Human rabies--Florida, 2004

Rabies is a viral infection of the central nervous system, usually contracted from the bite of an infected animal, and nearly always fatal without postexposure prophylaxis. In February 2004, a man aged 41 years died after a 4-day hospitalization in Broward County, Florida. A diagnosis of rabies was considered on the day before the patient's death; however, no antemortem samples were obtained for testing. In March 2004, postmortem samples of fixed brain material were sent to CDC, where laboratory testing confirmed a diagnosis of rabies, the 47th case of human rabies reported in the United States since 1990 (CDC, unpublished data, 2005). This report summarizes results of the subsequent investigation led by the Broward County Health Department and laboratory testing at CDC, which determined that the rabies virus was a canine variant present in Haiti, where the man had traveled and reportedly been bitten by a dog. Rabies should be considered in persons after a dog bite, especially if the bite occurs in a country where canine rabies is enzootic.     

Community survey after rabies outbreaks, Flagstaff, Arizona, USA

Flagstaff, Arizona, USA, experienced notable outbreaks of rabies caused by a bat rabies virus variant in carnivore species in 2001, 2004, 2005, 2008, and 2009. The most recent epizootic involved transmission among skunk and fox populations and human exposures. Multiple, wide-ranging control efforts and health communications outreach were instituted in 2009, including a household survey given to community members. Although the Flagstaff community is knowledgeable about rabies and the ongoing outbreaks in general, gaps in knowledge about routes of exposure and potential hosts remain. Future educational efforts should include messages on the dangers of animal translocation and a focus on veterinarians and physicians as valuable sources for outreach. These results will be useful to communities experiencing rabies outbreaks as well as those at current risk.     

Update: raccoon rabies epizootic--United States and Canada, 1999

In 1977, an outbreak of raccoon rabies was detected in an area on the West Virginia-Virginia border. Since then, the area affected by this distinct variant of rabies virus associated with raccoons has spread to Ohio in the west and New York, Pennsylvania, Vermont, New Hampshire, and Maine in the north. In addition, the once separate epizootics of rabies among raccoons in the southeastern and mid-Atlantic states converged in North Carolina. In July 1999, the raccoon rabies virus variant was reported from Ontario, Canada, on the New York border. This report describes the spread of this epizootic of raccoon rabies through mid-Atlantic and northeastern states and into Canada.     

Human rabies from exposure to a vampire bat in Mexico --- Louisiana, 2010

In August 2010, CDC confirmed a case of rabies in a migrant farm worker, aged 19 years, hospitalized in Louisiana with encephalitis. The man developed acute neurologic symptoms at the end of July, shortly after arriving in the United States from Michoacán, Mexico. Despite supportive care, his condition deteriorated, and he died on August 21. Antemortem diagnostic testing confirmed the diagnosis of rabies, and samples collected at autopsy were positive for a vampire bat rabies virus variant. The patient's mother reported that he had been bitten by a bat in July in Mexico but had not sought medical care. Postexposure prophylaxis (PEP) was offered to 27 of the patient's contacts in Louisiana and to 68 health-care workers involved in his care. Although bats have become the primary source of human rabies in the United States, this is the first reported death from a vampire bat rabies virus variant in the United States. Clinicians caring for patients with acute progressive encephalitis should consider rabies in the differential diagnosis and implement early infection control measures.     

Bat Rabies in Massachusetts, USA, 1985�C2009

To investigate rabies in Massachusetts, we analyzed bat rabies test results before and after introduction of raccoon variant rabies and after release of revised 1999 US Advisory Committee on Immunization Practices recommendations for rabies postexposure prophylaxis. Bat submissions were associated with level of rabies awareness and specific postexposure recommendations.     

Molecular epidemiology of rabies in northern Colombia 1994-2003. Evidence for human and fox rabies associated with dogs

During the period 2000-2003, wild grey foxes (Urocyon cinereoargenteus) in northern Colombia became infected with rabies. In order to derive phylogenetic relationships between rabies viruses isolated in foxes, dogs and humans in this region, 902 nt cDNA fragments containing the G-L intergenic region and encoding the cytoplasmic domain of protein G and a fragment of protein L were obtained by RT-PCR, sequenced and compared. Phylogenetic analysis showed that rabies viruses isolated in foxes, dogs and humans belonged to a single genetic variant. Speculative analysis together with epidemiological data indicated that rabies in foxes may have been due to contact with rabid dogs. Rabies transmission between dogs, wild foxes and humans may happen in natural conditions in northern Colombia. This finding is the first to suggest dog-to-fox rabies transmission in South America, and provides another example of dog rabies variants being able to successfully colonize wildlife hosts.     

The epidemiology of bat rabies in New York State, 1988-92.

In 1993 New York and Texas each reported a human rabies case traced to a rare variant of rabies virus found in an uncommon species of bat. This study examined the epidemiology of bat rabies in New York State. Demographic, species, and animal-contact information for bats submitted for rabies testing from 1988-92 was analysed. The prevalence of rabies in 6810 bats was 4.6%. Nearly 90% of the 308 rabid bats identified to species were the common big brown bat (Eptesicus fuscus), which comprised 62% of all submissions. Only 25 submissions were silver-haired bats (Lasionycterus noctivagans), the species associated with the two 1993 human cases of rabies, and only two of these bats were positive. Rabies was most prevalent in female bats, in bats submitted because of human [corrected] contact, and in animals tested during September and October. These results highlight the unusual circumstances surrounding the recent human rabies cases in the United States. A species of bat rarely encountered by humans, and contributing little to the total rabies cases in bats, has been implicated in the majority of the indigenously acquired human rabies cases in the United States. The factors contributing to the transmission of this rare rabies variant remain unclear.     

First human death associated with raccoon rabies--Virginia, 2003

Rabies is an acute, progressive, incurable viral encephalitis, caused by the bite of an infected animal. In March 2003, a previously healthy man aged 25 years from northern Virginia died from a diagnosed illness of meningoencephalitis of unknown etiology after a 3-week illness. Histopathologic review of central nervous system tissues at CDC revealed viral inclusions suggestive of Negri bodies, and subsequent tests confirmed a diagnosis of rabies. Genetic sequencing identified a rabies virus variant associated with raccoons, but how the patient became infected remains unknown. This report summarizes the investigation of the first documented case of human rabies associated with a raccoon rabies virus variant in the United States and highlights the importance of continued education in the prevention and diagnosis of rabies.     

Human rabies--Alberta, Canada, 2007

On April 26, 2007, a patient from Alberta, Canada, died after 9 weeks in an intensive care unit (ICU) from encephalitis caused by a rabies virus variant associated with silver-haired bats. This report summarizes the clinical course of disease in that patient, who was treated using the Milwaukee Protocol, an experimental treatment protocol similar to one used for the rabies survivor described in 2005. This report also describes the subsequent epidemiologic investigations by three regional public health departments in Alberta. Rabies continues to be a cause of human death in the developed and developing world. The findings in this report underscore the need for continued public education that promotes rabies prevention and postexposure prophylaxis while emphasizing the importance of bat exposure in rabies transmission.     

Investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004

On June 30, 2004, CDC confirmed diagnoses of rabies in three recipients of transplanted organs and in their common donor, who was found subsequently to have serologic evidence of rabies infection. The transplant recipients had encephalitis of unknown etiology after transplantation and subsequently died. Specimens were sent to CDC for diagnostic evaluation. This report provides a brief summary of the ongoing investigation and information on exposure risks and postexposure measures.     

Novel sylvatic rabies virus variant in endangered golden palm civet, Sri Lanka

Information is scarce about sylvatic rabies virus in Asia and about rabies in palm civets. We report a novel sylvatic rabies virus variant detected in a golden palm civet in Sri Lanka. Evolutionary analysis suggests the virus diverged from canine rabies viruses in Sri Lanka in ≈1933 (range 1886-1963).     

Human rabies--Virginia, 1998

On December 31, 1998, a 29-year-old man in Richmond, Virginia, died from rabies encephalitis caused by a rabies virus variant associated with insectivorous bats. This report summarizes the clinical and epidemiologic investigations by the Virginia Department of Health and CDC.     

Epidemiology and molecular virus characterization of reemerging rabies, South Africa

The incidence of dog rabies in Limpopo Province, South Africa, increased from 5 cases in 2004 to 100 in 2006. Human rabies had last been confirmed in 1981, but investigations instituted after an index case was recognized in February 2006 identified 21 confirmed, 4 probable, and 5 possible human cases between August 5, 2005, and December 31, 2006. Twelve of these case-patients were identified retrospectively because the diagnosis of rabies was not considered: 6 of these patients consulted a traditional healer, 6 had atypical manifestations with prominent abdominal symptoms, and 6 of 7 patients tested had elevated liver enzyme activity. Molecular genetic analysis indicated that outbreak virus strains were most closely related to recent canine strains from southern Zimbabwe. Delayed recognition of the human cases may have resulted from decreased clinical suspicion after many years of effective control of the disease and the occurrence of atypical clinical presentations.     

Human rabies--Iowa, 2002

On September 28, 2002, a man aged 20 years residing in Linn County, Iowa, died from rabies encephalitis caused by infection with a variant of rabies virus associated with silver-haired (Lasionycteris noctivagans) and eastern pipistrelle (Pipistrellus subflavus) bats. This is the first case of human rabies in Iowa since 1951. This report summarizes the investigation of the case by the Linn County and Iowa public health departments. Bats found in living quarters should be submitted to local public health laboratories for rabies testing.     

Rabies in a dog imported from Iraq--New Jersey, June 2008

Rabies vaccination and stray dog control have led to successful control of canine rabies in the United States. The number of rabid dogs reported decreased from approximately 5,000 in 1950 to 79 in 2006, when the canine rabies virus variant associated with dog-to-dog rabies transmission was declared eliminated in the United States. On June 18, 2008, a mixed-breed dog, recently shipped from Iraq into the United States, was confirmed to have rabies by the Public Health and Environmental Laboratories of the New Jersey Department of Health and Senior Services. A total of 24 additional animals in the shipment, all potentially exposed to the rabid dog, were distributed to 16 states. This report summarizes the epidemiologic investigation by the New Jersey Department of Health and Senior Services, Bergen County Department of Health, and CDC, and the ensuing public health response. These findings underscore the need for vigilance regarding rabies (and other zoonotic diseases) during animal importation to prevent the possible reintroduction and sustained transmission of canine rabies in U.S. dog populations.     

Knowledge of bat rabies and human exposure among United States cavers

We surveyed cavers who attended the National Speleological Society convention in June 2000. Fifteen percent of respondents did not consider a bat bite a risk for acquiring rabies; only 20% had received preexposure prophylaxis against the disease. An under-appreciation of the risk for rabies from bat bites may explain the preponderance of human rabies viruses caused by variant strains associated with bats in the United States.     

Skunk and raccoon rabies in the eastern United States: temporal and spatial analysis

Since 1981, an epizootic of raccoon rabies has spread throughout the eastern United States. A concomitant increase in reported rabies cases in skunks has raised concerns that an independent maintenance cycle of rabies virus in skunks could become established, affecting current strategies of wildlife rabies control programs. Rabies surveillance data from 1981 through 2000 obtained from the health departments of 11 eastern states were used to analyze temporal and spatial characteristics of rabies epizootics in each species. Spatial analysis indicated that epizootics in raccoons and skunks moved in a similar direction from 1990 to 2000. Temporal regression analysis showed that the number of rabid raccoons predicted the number of rabid skunks through time, with a 1-month lag. In areas where the raccoon rabies virus variant is enzootic, spatio-temporal analysis does not provide evidence that this rabies virus variant is currently cycling independently among skunks.     

Divergent Rabies Virus Variant of Probable Bat Origin in 2 Gray Foxes,New Mexico,USA

In the Western Hemisphere, bat-associated rabies viruses (RABVs) have established independent transmission cycles in multiple mammal hosts, forming genetically distinct lineages. In New Mexico, USA, skunks, bats, and gray foxes are rabies reservoir hosts and represent a public health risk because of encounters with humans. During 2015 and 2019, two previously undescribed RABVs were detected in 2 gray foxes (Urocyon cinereoargenteus) in Lincoln County, New Mexico. Phylogenetic analysis of the nucleoprotein gene indicated that the isolates are a novel RABV variant. These 2 cases probably represent repeated spillover events from an unknown bat reservoir to gray foxes. Molecular analysis of rabies cases across New Mexico identified that other cross-species transmission events were the result of viral variants previously known to be enzootic to New Mexico. Despite a robust rabies public health surveillance system in the United States, advances in testing and surveillance techniques continue to identify previously unrecognized zoonotic pathogens.     

Imported human rabies -New Jersey, 2011

On July 8, 2011, the New Jersey Department of Health and Senior Services (NJDHSS) contacted CDC about possible rabies in a hospitalized Haitian woman aged 73 years. Rabies was included in the differential diagnosis because she had acute, progressive encephalitis of unknown etiology. No history of animal exposure had been reported at the time of hospitalization. On July 18, CDC confirmed rabies virus infection, later identified as a canine rabies virus variant present in Haiti. The patient's neurologic status continued to deteriorate, leading to her death on July 20. This report summarizes the patient's clinical course and the associated public health investigation. This is the third report of human rabies in the United States acquired in Haiti since 2000 and highlights the importance of obtaining a detailed history for patients who have traveled from a rabies-endemic country and the value of consultation with medical and public health professionals regarding any animal bites.