History of Rabies in the United States

The history of rabies in the United States is intricately associated with the peoples who settled the land and their knowledge and beliefs about the disease. More importantly, much of the history of rabies is tied to what early settlers brought with them: dogs that introduced and drove the spread of rabies in the New World. Patterns of movement of early Old World explorers and settlers and their canine companions are reflected in the genetic and epidemiological patterns of rabies viruses seen today. As cases of this feared disease mounted to distressing levels in some areas, settlers relied upon treatments and prevention methods tied to their homelands. By elucidating the paths and timelines of rabies virus spread in the United States, stories are revealed of progressive prevention efforts, new laboratory diagnostic and research tools, effective pre- and post -exposure prophylaxis measures, and the means to efficiently deliver them to rapidly growing populations migrating across the continent. Innovative approaches such as mail order vaccination kits and mass vaccination campaigns to stamp out dog rabies led to the turning point to gain control over the virus. The Centers for Disease Control and Prevention declaration of the elimination of dog rabies in 2007 represented a monumental achievement but revealed more significant challenges to control sylvatic rabies that still remain today. Recognition of the presence and diversity of rabies virus variants in bats and their contribution to human rabies deaths is another piece of this story. This chapter, gleaned from a compilation of facts, anecdotes, and historical reports, synthesizes our understanding of the origin and spread of rabies in the United States and of the significant advances in diagnostics, epidemiology, and the tools to prevent and control this important public health problem.