Rabies is an acute and deadly disease caused by a viral infection of the central nervous system.

The rabies virus is most often spread by a bite and saliva from an infected (rabid) animal (e.g., bats, raccoons, skunks, foxes, ferrets, cats, or dogs). In the United States, rabies is most often associated with bat exposures. However, there have been rare cases in which laboratory workers and rabies virus in the air infected explorers in caves inhabited by millions of bats. Virtually 100% of those infected with rabies who do not receive the vaccine will die. Rabies illness includes rapidly progressing central nervous system symptoms such as anxiety, difficulty swallowing, and seizures. Although less than ten human rabies fatalities occur in the United States annually, as many as 40,000 Americans receive the vaccine each year after contact with animals suspected of being rabid. An additional 18,000 people get the vaccine before exposure as a preventative measure. Worldwide, at least 4 million people are vaccinated each year for rabies. The number of deaths that rabies causes each year is estimated to be at least 40,000, and as high as 70,000 if higher case estimates are used for densely populated countries in Africa and Asia where rabies is epidemic. India, with a very large population of stray, ownerless dogs, has about half of all cases of rabies worldwide. Between 30-60% of human rabies cases occur in children under 15 years of age. Prompt wound care and the administration of rabies immune globulin (RIG) plus vaccine are highly effective in preventing human rabies following exposure. Who Should and Should Not Receive the Vaccine Who should receive the vaccine pre-exposure? Vaccination before exposure (pre-exposure) should be offered to people in high risk groups such as veterinarians, animal handler/caretakers, or laboratory workers who may be exposed to the rabies virus. Pre-exposure vaccination may be considered for: People whose activities bring them into frequent contact with rabies virus or potentially rabid animals (e.g., bats, raccoons, skunks, ferrets, cats, dogs). Travelers who will spend more than one month in countries with a high rate of rabies infection, if they are likely to come in contact with rabid animals and immediate access to appropriate medical care is limited. Who should receive the vaccine post-exposure? Vaccination after exposure (post-exposure) is recommended for all individuals who have had contact with an animal (e.g., bites or abrasions) that they believe may be, or which is proven to be, rabid. Vaccination should be initiated as soon

after exposure as possible and should be accompanied by proper wound management and the administration of Rabies Immune Globulin, human (HRIG).