CDC issues alert about nationwide increase in rabies exposures

By Jacqueline Howard, CNN

(CNN) — The US Centers for Disease Control and Prevention is warning that exposure to rabies appears to be on the rise across the country.

From July through August, the agency received 17% more rabies-related inquiries than in the same time period last year, including reports of mass exposure events, according to an official CDC health advisory published Thursday.

During that time, the CDC said, it also received reports from at least eight state health departments about an increase in administering post-exposure prophylaxis (PEP) care for rabies, PEP administration errors or both.

This summer has seen a mass exposure event in North Carolina, where nearly 300 people were exposed to baby goats with rabies from a mobile petting zoo that made at least 10 visits between July 28 and August 27, including to assisted living centers and a back-to-school bash. The state health department recommended post-exposure prophylaxis to help prevent infection for 213 people.

Since July, “multiple United States jurisdictions have reported local increases in human rabies exposures involving known rabies vectors or animals in which rabies is less commonly reported,” the CDC warned in its new advisory.

“Several high-profile rabies outbreaks and mass rabies exposure events have highlighted the importance of performing careful rabies risk assessments and following evidence-based recommendations for administering PEP,” the agency said. “Rabies is a zoonotic viral disease that is nearly 100% fatal, but it is preventable when PEP is given appropriately before patient symptoms start.”

What does rabies PEP involve?

About 100,000 people are treated with rabies PEP each year in the US, according to the CDC. It typically starts with wound care if there was a bite or scratch from an infected animal, followed by a dose of human rabies immunoglobulin to help fight a potential infection until vaccines take effect.

Rabies vaccines are given at the time of the first medical visit, and another dose is typically given again on days three, seven and 14 after the first dose, based on whether the person has a weakened immune system and whether they had been vaccinated before. For people who have previously been vaccinated against rabies, PEP consists of two doses three days apart, according to the CDC.

In the past, people exposed to rabies received up to 30 painful vaccine shots in the stomach. Today, adults can get the shots in the shoulder muscle, while children can get them in the thigh over the course of 14 days. Side effects are generally mild and may include a sore arm, a headache and an upset stomach.

The CDC said in Thursday’s advisory that the use of rabies vaccines and immunoglobulin has surged this year.

According to weekly pharmacy data as of September 2, utilization of the two rabies vaccines and the two rabies immunoglobulins that are licensed in the United States has increased by an estimated 33% and 76%, respectively, this year compared with the same time period last year, the CDC said.

“Although there is currently no shortage of human rabies vaccine or human rabies immunoglobulin in the United States, it is important for clinicians to administer PEP appropriately because errors in rabies risk assessment and PEP administration could result in unnecessary treatment (e.g., additional doses of vaccine or HRIG), potential adverse effects, and avoidable costs,” the CDC said.

“A typical course of PEP can cost between $11,000 and $14,000 per person,” the agency added. “Following rabies PEP administration guidance helps ensure that lifesaving vaccines are available for persons who need it and extraneous costs are avoided.”

How quickly do you have to act?

PEP can prevent rabies from developing and is nearly 100% effective if you get it after exposure, but you must act quickly: before symptoms start.

Rabies primarily affects the central nervous system and can lead to severe brain disease and death if medical care is not received before symptoms start. Once clinical signs of rabies appear, the disease is nearly always fatal.

Symptoms, which can take up to two months to develop, may include headache, nausea and sore throat before progressing to hallucinations, delusions, disorientation, paralysis and coma.

What should I do if I think I’ve been exposed to rabies?

If you think you may have been exposed to rabies because you or your pets have been in contact with any wildlife or sick-acting animals, especially if you’ve been bitten or scratched, immediately wash any wounds with water and soap for 15 minutes, according to the CDC.

Talk with your doctor or a public health professional about your risk, including whether you might need rabies-related care, and tell them about the type of animal you encountered and whether you noticed any signs that the animal was not acting normally.

If you were bitten by someone else’s pet, ask the owner for proof that it’s up to date on its rabies vaccination.

If the animal was roaming in your area and you can do so safely, capture or confine it and contact your area’s animal control service or your local health department for assistance.

“In some circumstances and in consultation with a veterinarian, observing an available animal might be a reasonable alternative to rabies testing,” the CDC says.

How does rabies typically spread?

An infected animal can spread rabies to humans and other animals through bites, scratches or oral secretions like their saliva.

In the United States, more than 90% of reported cases of rabies in animals are in wildlife, according to the CDC. Rabies can be found in many wildlife species, including bats, raccoons, skunks and foxes.

Contact with infected bats is the leading cause of human rabies deaths nationwide, as at least 7 in 10 people who die from rabies in the US were infected by bats, according to the CDC. It’s estimated that nearly three-quarters of Americans live in a community where animals carry rabies.

Globally, domestic dogs are responsible for more than 95% of the estimated 70,000 human rabies deaths each year. But rabid dogs in the US remain uncommon due to rabies prevention and control programs.

Who’s most at risk?

The risk of rabies can increase when traveling outside the US, as rabies in dogs remains a major problem across parts of Africa, Asia and Central and South America, according to the CDC. Since 1990, more than 80 people in the US have died after being infected with rabies during travel.

In the US, outdoor activities such as camping or hunting may increase the risk of being exposed to rabies. And people with jobs that involve frequent animal contact have a higher risk, including veterinary professionals, animal control workers and wildlife researchers.

How can you prevent rabies?

Around the world, large-scale dog vaccination programs are the most effective way to prevent rabies, according to the CDC.

And in the United States each year, wildlife management professionals distribute more than 5 million oral vaccines to wildlife through baits to control rabies at its source, according to the CDC. Veterinarians vaccinate more than 90 million cats and dogs annually.

The CDC also recommends that you can help prevent rabies by:

• Making sure your pets are up to date on their rabies vaccines.
• Staying away from wildlife.
• Calling animal control to remove stray animals from your neighborhood.
• Washing bites or scratches immediately with soap and water after a possible rabies exposure.
• Seeking medical care urgently if you may have been exposed to rabies.

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CNN’s Jen Christensen contributed to this report.