Rabies: recent advances in pathogenesis and control.

Current knowledge of rabies is reviewed, with emphasis on recent developments in virology, immunology, pathogenesis, treatment, and prophylaxis. Although only a few cases of human rabies occur annually in the United States, the infection is enzootic in wildlife, and an estimated 30,000 possible exposures requiring treatment occur each year. Rabies belongs to the family rhabdovirus, and its molecular anatomy and biochemistry of replication have been described in some detail. There have been advances in measurement of antirabies antibodies, and techniques for measuring cellular immune response have recently been developed. Early stages of infection are more fully understood, with a hypothesis to explain peripheral sequestration of virus during prolonged incubation periods. Rabies was once thought to be uniformly f fatal, but a few patients have survived with aggressive supportive measures. A newly developed vaccine (soon to be licensed in the United States) has been shown highly potent for preexposure immunization and promises to be very effective for postexposure prophylaxis. Current Public Health Service recommendations for postexposure treatment are summarized. Recent research has suggested a novel approach to control of wildlife rabies through oral immunization.