Distribution and Incidence

Rabies occurs in most of the world, including Africa, Asia, the Americas, and most of Europe. It has never occurred in, or has been eliminated from, Britain, Ireland, Sweden, Norway, Japan, Australia, New Zealand, Hawaii, and many other islands in the Pacific and the Caribbean. Rabies is primarily a disease of wild carnivores, particularly canids such as the fox, wolf, jackal, and coyote. Skunks and raccoons are also common hosts, as are many species of bats. Virtually any species of mammal can contract the disease when bitten by an infected animal. Domestic dogs are the major threat to humans; cats are a growing danger in North America. Cattle, horses, sheep, and other livestock may also be affected. Outbreaks among farm animals may cause considerable economic loss, but bovine or equine rabies usually poses little danger for humans.

Rabies is a relatively uncommon disease in humans, occurring sporadically as isolated cases or in small clusters. Epizootics develop at irregular intervals in wild carnivores, and may infect humans mainly through dogs or rarely directly. Persons working alone in remote areas, such as hunters, trappers, or shepherds, are vulnerable to attack by infected animals. Wolves are especially dangerous because their size and strength allow them to inflict multiple bites. Most human cases, particularly in developing countries, are acquired by the bites of "mad dogs," which were themselves victims of attacks by feral animals. Vampire bats in Trinidad and parts of northern South America are a source of rabies for cattle and, on rare occasions, human beings. Elsewhere, other species of bats can infect people and terrestrial animals, but this seems to be uncommon.

Human rabies has become a rare disease in developed countries. There were 236 cases in the United States between 1946 and 1965; only 11 occurred after 1960, and no cases at all have been reported in many of the subsequent years. Canada reported only 21 cases from 1924 to 1986, but Mexico recorded 76 fatalities in 1985 and 81 in 1986. In Africa, Ghana confirmed 102 cases from 1977 to 1981, whereas Ethiopia recorded 412 in 1982. India reported the highest annual number of cases in the early 1980s -that is, 20,000-as well as the highest rate of infection - 28.8 per million individuals.

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