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5 People Died From Rabies In the U.S. in 2021 (Left)Tadarida Brasiliensis; (below from top) Eptesicus fuscus; and Lasionycteris noctivagans
Highest Total in a Decade BY ETHAN COVEY
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ive people died from rabies last year in the United States—the highest total in a decade. Four of the deaths were linked to bat exposure. Three of the deaths, which occurred in Idaho, Illinois and Texas, were included in a CDC report. They took place over a five-week period from Sept. 28 to Nov. 10, 2021 (MMWR Morb Mortal Wkly Rep 2022;71[2]:31-32). The cases included two adults and one child, all of whom had direct contact with a bat, by either collision or biting, within three to seven weeks before symptom onset. Three bat species were involved: • Lasionycteris noctivagans (silver-haired bat) • Tadarida brasiliensis (Mexican free-tailed bat) • Eptesicus fuscus (big brown bat) All three are common in the United States and have been linked to the spread of rabies. None of the patients received postexposure prophylaxis (PEP): two because they did not realize the risk for rabies infection associated with bat exposure, and the third due to anti-vaccination beliefs. The patients died within two to three weeks of developing symptoms. “This report is a sad and important reminder that direct contact with bats is a leading cause of rabies deaths in the U.S.,” said Amber Kunkel, ScD, a CDC Epidemic Intelligence Service officer. “Rabies transmission from bats to humans can be prevented,” Dr. Kunkel said. “People should avoid contact with bats whenever possible. People who have contact with a bat should consult their local health department to determine if they should receive postexposure prophylaxis and to have the
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bat tested for rabies, if possible.” One of the other cases was in an immunocompromised Minnesota man who was bitten by a bat and received PEP but still died because he could not mount an immune response to the PEP. The final case was a man who was bitten by a rabid dog while traveling and died upon return to the United States.
Is Rabies Risk Increasing? The number of cases is raising questions about whether rates of rabies are increasing in the United States. Although the three deaths investigated in the report match the total number recorded during the preceding 48 months, and the total of five is more than reported since 2011, there are differing opinions regarding whether the risk for rabies is increasing. “Although these all happened in a short time, they occurred in different states and involved different bat species,” Dr. Kunkel said. “The number of bats tested for rabies and the proportion that test positive have been relatively stable over recent years. (About 24,000 bats were tested for rabies in 2020, and about 1,400 were positive.) These data are not yet available for 2021, but so far we have not noticed any
