Rabies in New Hampshire and Vermont : An update

New Hampshire and Vermont currently have two rabies epizootics occurring in raccoon and fox populations. These are continuations of the established raccoon strain which has been migrating northward from the mid-Atlantic and the fox strain which is migrating south and eastward from Canada and New York. These started in the early 1990s, and the wild animal cases have increased from 0 to 1 case per year in Vermont in the late 1980s to 179 in 1995, and from 0 to 4 cases in New Hampshire to 152 in 1995. Since 1992 there has been a slight increase in domestic animal cases, but no human cases have been reported. The cost of prophylaxis and animal testing has greatly increased, including one episode where 665 persons were exposed to a rabid kitten and underwent postexposure prophylaxis at an estimated cost of $1.5 million. This paper gives epidemiologic data for the two states and reviews the current literature to discuss history, clinical features, testing, postexposure prophylaxis, and treatment of rabies.