Epidemiology

Rabies is distributed worldwide. It is present in more than 150 countries and territories, and on all continents except Antarctica. The main burden of disease is located in developing countries in Asia and Africa.[5] There has been a substantial reduction in the number of cases in Latin America and the Caribbean over the years.

Globally, about 59,000 people die from rabies every year, many of whom are children. Approximately 1-3 cases of rabies are reported in the US annually, but the main impact to the healthcare system is from the thousands of exposures that require risk assessment and postexposure prophylaxis every year.[6][7]​ Twenty-five human rabies cases were reported in the US between 2009-2019. Most of these cases were due to transmission via bats. Between 1960-2018, 28% of cases were attributed to bats, and 28% were attributed to dog bites during international travel.[8] Cases from organ transplantation have also been reported.[7] Between September and November 2021, 3 people died from rabies in the US after direct contact with bats in or around their homes, taking the total to 5 cases in 2021 (no cases were reported in the US in 2019, 2020 or 2022).[9][10]​ Nineteen cases were reported in Latin American countries (Bolivia, Dominican Republic, Guatemala, and Haiti only) in 2017.[11] Children account for 30% to 50% of rabies cases.[12] Approximately 50% of US cases occur between September and November.[13][14][15]

All mammals are susceptible to infection. The principal vector in developing countries is the dog. The elimination of canine rabies has successfully eradicated rabies in some countries. Canine rabies has been eliminated in the US but other vectors exist, including bats, raccoons, skunks, foxes, jackals, and mongooses.[16] Bats are now the major source of human rabies in the Americas. Infection of cats, dogs, and other domestic animals occurs with some frequency and increases the exposure risk to humans.

In Western Europe, Brazil, and South Korea, rabies has also been maintained in nature by other vectors. Many reservoirs are found in wild carnivora, including coyotes; red, arctic, and gray foxes; jackals; mongooses; raccoons; skunks; and wolves.[17]​ Bats have also emerged as vectors in some Latin American and European countries, parts of Africa, and in Australia. The main vector in Western Europe is the red fox.

[Figure caption and citation for the preceding image starts]: A canine suspected of being rabid that had been exhibiting signs of restlessness and overall uncharacteristic aggressive behaviorCDC [Citation ends].com.bmj.content.model.Caption@f7ac6f

Use of this content is subject to our disclaimer