Study Estimates Most Human Rabies Deaths in the US May Go Undiagnosed

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A new study in Communications Health suggests that human rabies may be substantially underdiagnosed in the United States. The researchers estimate that about 856 people may have died from rabies between 2000 and 2024, while only a small fraction were officially confirmed. Their central estimate implies that roughly 7% of human rabies deaths were recognized, although the uncertainty is wide and the estimate could be much lower or higher. The analysis was prompted in part by several cases in which rabies was not diagnosed in deceased organ or tissue donors until after transplantation, allowing infection to be discovered in recipients later. The researchers compared those donor cases with national death and donation data and assumed that deceased donors had roughly the same rabies risk as the wider population. That assumption is important because differences in geography, occupation, socioeconomic conditions, and the likelihood of becoming an organ donor could change the estimate. The study also points to practical reasons rabies can be missed. The disease can have a long and variable incubation period, while exposures may involve unnoticed bites or scratches, particularly from wildlife such as bats. A patient who develops severe neurological illness may therefore have no obvious history connecting the illness to rabies. The authors argue that better awareness, more detailed exposure histories, attention to geographic and occupational risk, and consideration of rabies when unexplained neurological illness resembles the disease could improve detection. The findings are an estimate rather than a direct count of hidden cases, so the striking 7% figure should be understood as a statistical projection rather than proof that exactly 93% of cases are being missed.