Disease Control and Environmental Epidemiology Division

Rabies

Public health importance of rabies

Over the last 100 years, rabies in the United States has changed dramatically. More than 90% of all animal cases reported annually to CDC now occur in wildlife, whereas before 1960 the majority were in domestic animals. The principal rabies hosts today are wild carnivores and bats infected with several virus variants. The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one to two per year in the1990's despite major outbreaks of animal rabies in several geographic areas. Modern day prophylaxis has proven nearly 100% successful; most human fatalities associated with rabies now occur in people who fail to seek medical assistance, usually because they do not recognize a risk in the animal contact leading to infection.

Cost of rabies prevention

Although human rabies deaths are rare, the estimated public health costs associated with disease detection, prevention, and control have risen, exceeding $300 million annually. These costs include the vaccination of companion animals, animal control programs, maintenance of rabies laboratories, and medical costs, such as those incurred for rabies post exposure prophylaxis (PEP).

Accurate estimates of these expenditures are not available. The total number of PEPs given in the United States is unknown, but it is estimated that 40,000 people may receive rabies PEP each year. As rabies becomes epizootic or enzootic in a region, the number of PEPs increases.  Although the cost varies, a course of rabies immune globulin and four doses of vaccine given over a 2-week period typically exceeds $3,000, and has been reported over $40,000 when a patient seeks care at a healthcare facility out of insurance network.  The cost per human life saved from rabies ranges from approximately $10,000 to $100 million, depending on the nature of the exposure and the probability of rabies in a region.

The estimated annual expenditure for rabies prevention in the United States is over US$300 million, most of which is spent on dog vaccinations. An annual turnover of approximately 25% in the dog population necessitates revaccination of millions of animals each year, and reintroduction of rabies through transport of infected animals from outside a controlled area is always a possibility should control programs lapse. Reservoirs of wildlife rabies, virtually unknown in Asia and tropical regions, are also potential sources of rabies infection for dogs in Europe and North America.

Return to: Rabies Home Page