New aspects of rabies with emphasis on epidemiology, diagnosis, and prevention of the disease in the United States

In 1994, six persons died of rabies in the United Slates, the highest total since 1979. These deaths, although tragic, hardly seem significant when compared with the thousands of deaths that occur each year from other infectious diseases. At a time when public health budgets are under close scrutiny, why would such an apparently well-controlled disease warrant an expenditure of millions of dollars for diagnostic laboratories in all 50 states and a national reference laboratory at the Centers for Disease Control and Prevention? The answer to that question, and the focus of this review, is to remind the reader that rabies control is not synonymous with rabies elimination. More than 8,000 animal rabies cases were diagnosed in the United States in 1994, and rabies virus is transmitted at endemic and occasionally epidemic levels in animal hosts as varied as the Arctic fox in the polar regions of Alaska to transient, neotropical bat species in Texas and other southwestern states. Bite or other wound contact with the saliva of these animals was reason to initiate preventive rabies treatment consisting of a series of injections of immune globulin and vaccine, to many thousands of humans at an estimated cost of up to $2,000 per treatment. Preventive vaccination of domestic animals and stray-animal control add several $100 million each year to the escalating cost of rabies control. The role of the public health rabies laboratory is to maintain a careful surveillance of animal populations affected by rabies, to advise the medical community when rabies preventive treatment is needed, and, equally important, to offer assurance on those occasions when it is not. Vaccination of wild species through oral baits and continued research in developing control methods for rabies in wild species may lead to improved control and prevention of rabies in the future.