RABIES - Medicine for Mountaineering and Other Wilderness Activities - page 484

CHAPTER 32
RABIES
James A. Wilkerson, M.D.
Principal Contributors
Rabies is a catastrophic viral infection that has been known and justifiably feared since an-
tiquity. In all of history, only six humans who have developed clinical signs and symptoms
of rabies are known to have survived. All but one were vaccination failures, and three had
severe residual neurologic damage. (One was blind, quadriplegic, and dead only thirty-four
monthsafterhebecameill.)Althoughrareinindustrializednations,rabiesremainsascourge
in developing countries that cannot afford the canine vaccination programs required to keep
theinfectionundercontrol.InIndiaapproximately25,000peopledieeveryyearfromrabies.
The incidence is probably similar in Africa—Ethiopia has a high incidence of rabies—but
surveillance andreporting are soinadequate the true rate isunknown.The WorldHealth Or-
ganization (WHO) estimates that 55,000 individuals die every year from rabies. This infec-
tion ranks eleventh among infectious causes of death worldwide.
RABIES WITHIN THE UNITED STATES
Within the United States, human rabies has been controlled to a large extent by vaccinating
domestic animals, mostly dogs and cats, and eliminating stray animals. Dog rabies dimin-
ished from 6949 cases in 1947 to 79 in 2006. (Rabies is now more common in cats, with
318 cases reported in 2006.) Human rabies has concomitantly declined from approximately
350 cases from 1940 to 1949 to 10 cases from 1980 to 1989, seven of which were acquired
outsidetheUnitedStates.Twooftheotherthreewereofbatorigin,andthethirdwasfroma
skunk. From 1990 through 2006, an additional forty rabies infections were acquired within
theUnitedStates;allbutthreewerecausedbyrabiesvirusstrainsassociatedwithbats( Figs.
32-1 and 32-2 ).
Figure 32-1. Human rabies acquired from bats in the United States, 1980-2006 (39 cases total)