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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 prophylaxis).3

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) (

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 small rodents.

Table 152-1 Geographic Boundaries of North American Reservoirs for Rabies

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