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


During 1938–2018, 588 cases of human rabies were reported in the United States. The elimination of CRVV in the United States through canine rabies vaccination has resulted in a tenfold decrease in human rabies cases reported from 1938 through 2018 (Figure 1). During 1960–2018, among 125 reported human rabies cases, 89 were U.S.-acquired, including six organ transplantation cases. Among all U.S.-acquired cases, 62 (70%) were caused by bat rabies virus variants (Figure 2). Since 1960, 36 (28%) U.S. residents have died of rabies acquired from dogs while traveling abroad.

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).

During 2017–2018, an average of 55,000 (range = 45,453–66,000) persons were treated for potential rabies exposure each year. The cost for rabies PEP averages $3,800 (range = $1,200–$6,500), not including costs for hospital treatment or wound care. This results in annual estimated PEP costs of $209 million (range = $66 million–$358 million).

Since 2003, the U.S. public health system has responded to approximately two human rabies deaths, 175 mass bat exposure events (events where >10 persons are exposed to a potentially rabid bat), and one rabid dog importation every year (Table). CDC estimates that 1.06 million dogs enter the United States every year, including 107,000 (10%) that are imported from countries where CRVV is enzootic, thereby posing a potential risk for reintroduction of CRVV into the United States. Since 2015, three canine rabies cases have been imported in rescue dogs adopted from countries with a high risk for rabies. Canine rabies importation events are estimated to cost $213,833 (range = $171,066–$256,599) per event in public health response and health care costs to prevent the spread of the disease to humans and their pets. Total estimated costs associated with rabies public health emergency response activities are $7.6 million per year (range = $2.6 million–$12.9 million) (Table).