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3 P U B L I C H E A L T H Rabies Epidemics in North Carolina, 1995 Information for the Medical Practitioner .Lee Hunter, DVM, MPH Rabies—long absent as a major health threat to the land-based wide to ensure that vaccination of dogs was affordable and animals of North Carolina--has now entered the state in three accessible close to home.2)Since rabies vaccination efforts did separate epidemics.As these epidemics spread from their entry not reach the population of stray dogs,these animals were(and points, the number of cases of rabies diagnosed by the State still are) unlikely to be vaccinated. They form a potential Laboratory of Public Health has increased dramatically,nearly reservoir for the disease.In order to significantly interrupt the doubling each year since 1990. dog-to-dog cycle of rabies(and thereby reduce the total number The relative absence of rabies among land-based animals of rabies cases), the carrying population(the population that (that is,mammals other than bats)in North Carolina has made allows the continuing transmission of disease in a population) many people complacent.We have forgotten thelessonslearned must be reduced.Therefore,local animal control departments during the major rabies epidemic of the 1950s.As a result,chil- undertook a(successful)program to reduce the population of dren are allowed to approach unknown animals,even animals stray animals. that appear to be ill,and people bitten by animals do not always These two efforts—mandatory mass vaccination with ef- seek medical assistance.Many dogs and cats are not vaccinated festive vaccines and a reduction in the numbers of stray ani- against rabies. People have forgotten that, once signs and mall—rapidly reduced the carrying population andbrought the symptoms appear,human rabies is almost invariably fatal. epidemic under controL For example, 174 animals in North Carolina were diagnosed as rabid during 1954,butby 1960only 11 were.Controlling the disease in the pet population reduced The Rabies Epidemic of the 1950s the spillover of the disease into the wild animal population. The reason that the disease has been absent from land-based animals is the effectiveness of the public health programs Rabies Epidemics Today launched to control rabies during the 1950s.In the mid-1950s, - several hundred animals per year were diagnosed as rabid and Now,the disease is threatening us once again.But not because there were some resulting human deaths.The main reservoir of of a failure of our established public health programs to deal rabies 40 years ago was the population of owned and stray dogs with domestic animals.This time the threat comes from a new and cats.Efforts at the state and local level to control the spread direction. The rabies epidemics in North Carolina predomi- of the disease within those populations efforts consisted of two nately affect the wild animal population.Thatmakes thecontrol main programs:l)The North Carolina General Assembly made of the disease much more difficult,if not impossible,given the it mandatory that all dogs be vaccinated against rabies. The tools we now possess. These epidemics are part of a larger Commission for Health Services permitted the use only of regional problem affecting the Southeast, Mid-Atlantic, and animal rabies vaccines that could be proven effective.County- Midwest United States.The reasons for the epidemic outbreaks sponsored rabies vaccination clinics were made available state- are varied and complex.The epidemic in the northwestern part of the state affects mainly skunks,while that in the northeastern, southeastern, and south-central regions of the state affects Dr.Hunter is with the Medical Evaluation and Risk Assessment Branch, Occupational and Environmental Epidemiology Sec- primarily raccoons.The difference is due to the origins of the tion,Division of Epidemiology.NC Department of Environment, epidemics affecting each area. Health,and Natural Resources, Raleigh 27611. Figures 1-3,next page,show the counties affected and the 14 NC:vt1/January 1906,Volume 57 Number I