Intended for US Residents Only
The most recent data from the US Centers for Disease Control (CDC) collected in 2013 found that a total of 5,398 wild animals and 467 domestic animals in the United States were infected with rabies.1
US data for animal bites range from 1 million to 4.5 million a year. Cat and dog bites result in 334,000 emergency room visits annually. Each year, 1 to 3 people in the United States report a rabies infection.1,2
In 2011, a Maryland man received a kidney transplant from a deceased donor who had lived in Florida and North Carolina. In 2013, the Maryland man began experiencing symptoms consistent with rabies, and eventually died from the disease a full year and a half after the kidney transplant. After a detailed medical investigation by the CDC, the source of the Maryland man's disease was determined to be the organ donor, a young man who died of unexplained encephalitis that had been attributed to complications from severe gastroenteritis. The CDC's investigation revealed that both the organ donor and the recipient in Maryland had died of a variant of the rabies virus carried by raccoons.
Had he known this threat and contacted his local health department or visited the emergency department, he might have been treated with rabies postexposure prophylaxis (PEP) and survived.
More recently, a 52-year-old Missouri man died in September 2014. It was reported that the victim had been infected with a rabies virus variant associated with the tricolored bat. The victim was said to have found bats in his home and at his workplace a month before his symptoms began, and he may have unknowingly sustained a bite.
In the case of the Maryland death in 2013 associated with the organ donor, better communication between the healthcare provider and the originally exposed patient and his family might have yielded a different outcome. In compliance with current organ donation policy, family members of the donor completed a questionnaire at the time of death, including the decedent's exposure to potentially rabid animals or receipt of rabies PEP. But when asked if the donor had been exposed to potentially rabid animals, the family answered "no," presumably unaware that the raccoons kept penned on the family property fell into the category of potentially rabid animals. The fact that the donor had sustained bites from these raccoons was never revealed in the patient's history until the CDC investigation of the Maryland organ recipient's death.
In the case of the Missouri man who died in 2014, he was presumably not aware of the rabies threat associated with bats, whether a bite is apparent or not. Had he known this threat and contacted his local health department or visited the emergency department, he might have been treated with rabies PEP and survived.
Providers in emergency departments, primary care offices, and pediatric offices need better education about rabies and PEP, as do consumers.
The prevention of human rabies deaths begins with increased awareness and better education among healthcare professionals, public health professionals, and the general public, along with improved screening of organ donors to recognize infectious encephalitis and closer monitoring of transplant recipients. That was the conclusion of researchers investigating the 2013 Maryland death.
While human rabies deaths have been significantly reduced over the last 100 years, the most desirable outcome is not a decline but the elimination of human rabies deaths.1
All rabies exposures are caused by a bite.