More than 2.5 billion people are at risk of rabies in over 100
countries.1 Rabies ranks number 10 worldwide as
a cause of infectious disease mortality and is responsible for an
estimated 50,000 to 60,000 deaths annually, despite the availability
of effective vaccines for postexposure prophylaxis.1
In addition, millions of persons, primarily in developing countries,
undergo costly postexposure treatment.2 In the
U.S., rabies continues to be endemic in many wild animal populations.
Although human rabies is rare in the U.S., postexposure rabies prophylaxis
is provided to an estimated 40,000 persons each year.3 Prevention
efforts in the U.S. are estimated to exceed $300 million
annually for vaccination of companion animals, animal control programs,
maintenance of rabies laboratories, and medical costs (e.g., postexposure
This chapter briefly reviews the epidemiology, microbiology, clinical presentation,
and treatment of rabies. The postexposure management of potential
exposures to a rabid animal is reviewed in detail. Current information
is available on the rabies home page posted by the Centers for Disease
Control and Prevention (CDC) (http://www.cdc.gov/rabies/).
Rabies is primarily a disease of animals.4 The
epidemiology of human rabies reflects both the distribution of the
disease in animals and the degree of human contact with these animals.4 In
those parts of the world where canine rabies has been controlled [i.e.,
the U.S. (Table 152-1), Canada, and Europe],
dogs account for <5% of the cases in animals. Where
canine rabies has not been controlled, dogs account for ≥90% of
reported cases in animals. The major wildlife vectors of rabies
are dogs both domestic and wild (major vector of rabies throughout
the world, particularly in Asia, Latin America, and Africa); foxes (Europe,
the Arctic, and North America); raccoons (eastern U.S.); skunks (midwestern
U.S., western Canada); coyotes (Asia, Africa, and North America); mongooses (yellow
mongoose in Asia and Africa; Indian mongoose in the Caribbean islands);
and bats (vampire bats from northern Mexico to Argentina, insectivorous
bats in North America and Europe). In 2007, in 49 states and Puerto
Rico, rabid wild animals accounted for 93% of the reported
cases of rabies in animals, and the breakdown by animal is as follows: raccoons (36.6%),
bats (27.2%), skunks (20.4%), foxes (6.7%),
and other wild animals including coyotes, opossums, otters, bobcats,
rodents, and lagomorphs (rabbits, hares, and picas) (1.8%). Rabid domestic
animals included cats (3.8%); dogs (1.3%); cattle
(0.79%); horses, donkeys, and mules (0.58%); sheep,
goats, and camels (0.18%); and other animals such as ferrets
(0.04%). The following animals very rarely have been
found to be rabid, and hence their bite almost
never requires postexposure prophylaxis for rabies: squirrels, hamsters, guinea
pigs, gerbils, chipmunks, rats, mice, domesticated rabbits, and other
Table 152-1 Geographic Boundaries
of North American Reservoirs for Rabies |Favorite Table|Download (.pdf)
Table 152-1 Geographic Boundaries
of North American Reservoirs for Rabies
|1. An expanding reservoir in raccoons that now encompasses
the entire East Coast from Maine to Florida.|
|2. A long-standing reservoir in red and arctic foxes in Alaska
that has ...|
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