Vital Signs

Trends in Human Rabies Deaths and Exposures — United States, 1938–2018

Emily G. Pieracci, DVM; Christine M. Pearson; Ryan M. Wallace, DVM; Jesse D. Blanton, DrPH; Erin R. Whitehouse, PhD; Xiaoyue Ma, MPH; Kendra Stauffer, DVM; Richard B. Chipman, MS, MBA; Victoria Olson, PhD


Morbidity and Mortality Weekly Report. 2019;68(23):524-528. 

In This Article


U.S. National Rabies Surveillance data maintained by CDC's Poxvirus and Rabies Branch were analyzed to assess trends in human and animal rabies in the United States during the past 81 years (1938–2018).[1] Initial risk assessment and treatment for exposure to a rabid animal commonly occurs in the emergency department because of the need for wound treatment and rabies immune globulin, typically only available in emergency departments.[11]

The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project's (HCUP; 2006–2014 data, which include longitudinal U.S. hospital care data, were used to estimate the rate of PEP visits (number per 100,000 persons) for 2017–2018 based on the U.S. population. HCUP patient data from emergency departments with an International Classification of Diseases, Ninth Revision diagnosis code of V04.5 (need for rabies prophylaxis) were evaluated ( In addition, 2017 national sales data for rabies immune globulin were provided by an independent consultant (Marketing Research Bureau, Inc., unpublished data, 2019).

The 2019 Centers for Medicare & Medicaid Services average sales price data were analyzed to estimate the cost of PEP.[12,13] The average sales price data lists rabies immune globulin at $312 per 150-IU dose (a 165-pound [75-kg] adult needs 10 doses and a 95-pound [45-kg] child needs 6 doses) and rabies vaccine at $290 per dose (4 total doses needed). The average PEP cost and range were determined using the 2019 average sales price data and previously published data from 2004, adjusted for inflation.[13,14]

The cost and frequency of U.S. public health system rabies responses were derived from previously published literature and opinions of subject matter experts.[13,15,16] An economic analysis conducted by CDC provided estimates of the number of imported dogs from countries at high risk for rabies and the public health cost associated with importation events.[15]