The Reemergence of Rabies

Abstract

Well before Louis Pasteur's success with the vaccination of Joseph Meister, rabies evoked strong sentiments in virtually all segments of the human population, providing rich fodder for legend and literature. In 1995, rabies in foxes and cats was still significant, with cats rather than dogs now leading as the most common rabid domestic animals. The gradual transition in animal rabies has resulted in major epidemiologic changes in human rabies, with concomitant implications for postexposure prophylaxis (PEP) recommendations. Rather, human attraction to the recreational and economic benefits provided by wildlife has contributed to the reemergence of rabies as a major zoonosis. Rabies PEP consists of wound care, active vaccination, and passive immunoglobulin administration. The foundation of human rabies prevention is based on reliable identification of an exposure and the institution of prompt, appropriate PEP. The example provided by raccoon rabies is perhaps the most striking translocation story in recent years. In 1977, when the index case occurred near the Virginia-West Virginia border, one of the most intensive outbreaks of wildlife rabies in the United States began. Given the multispecies complexity of rabies and the considerable size of affected geographic areas, together with the opportunity for translocation of infected furbearers, it is unclear if traditional preventive strategies can lessen its burden on the public health infrastructure.