Search

Introduction: Each year, rabies causes approximately 59,000 deaths worldwide, including approximately two deaths in the United States. Before 1960, dogs were a common reservoir of rabies in the United States; however, increasingly, species of wildlife (e.g., bats, raccoons) are the main reservoirs. This report characterizes human rabies deaths, summarizes trends in rabies mortality, and highlights current rabies risks in the United States.Methods: Rabies trends in the United States during 1938-2018 were analyzed using national rabies surveillance data. Data from the Healthcare Cost and Utilization Project for 2006-2014 were used to estimate the number of postexposure prophylaxis (PEP) visits per 100,000 persons during 2017-2018. The Centers for Medicare & Medicaid Services' average sales price data were used to estimate PEP costs.Results: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. In 2018, approximately 55,000 persons sought PEP after contact with a potentially rabid animal.Conclusions and Comments: In the United States, wildlife rabies, especially in bats, continues to pose a risk to humans. Travelers also might be exposed to canine rabies in countries where the disease is still present; increased awareness of rabies while traveling abroad is needed. Vaccinating pets, avoiding contact with wildlife, and seeking medical care if one is bitten or scratched by an animal are the most effective ways to prevent rabies. Understanding the need for timely administration of PEP to prevent death is critical. [ABSTRACT FROM AUTHOR]

Canine rabies virus variant has been eliminated in the United States and multiple other countries. Globally, however, dogs remain the principal source for human rabies infections. The World Health Organization recommends that when dogs cross international borders, national importing authorities should require an international veterinary certificate attesting that the animal did not show signs of rabies at the time of shipment, was permanently identified, vaccinated, or revaccinated, and had been subjected to a serologic test for rabies before shipment. On June 8, 2015, an adult female dog that had recently been picked up from the streets of Cairo, Egypt, and shipped by a U.S. animal rescue organization to the United States was confirmed to have rabies by the Virginia Department of General Services Division of Consolidated Laboratory Services (DCLS). This dog was part of a large shipment of dogs and cats from Egypt that rescue organizations had distributed to multiple states for adoption. During the investigation, public health officials learned that the rabies vaccination certificate used for entry of the rabid dog into the United States had intentionally been falsified to avoid exclusion of the dog from entry under CDC's current dog importation regulations. This report underscores the ongoing risk posed by U.S. importation of domestic animals that have not been adequately vaccinated against rabies. [ABSTRACT FROM AUTHOR]

The article presents case reports of rabies acquired in the U.S. but with symptoms onset, medical management and diagnosis abroad. One incident involves a U.S. resident who was admitted to a hospital in Dubai, United Arab Emirates who acquired rabies from contact with a bat in California. Fluorescent antibody testing of brain tissue confirmed a rabies diagnosis. Another incident involves a U.S. resident who died in Switzerland from rabies.

The article discusses the need for guidelines for proper remediation of bat infestation and public health investigations of potential mass bat contacts. The Kentucky Department for Public Health and the Centers for Disease Control (CDC) assessed the risk for bat exposure at a volunteer facility in eastern Kentucky that was a roosting colony of 200-300 big brown bats. Members were informed that bats are a reservoir for rabies and sightings should be reported to the local health department.

Summarizes data from the registry about women with smallpox vaccine exposure during pregnancy, reported to the National Smallpox Vaccine in Pregnancy Registry in the U.S. in 2003. Ways to prevent inadvertent exposure of pregnant women to vaccinia virus; Composition of the registry; Manner in which cases of women inadvertently exposed to smallpox vaccine during pregnancy are reported to the registry.