CDC Alerts Clinicians to Surge in U.S. Rabies Exposures as Fatal Pediatric Case Highlights PEP Gaps
核心洞察
The CDC (搜索) issued a clinician alert after rabies (搜索)-related inquiries rose 17% in July and August versus the same period last year, with vaccine use up 33% and immune globulin up 76%.
The alert followed the euthanasia of four rabid baby goats at a North Carolina petting zoo that exposed people to the virus, an event experts say may explain the entire increase.
A separate CMAJ report documented Ontario's first fatal human rabies (搜索) case since 1967 in an 11-year-old boy exposed to a bat without visible bite or scratch marks.
The U.S. Centers for Disease Control and Prevention has alerted clinicians and public health departments to a surge in potential human rabies (搜索) exposures and vaccinations nationwide, reporting a 17% increase in rabies-related inquiries during July and August compared with the same period in 2025. According to the agency, use of rabies vaccine rose 33% and use of rabies immune globulin rose 76% in 2026.
The CDC (搜索) attributed the jump to "several high-profile rabies (搜索) outbreaks and mass rabies exposure events." The alert was issued two weeks after four baby goats with rabies at a North Carolina petting zoo were euthanized following human exposures to the virus.
David O. Freedman, MD, FIDSA, professor emeritus of infectious diseases at the University of Alabama at Birmingham, cautioned against overinterpreting the annual comparison. "An extra cluster this year compared to last year might account for the entire 17% increase," Freedman said. "And 17% is certainly within annual variability."
Post-Exposure Prophylaxis Remains the Only Defense
The CDC (搜索) reiterated in its alert that rabies (搜索) is preventable when post-exposure prophylaxis (PEP) is administered before symptoms emerge. PEP comprises four vaccine doses given on days 0, 3, 7 and 14, plus rabies immune globulin and proper wound care for patients who have been bitten or scratched. People who are immunosuppressed or immunocompromised should receive a fifth vaccine dose on day 28, the agency said.
The agency urged clinicians to perform "careful rabies (搜索) risk assessments" and to follow "evidence-based recommendations for administering PEP," and estimated that 100,000 Americans are vaccinated against rabies each year.
Freedman emphasized the narrow therapeutic window. "It's not sufficient to just wash out the wound and then wait for symptoms," he said. "Once you get symptoms, it's too late. You're probably going to die." He also noted that no U.S. hospital emergency department or county health department can deny rabies (搜索) treatment to a patient because of lack of money or insurance, describing the disease as a public health issue.
Fatal Pediatric Case in Ontario Underscores Bat Exposure Risk
The CDC (搜索) alert coincides with a case report published in CMAJ (Canadian Medical Association Journal) documenting Ontario's first fatal human rabies (搜索) case since 1967. The patient, an 11-year-old boy, awoke with a bat lying on his mouth and nose and had no apparent bite or scratch marks. Nineteen days after exposure, he presented to an emergency department with vomiting, facial "pins and needles," and numbness, and was later diagnosed with rabies. The health care team provided supportive care, as there is no cure once rabies symptoms develop. The parents agreed to share their son's case to help raise awareness.
"Any direct human contact with a bat, even in the absence of a visible bite or scratch, is an indication for PEP and should be discussed with public health authorities," wrote Dr. Brian Hummel, a pediatric infectious disease specialist at McMaster Children's Hospital and assistant professor at McMaster University in Hamilton, Ontario, with coauthors. "This is especially important to consider as we approach the summer months, when human–bat encounters are at their peak," Hummel emphasized.
The authors noted that although rabies (搜索) in humans is rare — with only 28 cases reported since 1924 — awareness, prompt action with PEP, and clinical judgment are essential in suspected exposure. "Rabies is almost always fatal, with no established efficacious therapies, making prevention crucial. Rabies PEP is highly effective if administered promptly, in consultation with public health authorities, after any direct human contact with a bat, even in the absence of visible lesions," the authors concluded. They added that bats may or may not show classic signs of rabies, so any direct human contact with a bat is considered high risk, and that clinicians should ask about exposure to potentially rabid animals in patients with neurological symptoms compatible with rabies.
Overlapping Risk Landscape
Both reports point to bats as the principal source of human rabies (搜索) cases in North America. In the United States, bats are responsible for most rabies cases, and the CDC (搜索) notes the virus can spread to humans through bites, scratches or oral secretions. In North America, bats, raccoons, skunks and foxes are the prime carriers, and bats pose heightened risk because scratches or bites may be small and hard to see.
People who may have been in contact with a wild animal that could potentially have rabies (搜索) should seek medical attention promptly, with public health authorities notified and PEP started in consultation.