Increase in US rabies deaths ‘a sobering reminder’ of ongoing risk
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Five people died from rabies in the United States last year, including three in just a 6-week span from Sept. 28 to Nov. 10 — a “sobering reminder,” one expert said, of the risk still posed by one of the world’s deadliest diseases.
The five deaths from rabies came after none were reported in 2019 and 2020, the CDC noted.
Exposure to rabid bats — not dogs — is the leading cause of human rabies in the U.S., accounting for around 70% of infections. Although bats do not always leave a visible mark, they can spread infection through saliva and any direct contact with them should be clinically assessed, the CDC noted in a press release accompanying the new MMWR report.
Because rabies is almost always fatal once symptoms begin, it is important that people who are infected receive post-exposure prophylaxis (PEP), which is nearly 100% effective at preventing rabies if administered before the start of symptoms, the CDC said.
The CDC estimates that approximately 60,000 people receive PEP annually to prevent infection.
Among the three people who died from rabies during the last months of 2021, none sought PEP, according to Amber Kunkel, ScD, an Epidemic Intelligence Service officer in the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and colleagues.
Kunkel and colleagues said each of the three cases was a result of direct contact with bats, either in or around the person’s home.
“All three patients had recognized direct contact with a bat approximately 3 to 7 weeks before symptom onset and died approximately 2 to 3 weeks after symptom onset,” they wrote.
Of the three most recent cases, two were considered avoidable. One patient picked up a bat with their bare hands, whereas the other was attributed to a bat roost in the person’s home. The third patient submitted the bat for testing but refused PEP, despite the bat testing positive for rabies.
“We have come a long way in the United States toward reducing the number of people who become infected each year with rabies, but this recent spate of cases is a sobering reminder that contact with bats poses a real health risk,” Ryan Wallace, DVM, MPH, a co-author of the report and a veterinarian and rabies expert in the CDC’s Division of High-Consequence Pathogens and Pathology, said in a statement.
The number of rabid bats in the U.S. has been stable since 2007, according to the National Rabies Surveillance System. The CDC reported that the uptick in cases may be a result of lack of awareness about the risk and urged people to avoid direct contact with bats.
After coming into contact with a bat or someone who had contact with a bat, the CDC said people should call their state or local health department or animal control to trap the bat for testing, which can help determine if PEP is needed.
Currently, the guidance for PEP includes a dose of human rabies immune globulin and four doses of rabies vaccine given intramuscularly on days 0, 3, 7 and 14.
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