Despite HHS Secretary Robert F. Kennedy Jr’s unscientific comments about rabies and shutting down the CDC’s rabies testing (which was later rescinded), the CDC is reporting a significant increase in rabies activity in the USA.

There have been reports of mass rabies exposure events, including one from officials in North Carolina warning that nearly 300 people were potentially exposed to rabid goats at a mobile petting zoo. As you can imagine, it involved mostly young children and parents.

Rabies is a deadly disease — it is nearly 100% fatal after symptoms appear. A vaccine and immunoglobulin combination is the only way to treat rabies before symptoms appear.

The CDC is reporting an uptick in human exposures to rabid animals, saying it fielded 17% more rabies-related inquiries in the past two months than it did during the same period last year.

The CDC provided tools in response to this uptick in rabies activity. The CDC offered clinicians a range of postexposure resources, including PEP guidance from the Advisory Committee on Immunization Practices, risk assessment tools, and links to state and local health departments to report potential cases.

All about rabies and the rabies vaccine

Rabies is a viral disease that causes a brain inflammation in humans and other mammals. Infected mammals transfer the virus to humans through bites or scratches.

The rabies virus is slow to infect humans, although the course of infection varies widely depending on how much virus the infected mammal transmits. The incubation period (the period between initial infection and the first symptoms) is about 1-3 months in humans, but can be as short as 4 days and as long as 6 years.

The initial signs and symptoms of rabies are nonspecific, including fever and headache, which can be misdiagnosed as many other diseases. As the infection progresses and causes meningoencephalitis, an inflammation of the brain and/or meninges, it can lead to more severe symptoms. These signs and symptoms can include paralysis, anxiety, insomnia, confusion, agitation, paranoia, terror, and hallucinations. This eventually leads to coma and death, usually 2 to 10 days after the first symptoms appear.

Once someone presents with the earliest symptoms of rabies, they have an extremely poor prognosis – approximately 100% will die.

The only prevention and treatment for rabies is the rabies vaccine. Although the vaccine is strongly recommended (and usually legally mandated) for your pets, it is generally not given to humans before infection except when someone is frequently in contact with rabies-infected mammals.

However, the CDC’s Advisory Committee on Immunization Practices (ACIP) has established a postexposure prophylaxis protocol (PEP) to treat rabies. PEP should be implemented immediately after exposure to an infected animal (confirmed or suspected) – once again, when symptoms appear, it’s too late.

This protocol includes the following steps:

• Thoroughly cleansing the wound site with a virucidal soap and water.
• A proper dose (based on patient weight) of human rabies immunoglobulin, which attacks the rabies virus.
• Four doses of the rabies vaccine, on days 0, 3, 7, and 14, boost the immune system to destroy the rabies virus.

The old method of several painful injections in the abdomen is long gone. The vaccine is injected intramuscularly in the deltoid muscle. If administered immediately after exposure, PEP’s success rate approaches 100%.

Thus, if you get immediate treatment for rabies after a bite or scratch from a confirmed or suspected rabies-infected mammal, your chances of living are quite high. If you wait until symptoms appear, the chances of survival drop to almost nothing. Vaccination is the only choice.

Here’s what you need to know about rabies. It is nearly 100% fatal once rabies symptoms appear. Also, no effective treatments for rabies exist once symptoms appear.

According to the CDC, an estimated 1.3 million people in the U.S. seek medical care for an animal bite, and about 100,000 of them (7%) get rabies PEP. Annually, the nation’s rabies prevention system costs about $7.2 billion to operate.

The disease is rare in people in the United States, with fewer than 10 deaths reported each year; one happened recently. We aggressively attack the disease with an effective post-exposure prophylaxis protocol and have a strong rabies vaccination program for our pets. However, because rabies occurs in wildlife throughout the country (except for Hawaii), rabies poses a serious public health threat.

Summary

I’m not sure what is causing this uptick in rabies activity in the US this summer. Possibly, more people are encountering wildlife that carries the virus than in the past. Or it could be a lower pet vaccination rate, and those unvaccinated pets encounter rabid wildlife. I’m only speculating because there have been no official explanations for the increase in rabies.

Importantly, an animal does not necessarily have to bite a person to transmit rabies. A scratch from a diseased animal can lead to rabies. Also, handling a dead animal can be dangerous. I wrote about a young teacher who died from a small scratch from a bat.

And getting exposed to rabies means the victim has no choice — get vaccinated or die. There are no miracle cures for rabies.

If your pets aren’t vaccinated, ignore the pseudoscience about pet vaccinations and protect your pets from rabies. That will also protect yourself and your family.

I hope RFK Jr. and the CDC will stand firm about rabies and the rabies vaccine. Unfortunately, I worry because of their anti-vaccine rhetoric.

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