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Rabies is a rare diagnosis, but with a fatality rate of over 99%, it is one of the world’s most deadly infectious diseases.1 Once symptoms begin, no treatment is available, and death is almost inevitable within weeks of symptom onset.1 As above, rabies is responsible for approximately 59,000 annual deaths worldwide; this figure is likely a gross underestimate due to poor surveillance and underreporting.2 Rabies is a scourge of the developing world, with more than 95% of cases arising in resource-limited countries in Africa and Asia; 35% of cases are found in India alone.2 Children account for nearly half of human rabies cases.3 The estimated annual economic burden of rabies worldwide is $8.6 billion.2
Worldwide, 99% of human rabies deaths are attributed to bites from infected dogs.1,3 In North America, Europe, and some countries in Latin America, rabies has been eliminated in domestic dogs due to widespread vaccination programs beginning in the early 1950s.3 (See Figure 1.) This successful public health effort has reduced the number of human rabies cases in the United States from more than 100 per year in the early 20th century to no more than 6 per year since 1960.4,5 The canine rabies virus strain was eradicated from the United States in 2004, but dogs can occasionally acquire other strains from encounters with wildlife.1
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Following are the most informative references cited in this paper, as determined by the authors.
1. Pieracci EG, Pearson CM, Wallace RM, et al. Vital signs: trends in human rabies deaths and exposures - United States, 1938-2018. MMWR Morb Mortal Wkly Rep. 2019;68(23):524-528. (Surveillance)
5. *Nigg AJ, Walker PL. Overview, prevention, and treatment of rabies. Pharmacotherapy. 2009;29(10):1182-1195. (Review)
8. US Centers for Disease Control and Prevention. "Domestic Animals." 2018. Accessed January 15, 2022. (CDC website)
16. Johnson N, Phillpotts R, Fooks AR. Airborne transmission of lyssaviruses. J Med Microbiol. 2006;55(Pt 6):785-790. (Basic science)
29. *Rupprecht CE, Briggs D, Brown CM, et al. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010;59(Rr-2):1-9. (CDC ACIP clinical practice guidelines)
34. Nasser R, Rakedzon S, Dickstein Y, et al. Are all vaccines safe for the pregnant traveller? A systematic review and meta-analysis. J Travel Med. 2020;27(2). (Systematic review, meta-analysis)
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Keywords: rabies, bite, wild, animal, canine, bat, travel, pre-exposure prophylaxis, PrEP, post-exposure prophylaxis, PEP, vaccination, saliva, prodrome, encephalitis, furious, paralytic, dumb, hydrophobia, aerophobia, HRIG, rabies immune globulin
Keith Pochick, MD, FACEP
Novant GoHealth Urgent Care
Claude Shackelford, MD
Assistant Professor of Clinical Medicine, Vanderbilt University Medical Center; Assistant Medical Director,
Walk-In Clinics, Vanderbilt University Medical Center, Nashville, TN
Patrick O’Malley, MD
Bess Storch, MD
Jason Chu, MD; Edward Otten, MD, FACMT, FAWM
June 1, 2022
June 1, 2025   CME Information
4 AMA PRA Category 1 Credits™. 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits