Rabies prevention.

Rabies is an almost uniformly fatal encephalomyelitis with no treatment option other than supportive care for those who contract the illness. Mortality worldwide is estimated to be 40,000-70,000 people annually. Fortunately, public health measures begun in the 1940s and 1950s regarding vaccination and control of domestic animals in this country and the availability of safe and effective rabies postexposure prophylaxis treatment (RPEP) for humans has made rabies a rare disease in the United States. Community healthcare providers continue to play a pivotal role in the prevention of this devastating disease. This article emphasizes the challenges that the evolving epidemiology of rabies presents to our healthcare system, especially regarding international travel, the importance of domestic animal vaccination against rabies, the use and cost of RPEP, recent rabies epizootics in wildlife populations and the role of bats in disease transmission.