History

The first clear reference to rabies was from writings by Aristotle in circa 380 BC in which he described the symptoms and transmission of rabies in dogs. Despite centuries of observations on the transmission, symptoms, and a myriad of unsuccessful remedies, the disease remained invariably fatal until approximately 1885, when Louis Pasteur developed the first rabies vaccine in Paris. Unable to identify the organism – indeed unaware of even the difference between bacteria and viruses – he cultured it in the spinal cords of rabbits and, ultimately, injected it into Joseph Meister, a young boy attacked by a rabid dog on his way home from school. Given the severity of his wounds on his face, hands, and legs he undoubtedly would have died; however, he received a series of 13 injections, survived, and subsequently spent his life working as a guard at the Pasteur Institute.

Epidemiology

In 2010, the Centers for Disease Control and Prevention (CDC) reported that there were 6153 cases of rabies in animals and 2 human cases in the United States. Hawaii has been the only state free of rabies infection in humans and animals. Ninety-two percent of cases were in wild animals. In Europe, the World Health Organization (WHO) reported 6065 cases of animal rabies and 9 human cases in 2012. Most of these occurred in Eastern Europe. In Latin America, there were 111 cases of human rabies reported between 2010 and 2012. The highest prevalence of rabies worldwide is still in developing countries, with India being in the lead followed by China, Nepal, and Myanmar. A rising incidence has also been seen in some African countries such as Malawi. In the United States the largest reservoirs remain in raccoons followed by skunks, bats, foxes, and coyotes. Raccoon and fox reservoirs are mainly from the eastern states; bat and skunk cases were also found in parts of the south, Pacific Northwest, and California. Domestic animals only accounted for about 6.8% of rabies. Interestingly, cats are found to be infected with rabies almost double the infections of dogs. The cases of rabid cats continue to rise, whereas the cases in other animals are declining yearly. This paradox may be due to administration of vaccines in certain animals, especially dogs. In Europe, the rabies reservoir is mainly the fox, whereas the bat is the main reservoir in Australia, Mexico, and parts of South America. Worldwide, death from rabies is usually from a rabid dog.