Rabies virus (family Rhabdoviridae, genus Lyssavirus), can infect many mammalian species through a bite from an infected animal. Once the neurotropic virus enters the host, it travels retrograde along peripheral nerves to the central nervous system and salivary glands. From a traveler's health perspective, rabies is an underrecognized risk. As per the World Health Organization and the Centers for Disease Control and Prevention (CDC), rabies causes approximately 59,000 human deaths yearly, with 95% occurring in Southeast Asia and Africa. Countries with high cases of human rabies include India, Vietnam, and Thailand, owing in part to their large stray canine populations. Approximately half of those bitten are children, whom, as any parent knows, are very curious and like to explore their environment through touch. There have even been rare cases of rabies occurring without a bite, the virus apparently transmitted through saliva when children with cuts or scrapes to their fingers, head, or neck were licked by infected animals. In the United States, 25 cases of human rabies were reported between 2009 and 2018, more than a quarter of which were acquired during international travel. Although no cases were reported in 2019 or 2020, an alarming uptick of 5 US cases were reported in 2021, 3 of which occurred within 5 weeks. All were caused by direct contact with bats.
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