The US Centers for Disease Control and Prevention is warning that exposure to rabies appears to be on the rise across the country, reports BritPanorama.
From July through August, the agency received 17% more rabies-related inquiries than in the same time period last year, including reports of mass exposure events, according to an official CDC health advisory published Thursday. During that time, the CDC said, it also received reports from at least eight state health departments about an increase in administering post-exposure prophylaxis (PEP) care for rabies, PEP administration errors, or both.
This summer has seen a mass exposure event in North Carolina, where nearly 300 people were exposed to baby goats with rabies from a mobile petting zoo that made at least 10 visits between July 28 and August 27, including to assisted living centers and a back-to-school bash. The state health department recommended post-exposure prophylaxis to help prevent infection for 213 people.
Since July, “multiple United States jurisdictions have reported local increases in human rabies exposures involving known rabies vectors or animals in which rabies is less commonly reported,” the CDC warned in its new advisory. “Several high-profile rabies outbreaks and mass rabies exposure events have highlighted the importance of performing careful rabies risk assessments and following evidence-based recommendations for administering PEP,” the agency said. “Rabies is a zoonotic viral disease that is nearly 100% fatal, but it is preventable when PEP is given appropriately before patient symptoms start.”
What does rabies PEP involve?
About 100,000 people are treated with rabies PEP each year in the US. It typically starts with wound care if there was a bite or scratch from an infected animal, followed by a dose of human rabies immunoglobulin to help fight a potential infection until vaccines take effect.
Rabies vaccines are given at the time of the first medical visit, and another dose is typically administered again on days three, seven, and 14 after the first dose, based on whether the person has a weakened immune system and whether they had been vaccinated before. For people who have previously been vaccinated against rabies, PEP consists of two doses three days apart.
In the past, people exposed to rabies received up to 30 painful vaccine shots in the stomach. Today, adults can get the shots in the shoulder muscle, while children can receive them in the thigh over the course of 14 days. Side effects are generally mild and may include a sore arm, a headache, and an upset stomach.
The CDC reported that the use of rabies vaccines and immunoglobulin has surged this year. According to weekly pharmacy data as of September 2, utilization of the two rabies vaccines and the two rabies immunoglobulins licensed in the United States has increased by an estimated 33% and 76%, respectively, compared to the same period last year.
“Although there is currently no shortage of human rabies vaccine or human rabies immunoglobulin in the United States, it is important for clinicians to administer PEP appropriately because errors in rabies risk assessment and PEP administration could result in unnecessary treatment (e.g., additional doses of vaccine or HRIG), potential adverse effects, and avoidable costs,” the CDC said. “A typical course of PEP can cost between $11,000 and $14,000 per person,” the agency added. “Following rabies PEP administration guidance helps ensure that lifesaving vaccines are available for persons who need them and extraneous costs are avoided.”
How quickly do you have to act?
PEP can prevent rabies from developing and is nearly 100% effective if administered after exposure, but timing is critical: treatment must occur before symptoms start. Rabies primarily affects the central nervous system and can lead to severe brain disease and death if medical care is not provided before symptoms manifest. Once clinical signs of rabies appear, the disease is nearly always fatal.
Symptoms may take up to two months to develop and can include headache, nausea, and sore throat before progressing to hallucinations, disorientation, paralysis, and coma.
Contact with infected bats is the leading cause of human rabies deaths nationwide, with at least 70% of people who die from rabies in the US infected by bats. It is estimated that nearly three-quarters of Americans live in areas where animals carry rabies.
Globally, domestic dogs account for more than 95% of the estimated 70,000 human rabies deaths each year. However, rabid dogs in the US remain uncommon due to effective rabies prevention and control programs.
Who’s most at risk?
The risk of rabies can increase when traveling outside the US, as rabies in dogs is a significant problem across parts of Africa, Asia, and Central and South America. Since 1990, more than 80 people in the US have died after being infected with rabies during travel. In the US, outdoor activities such as camping or hunting may increase exposure risk. Moreover, individuals with jobs that involve frequent animal contact face a higher risk, including veterinary professionals, animal control workers, and wildlife researchers.
How can you prevent rabies?
Around the world, large-scale dog vaccination programs are the most effective means to prevent rabies. In the United States, wildlife management professionals distribute more than 5 million oral vaccines to wildlife through baits annually to control rabies at its source, while veterinarians vaccinate over 90 million cats and dogs each year.
The CDC recommends that individuals can help prevent rabies by:
- Making sure pets are up to date on their rabies vaccines.
- Staying away from wildlife.
- Calling animal control to remove stray animals from neighborhoods.
- Washing bites or scratches immediately with soap and water after possible rabies exposure.
- Seeking medical care urgently if exposed to rabies.
The emergence of increased rabies exposure events underscores the ongoing public health challenge, necessitating vigilance from both health officials and the public alike.
