Rabies is a rare infectious disease, but potential exposures are more common than you might think. About 100,000 Americans receive preventive treatment for rabies each year after a potential exposure, the Centers for Disease Control and Prevention (CDC) reports.

Once symptoms appear, rabies is almost always fatal. The good news: If exposure is caught early, before symptoms begin, preventive treatment is highly effective. The challenge is knowing when you’ve been exposed, and when it’s time to seek medical care.

While it can be contracted year-round, there are usually more reported cases of rabies in the summer simply because people are outside more often, said Aliza Hekman, a PA who specializes in infectious diseases at Novant Health Infectious Disease Specialists - Winston-Salem.

Recent rabies cases in baby goats linked to a North Carolina mobile petting zoo have sparked questions about how the disease spreads, which animals carry it and what to do after a potential exposure.

We asked Hekman those questions and more. Highlights of our conversation are below.

What exactly is rabies?

Rabies is a virus that attacks the central nervous system, meaning the nerves, brain and spinal cord.

How is rabies contracted?

You can become infected through contact with the saliva of an infected animal. A bite is the most common way people get infected. But you could get saliva in a cut, scrape or in your mucous membranes. If you’re handling an infected animal and then touch your nose or mouth, you could come in contact with their saliva.

The CDC explains: In the U.S., around 4,000 animal rabies cases are reported each year, with more than 90% occurring in wildlife. This is a big change from the 1960s, when most rabies cases came from domestic dogs, a trend changed by modern pet vaccination requirements and animal control programs.

What animals are most likely to carry rabies? Recently, there were reported cases of goats with rabies in a mobile petting zoo that exposed people in several counties. I’ve never heard of a rabid goat.

That’s an unusual case. Usually, any livestock that might come in contact with the public will most likely be vaccinated. But those baby goats were too young to get vaccinated. The suspicion is that they came in contact with an infected skunk, and skunks are on the list of animals most likely to carry rabies.

Other animals on that list are raccoons, foxes, coyotes, bobcats and woodchucks. And bats are one of the highest-risk animals.

What are some signs that an animal might be rabid?

One that comes to mind is foaming at the mouth. The virus makes the body produce more saliva than normal and can cause muscle spasms in the throat, which can combine to create foam.

But rabid animals don’t always foam at the mouth. Any change in behavior could be a sign.

If an animal isn’t eating or is weak and possibly staggering, those could be indicators. But really, anything outside the norm should be an alarm. In animals that are usually nocturnal, being out during the day could signal that the animal has rabies.

Is aggressive behavior a sign of rabies?

It is, but it’s one that comes in the later stages of the illness.

What should you do if you think you were in contact with a rabid animal?

Because rabies is so serious, if you suspect exposure, you need to contact your doctor immediately or go to the ER.

As soon as you think you may have been exposed, act on it. And remember: Exposure doesn’t mean you have to have been bitten. In the case of those baby goats, if you were holding, feeding or petting them, there’s a risk that you came in contact with their saliva.

Bats are kind of a special case. They account for most of the rabies cases in the U.S., and you may not always know you were bitten by a bat because they’re so small. If you were asleep and wake up to find a bat in the vicinity, you should assume there was contact. That’s enough to warrant an evaluation.

You never want to wait to see if symptoms appear. The average timeframe for symptoms to show is 3-12 weeks, but it can be more or less time than that. You have to be treated before they appear.

What happens if you’re not treated quickly for rabies?

Once symptoms begin, rabies is almost always fatal, usually leading to death within 4 weeks.

Fortunately, most people will never encounter a case of rabies. But what are the symptoms in humans?

The symptoms in humans are similar to those in animals. The virus travels along the nerves, so you can have some tingling or pain at first. Then, you might get neurological symptoms like confusion and headaches, fatigue and fever.

Some of the signs of rabies sound subtle.

They can be at first, but they progress to significant cognitive issues as a result of brain damage.

How is rabies treated?

With preventive therapy. If you’ve been exposed — or, in the case of a bat, you even think you’ve been exposed — you need to begin the post-exposure vaccination series. That’s four shots, given at four separate visits, over 2 weeks.

Those are typically given in the ER, which is the recommendation from public health departments. That’s what public health officials recommended for anyone who’d been in contact with the goats that were later found to have rabies at the petting zoo.

You’ll come to an ER for the first shot, which they’ll administer there. They’ll schedule you then to return for the subsequent doses. At Novant Health, we can give the vaccine at an infusion center. So, Novant Health patients may receive their subsequent doses at an ER or an infusion center.

Is the rabies vaccine safe for everyone?

Yes. Because it's so important to receive it if you've been exposed to rabies, there’s no category of people who can’t get the rabies vaccine series.

Does rabies spread from human to human?

No. There really hasn’t been any human-to-human transmission, so there’s no risk to family members of someone who was exposed. There’s no risk to healthcare workers who treat people who were exposed to rabies.

Anything else you want to share about rabies?

I think it’s important to reiterate that in the case of situations like the mobile petting zoo, it’s really only if you were holding, feeding or petting an animal that carried rabies that you need to alert your doctor. If you were, say, just walking around at a petting zoo where animals were found to have rabies, you’re not at risk.

And lastly, rabies is highly treatable as long as you begin the vaccine series soon after exposure.