0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Epidemiology of Human Rabies in the United States, 1980 to 1996

Donald L. Noah, DVM, MPH; Cherie L. Drenzek, DVM, MS; Jean S. Smith, MS; John W. Krebs, MS; Lillian Orciari, MS; John Shaddock, BS; Dane Sanderlin, MS; Sylvia Whitfield, MS; Makonnen Fekadu, DVM, PhD; James G. Olson, PhD; Charles E. Rupprecht, VMD, PhD; and James E. Childs, ScD
[+] Article and Author Information

From National Center for Infectious Diseases, Atlanta, Georgia; and Centers for Disease Control and Prevention, Atlanta, Georgia. For current author addresses, see end of text. Acknowledgments: The authors thank the many state health department employees who provided epidemiologic and laboratory data on these cases; Pam Yager and past members of the Viral and Rickettsial Zoonoses Branch, who participated in the investigation and publication of some of the cases reviewed; and John O'Connor for careful editing. Requests for Reprints: James E. Childs, ScD, Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-13, Atlanta, GA 30333. Current Author Addresses: Dr. Noah: 902 Seminole Street, Frederick, MD 21701.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(11):922-930. doi:10.7326/0003-4819-128-11-199806010-00012
Text Size: A A A

Purpose: To summarize the epidemiologic, diagnostic, and clinical features of the 32 laboratory-confirmed cases of human rabies diagnosed in the United States from 1980 to 1996.

Data Sources: Data were obtained from case reports of human rabies submitted to the Centers for Disease Control and Prevention by state or local health authorities.

Study Selection: All cases of human rabies reported in the United States from 1980 to 1996 in which infection with rabies virus was confirmed by laboratory studies.

Data Extraction: Patients were reviewed for demographic characteristics, exposure history, rabies prophylaxis, clinical presentation, treatment, clinical course, diagnostic laboratory tests, identification of rabies virus variants, and the number of medical personnel or family members who required postexposure prophylaxis after coming in contact with an exposed person.

Data Synthesis: 32 cases of human rabies were reported from 20 states. Patients ranged in age from 4 to 82 years and were predominantly male (63%). Most patients (25 of 32) had no definite history of an animal bite or other event associated with rabies virus transmission. Of the 32 cases, 17 (53%) were associated with rabies virus variants found in insectivorous bats, 12 (38%) with variants found in domestic dogs outside the United States, 2 (6%) with variants found in indigenous domestic dogs, and 1 (3%) with a variant found in indigenous skunks. Among the 7 patients with a definite exposure history, 6 cases were attributable to dog bites received in foreign countries and 1 was attributable to a bat bite received in the United States. In 12 of the 32 patients (38%), rabies was not clinically suspected and was diagnosed after death. In the remaining 20 cases (63%), the diagnosis of rabies was considered before death and samples were obtained specifically for laboratory confirmation a median of 7 days (range, 3 to 17 days) after the onset of clinical signs. Of the clinical differences between patients in whom rabies was diagnosed before death and those in whom it was diagnosed after death, the presence of hydrophobia or aerophobia was significantly associated with antemortem diagnosis (odds ratio, 11.0 [95% CI, 1.05 to 273.34]). The median number of medical personnel or familial contacts of the patients who received postexposure prophylaxis was 54 per patient (range, 4 to 179). None of the 32 patients with rabies received postexposure prophylaxis before the onset of clinical disease.

Conclusions: In the United States, human rabies is rare but probably underdiagnosed. Rabies should be included in the differential diagnosis of any case of acute, rapidly progressing encephalitis, even if the patient does not recall being bitten by an animal. In addition to situations involving an animal bite, a scratch from an animal, or contact of mucous membranes with infectious saliva, post-exposure prophylaxis should be considered if the history indicates that a bat was physically present, even if the person is unable to reliably report contact that could have resulted in a bite. Such a situation may arise when a bat bite causes an insignificant wound or the circumstances do not allow recognition of contact, such as when a bat is found in the room of a sleeping person or near a previously unattended child.

Topics

rabies

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)