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The researchers examined the evolution of rabies in the United States over a period of 80 years, from 1938 to 2018. They found that most infections were caused by dog bites until 1960, year when wild species, especially bats, have become the main source of human infection. This followed efforts across the country in the 1950s to impose pet vaccines and implement leash control laws, the report says.
"Reducing rabies in dogs is a remarkable achievement of the American public health system, but with this deadly disease still present in thousands of wild animals, it's important that Americans be aware of the risk," said in a new CDC director, Robert Redfield. Release.
From 1960 to 2018, 125 cases of human rabies were reported in the United States. Of these, 28% came from contacts with dogs outside the United States, where rabies vaccines may not be required or readily available. The cases acquired in the United States came from wild species; 70% of them were due to bites or scratches of bats and the rest to human contact with raccoons, skunks or foxes.
Once a person is infected, rabies is almost always fatal without treatment. In the United States, the number of deaths ranged from 30 to 50 per year in the 1940s, but has since fallen to one to three deaths per year. This is the result of routine vaccination of pets and the availability of post-exposure treatment with vaccine and immunoglobulins, proteins that trigger the body's defense system to fight against the infection.
"We wanted to write a report to make people aware that rabies is still a problem and remains one of the most deadly diseases on the planet," said Dr. Emily Pieracci, CDC veterinarian and lead author. of the report. "If you benefit from post-exposure prophylaxis and you get it before the onset of the signs or symptoms of rabies, you can prevent the disease."
How to prevent rabies
The CDC recommends three measures to prevent rabies: avoid wild animals, vaccinate pets and quickly consult a doctor after contact with animals.
Rabies is a virus that infects mammals. When an infected animal bites a human, rabies is spread from saliva through the open wound and into the nerves, where the virus spreads to the brain and spinal cord. This process can take between three and 12 weeks. Before the virus reaches the brain, a person may have no symptoms or mild symptoms such as fever, weakness or discomfort. At this point, a person can get a post-exposure treatment while surviving.
But once the virus enters the brain, it multiplies and pbades through the glands that produce saliva, becoming more than 99% deadly. At this point, a person may experience symptoms such as confusion, abnormal behavior, hallucinations, insomnia, drooling, difficulty swallowing and hydrophobia, fear of water. Most people die within two to three weeks of the onset of these last symptoms. That is why CDC experts recommend consulting a doctor for post-exposure treatment shortly after contact with an animal, before the virus becomes fatal.
In the United States, most human deaths from rabies occur because people do not seek medical treatment, probably because they are unaware of contact with the animal. For example, bat stings may be smaller than the top of an eraser, said the CDC.
"We have seen cases in people in the United States who do not really seem to know that rabies can be transmitted by wildlife, especially bats," said Pieracci. "Very often, the bites and scrapes are very small, so a lot of people will try to hold a bat and they do not realize that this bat has been bitten."
Bats in good health try to avoid contact with people. But people infected with rabies will act differently, whether they are active during the day or they stumble on the ground. In these cases, people can contact their animal control office or wildlife rehabilitation center. Pieracci said people should avoid touching all bats, regardless of their appearance.
If you wake up with a bat in your immediate environment, you must badume your exposure to rabies and seek immediate medical attention, recommends the CDC.
Although exposure to wildlife is the most common cause of rabies deaths in the United States, infected dogs are responsible for 98% of the 59,000 human deaths recorded each year. Americans traveling abroad should look for rabies on their destination, avoid contact with dogs, take out travel insurance to pay for treatment, if necessary, and consider pre-exposure vaccination. CDC report.
Each year, 10% of the more than one million dogs imported into the United States come from countries where the risk of rabies is high. Since 2015, three cases of rabies in imported dogs have been reported in the United States.
How is rabies treated?
In 2018, about 55,000 people in the United States received post-exposure treatment for rabies risk, although some may not have been in contact with an infected animal. Even though the animal could not be captured to confirm the presence of rabies, people bitten by a suspect animal were receiving post-exposure treatment because of the severity of the disease, Pieracci added.
Post-exposure treatment is available in almost all the country's emergency departments. For people who have not received the rabies vaccine, the treatment includes a single dose of immunoglobulins and four doses of vaccine over a two-week period. People who have received the vaccine do not need immunoglobulins, but only doses of vaccine. The immunoglobulin costs about $ 312 per dose, while the rabies vaccine costs $ 290 per dose, although the hospital bills for treating rabies may vary, according to the CDC report.
Oral rabies vaccines in wild animals have been used to control the spread of the disease in raccoons and coyotes. The program, run by the United States Department of Agriculture, was launched in the 1990s and helped prevent the spread of raccoon rabies to the west.
The vaccine is put in a package and covered with flavored bait such as egg or fish to attract animals. Packages are dropped by plane or by hand, along the roads. Once the animal has bitten into the pack, it consumes the vaccine inside and is protected from rabies.
There are no vaccines or management programs to combat rabies in the bat population.
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