With camping and other forms of outdoor activity more common in the summer months, the CDC used its June Vital Signs report to warn that exposure to animals infected by rabies remains a concern. “About 55,000 Americans receive post-exposure prophylaxis [PEP] for potential rabies exposure in emergency departments each year. Most dogs and cats receive annual rabies shots to keep them protected,” explained Anne Schuchat, MD, the CDC’s principal deputy director, in a media briefing with reporters that occurred June 13, 2019.

However, there have been significant changes in recent years regarding which animals pose the biggest threat for the disease. “Among all rabid animals detected in the United States, 32% are bats, 28% are raccoons, 21% are skunks, 7% are foxes, and 6% are cats,” Schuchat noted. “Starting in 2015, the number of rabid bats reported surpassed the number of raccoons for the first time. The gap has been widening ever since.”

Another reason why bats are concerning is because bat bites typically are smaller than the head of a pencil eraser, which means those bites can go unnoticed. “This is a problem because rabies is deadly once symptoms start. Recognizing the risk and getting treatment fast is important,” Schuchat added.

Further, seven out of every 10 people who die from rabies each year in the United States were infected with the disease by bats. Since 2015, there have been more cases involving mass exposures. “These are instances where we have 10 or more people that are exposed to a potentially rabid bat,” Schuchat said. “We have had several large groups of people exposed to bats in university dorms, camping lodges, and schools,” observed Emily Pieracci, DVM, MPH, a veterinary epidemiologist at the CDC who also participated in the media briefing. In fact, the CDC noted that public health authorities respond to as many as 175 of these mass exposures in the United States every year.

“Rabid bats have been reported from every state except Hawaii,” Pieracci added.

In cases of possible exposure, the best course of action is for providers to administer PEP before symptoms begin, Pieracci offered. “If people are exposed to rabies but do not get PEP prior to symptoms starting, the disease is nearly always fatal,” she said. “PEP is extremely effective, but it needs to be started quickly.”

Pieracci further advised healthcare providers to query patients about whether they have sustained any animal bites recently or have been in contact with or scratched by bats. “If the answer is yes, assess whether they need PEP,” she said. “State and local health departments have tools to help healthcare providers if they have questions.”

(Editor’s Note: For more information on how to manage a case of potential rabies, please visit this CDC resource: http://bit.ly/2X7YKfM. The CDC’s June Vital Signs report on the subject can be accessed at this address: http://bit.ly/2RDXGzc.)