the Mexican strain had virus in the submaxillary glands. Eight of these dogs also excreted virus in the saliva up to seven days before signs of disease were observed. These findings indicate that rabid dogs may excrete virus in their saliva much earlier than previously reported.