Rabies in the United States: Protecting Public Health

Public health importance of rabies

Rabies is a rare but serious public health concern in the United States. Before 1960, several hundred people died of rabies each year. Thanks to the coordinated efforts of human and animal health experts, fewer than 10 human deaths are reported each year in the U.S. While rabies is uncommon in humans, three out of four Americans live in a community where raccoons, skunks, or foxes carry this deadly disease.

In the U.S., around 4,000 animal rabies cases are reported each year, with more than 90% occurring in wildlife like bats, raccoons, skunks, and foxes. This is a big change from the 1960s, when domestic animals, mainly dogs, represented most of the rabies cases.

The decrease in human deaths from rabies from over 100 per year in the early 1900s to fewer than 10 annually since the 1960s is directly related to:

• Successful vaccination of pets and animal control programs,
• Public health tracking and testing of human and animal rabies cases, and
• The availability and use of rabies-related medical care, called post-exposure prophylaxis (PEP).

Even though rabies is well-controlled in the U.S., over 4 million Americans report animal bites each year with 800,000 seeking medical attention. Rabies vaccines are complex, expensive, and limited. Public health programs can assess each person who may have been exposed to rabies to determine if they need rabies-related medical care, including the vaccine.

Sometimes, people still die from rabies, usually because they didn't get medical help soon enough after being scratched or bitten. It's important to be aware of the risk, especially with bat bites, which can be easy to ignore because they don't always leave obvious marks.

Animal rabies surveillance in the U.S.

Every year, the CDC collects and analyzes data on animal and human rabies cases from state health departments. The latest report, "Rabies Surveillance in the United States," gives a detailed look at the current rabies landscape in the United States:

• Wildlife Rabies Surveillance: Wild animals account for >90% of reported cases, with bats (33%), raccoons (30%), skunks (20%), and foxes (7%) most often exposing Americans to rabies.
• Rabies Virus Variants: The rabies virus has adapted to specific animal reservoir hosts (like raccoons, bats, skunks, and foxes), and these variants can be found in specific parts of the U.S.

Rabies animal reservoirs in the U.S.

Bats: Rabid bats are found in all U.S. states, except for Hawaii. While certain bats are more commonly diagnosed with rabies, all bat species are susceptible and any direct contact with a bat should be reported to a medical provider or your public health department.

Raccoons: Raccoons are a rabies reservoir in the eastern U.S., extending from Canada to Florida and as far west as the Appalachian Mountain range. Within these areas, 10% of raccoons that expose people or pets have rabies, making them one of the highest rabies-risks in the U.S. However, rabid raccoons are rarely reported outside of the eastern U.S., highlighting the importance of considering the local patterns of rabies when assessing a patient's rabies exposure risk [LINK].

Skunks: Skunks are a rabies reservoir across most states in the Midwest and Western parts of the U.S. While exposures to rabid skunks are not very common in the U.S., when they occur >20% of skunks that expose people or pets have rabies. This means that skunks are the highest risk for rabies in the U.S., if they bite or scratch a person or pet. Even skunks found in states where raccoons are the reservoir are considered high-risk.

Foxes: Foxes are a reservoir for rabies in the Southwestern U.S. (Gray Foxes) and Alaska (Arctic Foxes). Like skunks, >20% of foxes that bite or scratch people or pets have rabies. The risk is highest in the U.S. Southwest and Alaska, however rabid foxes have been reported in many parts of the U.S. and should be considered a high-risk exposure. Since 2023, rabies outbreaks in foxes were reported in Arizona, California, and Alaska.

Mongoose: Mongoose are a rabies reservoir in Puerto Rico, and they often infect unvaccinated, stray dogs. Over 80% of mongooses that expose people or pets have rabies, making them the highest risk rabies exposure. In Puerto Rico, dogs are also often reported with rabies, and exposure to unfamiliar or strange-acting dogs should always be regarded as high-risk.

Other mammals do get rabies in the U.S., despite not being reservoirs for this disease. Any contact with unfamiliar and strange acting animals should be reported to health authorities, who can determine if you need further medical care, please refer to the When to Seek Medical Care page.

Rabies Virus Variant territories in the United States. Abbreviations: ARC FX = Arctic Fox, CA SK = California Skunk, AZ FX = Arizona Gray Fox, SC SK = South Central Skunk, NC SK = North Central Skunk, E RC = Eastern Raccoon, MG = Mongoose

Prevention efforts: behind the scenes

Human rabies cases in the U.S. are rare because of comprehensive efforts across sectors:

• Wildlife Vaccination: Wildlife professionals distribute over 8 million oral vaccines to wild animals annually, through baits, to stop the virus from spreading in them.
• Pet Vaccination: Veterinary professionals vaccinate more than 40 million cats and dogs each year, keeping pets and families safe.
• Animal Re-homing: Humane societies and shelters find new homes for stray animals, lowering the risk of rabies spreading.
• Research and Development: Scientists are always working to improve vaccines and find new treatments for rabies.

Wildlife rabies management

The United States National Wildlife Rabies Management Program is a collaboration of over 50 U.S. animal and human health organizations to implement a coordinated, cost-effective, science-based program to control rabies in wildlife. Under this plan, each year over 10 million wildlife vaccine baits are distributed to prevent rabies spread. CDC's National Rabies Reference Laboratory provides diagnostic testing expertise to support over 130 U.S. laboratories maintain accurate testing. CDC's National Rabies Surveillance System works with 54 health jurisdictions to analyze patterns of rabies in the U.S.

Response measures

Veterinary professionals, animal control officers, and public health workers play an important role in responding to a potential rabies exposure by determining the risk of rabies. Specifically, they conduct:

• Assessments: Veterinary evaluations and public health interviews help determine exposure risk.
• Testing: More than 130 labs test nearly 100,000 animals for rabies annually. In a typical year, over 4,000 animals test positive for rabies.

Public health impact

With a solid public health infrastructure in place, human rabies deaths have been kept to fewer than 10 per year. However, it costs more than $500m per year to run these animal rabies prevention systems. These surveillance and control efforts save over $1 billion in healthcare cost annually by accurately assessing risk and preventing unnecessary medical costs.

Human rabies surveillance in the U.S.

Human rabies cases are now rare in the United States, with fewer than 10 cases reported annually. From 2009 to 2018, 25 cases of human rabies were documented, seven of which were contracted outside of the U.S.

Even though human rabies cases are rare, each year hundreds of thousands of animals are observed or tested for rabies, and 60,000 people require postexposure prophylaxis. Ongoing potential for animal exposure, and the deadly nature of rabies, highlights the continuing need to track disease patterns and continue programs that work to prevent people from becoming exposed.

Morbidity and mortality weekly reports: case histories of most recent cases

• Utah – 2018
• Virginia – 2017
• Puerto Rico – 2015
• Wyoming – 2015
• Missouri – 2014
• Texas – 2013
• California – 2012
• California – 2011
• New Jersey – 2011
• New York – 2011
• Louisiana – 2010
• Wisconsin – 2010
• Texas – 2009
• Indiana – 2009
• Virginia – 2009
• Michigan – 2009

Annual surveillance reports for 2020 and 2021 can be found in references on this page.