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

Discussion and Conclusions

Bats are currently the leading cause of human rabies deaths in the United States. Unlike rabies management programs targeting raccoon, fox, and coyote populations, bat vaccination is not yet logistically feasible, nor are any rabies vaccines currently approved for use in bats. Despite the rabies exposure risk, the vast majority of bats submitted for testing (94%) do not have rabies.[1] Thus, widespread killing of bats is not recommended to prevent rabies. However, increased awareness of the risk for rabies from bats and knowledge of when to seek medical attention for PEP are needed. In addition to bat rabies cases, international travel-related rabies cases occur because of a lack of awareness about the ongoing global risk of rabies in dogs.

Efforts to control rabies in wildlife and maintain canine rabies elimination in the United States require ongoing, high-quality rabies surveillance and timely response capabilities. Rabies continues to be a priority zoonotic disease for One Health collaboration,[17] requiring multi-agency cooperation to ensure continued success of the U.S. rabies control program. Currently, U.S. public health laboratories and United States Department of Agriculture Wildlife Services test approximately 100,000 animals per year, and approximately 5,000 are rabies-positive.[1] Although CRVV has been eliminated from the United States, dogs might still acquire rabies from wildlife.

Whereas canine rabies vaccination is required throughout the United States, animal registration and rabies vaccination laws vary by county, making it difficult to estimate the current rabies vaccination coverage rates among dogs in the United States. In addition, recent antivaccination sentiments have been documented in owners reluctant to vaccinate their dogs against diseases.[18] Failure to vaccinate dogs against rabies could constitute a considerable public health threat to both humans and animals. Thus, maintaining current rabies vaccination rates of at least 70% in dogs is critical not only to protect pets, but to protect pet owners as well.[19]

The findings in this report are subject to three limitations. First, although rabies is a notifiable disease for both humans and animals, data on PEP use among persons seeking care for a potential exposure are limited and rely on emergency department data, some of which may be incomplete. Second, previously published data and current average sales price data from the Centers for Medicare & Medicaid were used to estimate costs for this analysis, but the actual amount hospitals bill for PEP varies considerably, making it difficult to assess the true cost of PEP.[10] Finally, rabies prevention and control costs have a high degree of variability. For example, costs for public health emergency responses can vary considerably between states depending on the number and type of animals and humans involved.

As the human urban environment encroaches into wildlife settings, human rabies exposures continue to occur. However, the relatively few human rabies deaths that occur in the United States are a testament to the robust response capabilities of the nation's public health system, as well as the success of wildlife and pet vaccination programs and the availability of effective PEP. Although human rabies is now a rare disease in the United States, it remains one with extremely high consequences.