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Rabies: Still a Uniformly Fatal Disease? Historical Occurrence, Epidemiological Trends, and Paradigm Shifts

  • Central Nervous System and Eye Infections (KC Bloch, Section Editor)
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Abstract

Rabies has the highest case fatality of any infectious disease. Pathobiological and clinical insights have questioned the assertion that death is inevitable after onset of acute encephalomyelitis. Relying upon national laboratory-based surveillance, we reviewed records of human rabies acquired in the United States during 1960–2009. Changes in the epidemiology of human rabies were notable, due to improved animal management, safer and more efficacious biologics, and revisions in prevention guidelines. Historically, domestic animals were the most important source of infection. Since the 1990s, more human cases were associated with rabid bats. Prior to 1980, postexposure prophylaxis failures were reported. After development of modern rabies immune globulin and vaccines, none occurred. Of 75 human cases identified, only four patients survived. Rabies remains an extremely high consequence zoonosis, but the disease is not uniformly fatal, per se. Rabies is essentially preventable when primary exposures are averted, or appropriate prophylaxis occurs before illness.

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Acknowledgments

The authors thank all of the local, state, and national health care professionals and health departments whose combined efforts have contributed to the surveillance, diagnosis and care of human rabies patients, and those researchers whose work support biomedical insights into the prevention, control, and treatment of rabies.

The views expressed in this paper represent the authors and not necessarily their home institutions.

Use of commercial or trade names is for comparison purposes only and does not constitute endorsement by the authors or their institutions.

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Authors and Affiliations

  1. Departments of Family Medicine and Pediatrics, University of Connecticut Health Center, Farmington, CT, 06030, USA

    Henry M. Feder Jr.

  2. National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA

    Brett W. Petersen

  3. National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA

    Kis L. Robertson

  4. National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA

    Charles E. Rupprecht

  5. CDC, 1600 Clifton Rd., MS G33, Atlanta, GA, 30333, USA

    Charles E. Rupprecht

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  1. Henry M. Feder Jr.
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  2. Brett W. Petersen
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  3. Kis L. Robertson
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  4. Charles E. Rupprecht
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Correspondence to Henry M. Feder Jr. or Charles E. Rupprecht.

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Feder, H.M., Petersen, B.W., Robertson, K.L. et al. Rabies: Still a Uniformly Fatal Disease? Historical Occurrence, Epidemiological Trends, and Paradigm Shifts. Curr Infect Dis Rep 14, 408–422 (2012). https://doi.org/10.1007/s11908-012-0268-2

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