Rabies watch: CDC eyes 14 potential outbreaks in 20 states—what that really means

Rabies is rare in the US, but it’s unforgiving. Since September 2024, six people have died nationwide, and federal health officials say they’re monitoring 14 potential rabies outbreaks across 20 states. “Potential” here means clusters and red flags in the animal and exposure data that warrant extra attention—not that widespread human illness is underway. Still, the stakes are high because once symptoms start, rabies is almost always fatal.

So what are we actually talking about? Rabies is a Lyssavirus spread mostly through the saliva of infected animals. Bites are the classic route, but scratches or saliva getting into your eyes, mouth, or an open cut can also transmit it. After exposure, the virus heads for the central nervous system, inflaming the brain and spinal cord. There’s usually a quiet stretch — weeks to months — when you feel fine. Early symptoms, when they appear, can mimic the flu with fever, headache and body aches, sometimes with tingling or discomfort at the bite site. Things escalate fast after that: confusion, agitation, hallucinations, muscle thrashing, heavy drooling and the hallmark hydrophobia, where even the sight of water triggers panic despite intense thirst. Death follows soon after without prompt, proper treatment.

Which animals matter depends on where you are. Globally, dogs drive most human rabies deaths, especially affecting young children. In the US, thanks to robust pet vaccination, bats are the leading source of deadly exposures. Raccoons, skunks, foxes and coyotes also carry rabies here. Each year, about 4,000 animals test positive nationwide, and the vast majority are wild.

Risk isn’t the same for everyone. Travelers heading to places where dog rabies is common face higher odds, particularly if medical care would be hard to reach in an emergency. People who work around animals — veterinarians and techs, wildlife and animal-control staff, and lab workers handling the virus — carry occupational risk. Even hikers and cavers can stumble into trouble in regions with rabid dogs or bats.

Vaccination can be used two ways. For people at higher ongoing risk, pre-exposure prophylaxis is a safeguard: two vaccine doses a week apart, followed by periodic antibody checks or a one-time booster depending on how often you’re exposed. That’s not something most Americans need. For everyone else, vaccination is part of post-exposure care after a bite or credible contact. The first move is immediate, thorough wound washing with soap and water. If you’ve never been vaccinated, you’ll get human rabies immunoglobulin to neutralize the virus at the exposure site plus a vaccine series that starts right away and continues on days 3, 7 and 14, with an extra dose on day 28 for people who are immunocompromised. If you were previously vaccinated, you’ll skip the immunoglobulin and receive two vaccine doses to re-prime your immunity.

Figuring out whether an encounter counts as an exposure isn’t always straightforward. A clear bite from a bat, raccoon, fox or stray dog is obvious. A bat in the bedroom while you were sleeping is treated seriously unless a bite or scratch can be definitively ruled out. If there’s a safe way to contain the animal so authorities can test it, do so — but don’t put yourself at further risk. Never handle a dead bat; call animal control so it can be collected and tested. When in doubt, reach a clinician or your local health department. It’s far better to start prophylaxis and later learn it wasn’t needed than to wait and miss the window.

Prevention is the quiet hero in all of this. Keep pets current on rabies shots. Teach kids not to touch unfamiliar animals. Give wildlife a wide berth, especially if a fox or raccoon is acting strangely. Bat-proof your home by sealing gaps in attics, chimneys and eaves. And if a possible exposure happens to you, a family member or a pet, get medical care right away.

Rabies remains a global killer — tens of thousands of deaths each year, mostly in Africa and Asia — but in the US, vigilance is what keeps it rare. The CDC’s active tracking of potential outbreaks is part of that vigilance. Your part is simple: avoid risky encounters, vaccinate your animals, and take any exposure seriously.

The original story by Katia Hetter for CNN.