Vital Signs: Trends in Human Rabies Deaths and Exposures - United States, 1938-2018

Abstract

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.

FIGURE 1

Rabies cases in humans and domestic animals — United States, 1938–2018

FIGURE 2

Rabies virus variants associated with human rabies cases (N = 125)^† — United States, 1960–2018 * Other rabies virus variants included skunk, fox, and unknown. ^† Includes 120 persons who died and five survivors with suspected rabies infection in 1970, 1977, 2004, 2009, and 2011. Cases in survivors were never laboratory-confirmed; three cases are included in bat rabies virus variants because of epidemiologic links to bats and two are included in other (one unknown and one lab-acquired).