Why was there a rabies spike in the US in 2021?

By Oladimeji Ewumi
Published January 30, 2022

Key Takeaways

  • There were five rabies-related deaths in the US in 2021, compared to none in 2019 and 2020.

  • At least three of the cases were considered preventable with timely treatment and bat-handling knowledge.

  • Clinicians can play a role in prevention and treatment by following CDC guidance on proper testing, symptom identification, and care.

In 2021, the US saw the highest number of rabies deaths in a decade. Five people died. While that might not be a staggering figure, rabies-related deaths in the US are typically rare — there were no reported cases or deaths in 2019 or 2020.

2021 cases: What we know

Rabies is typically transmitted through the bite of an infected animal. About a quarter of cases from 1960 to 2018 resulted from dog bites, and about 70% were attributed to bat exposures. The cases in 2021 resulted from both dogs and bats.

  1. A man from Minnesota was bitten by a bat. He received postexposure prophylaxis (PEP), but the treatment failed.

  2. A man was bitten by a rabid dog during a trip to the Philippines. He died after returning home to New York.

  3. In mid-August, an Illinois resident in his 80s woke up with a bat on his neck. He refused to receive PEP due to vaccine hesitancy, even after the bat that bit him tested positive for rabies.

  4. A man in Idaho came across a bat on his property in late August. Even though the bat got caught in his clothes, he didn't believe he had been scratched or bitten. He became sick in October and died shortly after hospitalization.

  5. A child in Texas was bitten by a bat and developed rabies.

Understanding the figures

These rabies-related deaths were linked to a lack of awareness about rabies risk and the importance of PEP upon exposure, not an increase in rabid bat populations.

Some of the patients did not know or realize they were at risk for rabies after exposure, and at least three of the cases were considered preventable with PEP or with knowledge of best practices for handling bats. These deaths highlight the importance of rabies public health awareness and patient education.

What this means for you

The CDC recommends clinicians be mindful of proper procedures such as recommended laboratory tests that can save a patient from unnecessary actions in cases where an animal was not rabid, or save a life with proper and timely treatment. In addition to testing, the CDC recommends clinicians be aware of positive rabies indicators.


  1. CDC. Animals and Rabies. Centers for Disease Control and Prevention. 2022.

  2. CDC. Human rabies. Centers for Disease Control and Prevention. 2021. 

  3. CDC. Rabies Vaccination: Information for Healthcare Providers. Centers for Disease Control and Prevention. 2017. 

  4. Pieracci EG, Pearson CM, Wallace RM, et al. Vital Signs: Trends in Human Rabies Deaths and Exposures - United States, 1938-2018. Morbidity and Mortality Weekly Report. 2019; 68(23):524-528.

  5. WHO. Rabies epidemiology and burden of disease. World Health Organization. 2022.

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