D.W. Jones, Alabama Department of Public Health, RSA Tower, 201 Monroe Street, Suite 900, Montgomery, Alabama 36104, USA (dee.jones@adph.state.al.us)

Wildlife rabies surveillance: a southern perspective

• For ten days in November 1971 a team of health professionals in Lima Ohio worked together to save the life of a 6 year old boy with rabies. The expectation was the boy would die, rabies is always fatal. But we knew better. We were tasked to try to change the story. Here is what happened. Was it a miracle? You can decide.

Rabies provides a compelling example of how the perception of rarity can distort our understanding of zoonotic disease risk. The global burden remains uncertain but is likely measured in tens of thousands of deaths annually, concentrated overwhelmingly in Asia and Africa and driven primarily by transmission from domestic dogs. Against this background, human infections involving wildlife-associated rabies virus variants and other lyssaviruses are easily characterized as rare.

Laboratory diagnosis is essential for rabies epidemiological surveillance, supporting prevention and control measures. This study evaluated the performance of the direct rapid immunohistochemical test (dRIT) for the post-mortem diagnosis of rabies in different animal species and RABV isolates in an experimental mouse model. A total of 176 central nervous system (CNS) samples were analyzed, obtained from the Rabies Diagnostic Section of Instituto Pasteur (CCD/SES-SP) and the Ceará State Public Health Laboratory, Brazil.

The emergence of rabies in Flagstaff, Arizona, in 2001 served as a catalyst for researching strategies to protect free-ranging dogs from rabies. The Flagstaff epizootic involved a bat-associated rabies virus variant that established sustained transmission among striped skunks; domestic dogs were not involved in the outbreak. However, the event highlighted the potential consequences of rabies introduction into northern Arizona and prompted consideration of the inadequate rabies vaccination coverage among free-ranging dogs on the Navajo Nation.

Rabies remains a pressing public health challenge in India, where a substantial burden of human disease persists despite the availability of effective post‑exposure prophylaxis (PEP). Drawing on experiences from the clinical and diagnostic front line, this keynote highlights the evolving clinical spectrum of rabies, with increasing recognition of paralytic and atypical presentations, particularly among individuals who received partial or incomplete vaccination.

Introduction

Rabies remains a sporadic cause of encephalitis in the United States. This analysis characterizes the frequency and timing of symptoms, healthcare presentation, and diagnostic recognition among U.S. cases.

Methods

Human rabies cases included in CDC U.S. surveillance totals between January 1, 2000-December 31, 2025, were eligible for inclusion. Clinical data were abstracted from CDC case and annual surveillance reports. Overall, 110 variables were included; each case was reviewed twice in detail for accuracy. 

Rabies, a lethal zoonotic disease, is primarily diagnosed post-mortem using the direct fluorescent antibody (DFA) test on fresh animal brain tissues. Because handling fresh potentially infectious tissue requires rabies vaccinated personnel, and sample transport demands strict cold chains and biosafety precautions, field surveillance remains challenging. To overcome these logistical barriers, molecular testing for the rabies virus (RABV) could serve as a valuable alternative for diagnosis.

Effective wildlife disease management depends on reliable metrics to guide programmatic decisions. Rabies virus (RV) circulates in wild carnivore populations in the United States (U.S.). One primary management goal is to prevent the spread of and eliminate the raccoon (Procyon lotor) RV variant (RRV) using landscape level oral rabies vaccination (ORV). Management impacts are measured using two approaches: determining the raccoon population proportion with serum RV neutralizing antibodies (RVNA) post-ORV (i.e., raccoon RVNA seroprevalence) and evaluating RRV case trends.

Background: KEDRAB® (Human Rabies Immune Globulin) is indicated for passive, transient post-exposure prophylaxis of rabies infection in persons of all ages following contact with a rabid or possibly rabid animal, administered concurrently with a full course of rabies vaccine.