PRIMER: Rabies

Plagues with Dr. Keith

This episode provides a deep dive into the rabies virus, detailing its terrifying progression from a minor bite to near-certain fatality. It

Key takeaways

• Rabies is one of the few diseases on Earth that is almost universally fatal once clinical symptoms like hydrophobia appear.
• A September 2026 CDC health alert identified a rabies outbreak in baby goats at a North Carolina petting zoo following skunk exposure.

Main topics

• Rabies pathology and symptoms
• 2026 North Carolina outbreak

Notable quotes

one of the only diseases on earth that is almost universally, unforgivingly fatal once symptoms begin.

Conclusion

The episode emphasizes that while rabies remains a lethal ancient kill

Transcript preview

Speaker 1 (0:01) Imagine this. A man wakes up in the middle of the night, drenched in sweat, his heart pounding for no reason he can name. He tells himself it's nothing, maybe a bad dream, maybe the flu coming on. Weeks earlier, a stray dog had nipped at his ankle while he was traveling abroad. It barely broke the skin. He washed it, shrugged it off, and forgot about it entirely. Now, the tingling starts, a strange electric itch. at the side of that long-heeled bite, as if something is stirring beneath his skin and beginning its slow crawl toward his spine. Within days, his mood shifts. He becomes agitated, then afraid of things that shouldn't frighten him. A glass of water is placed in front of him, and his throat seizes with a violent, involuntary spasm. He recoils. The thought of drinking, of simply swallowing, sends his body into a wave of panic he cannot control. Soon he is hyper salivating, unable to clear his own throat, every breath a struggle. Bright light irritates him, sound irritates him. His own family gathered at his bedside begin to frighten him. This is rabies, one of the only diseases on earth that is almost universally, unforgivingly fatal once symptoms begin. And yet, one of the most preventable diseases known to medicine, if caught in time. We're going to talk about that virus, where it hides, how it moves through a body, the bizarre history behind how we learned to fight it, and a startling number of stories still unfolding in headlines right now in 2026. Speaker 1 (2:06) On September 10, 2026, the CDC issued a Health Alert Network health advisory to inform clinicians, health departments, and the public about increases in recent animal rabies activity and associated human exposures. The warning came less than two weeks after it was confirmed that three baby goats in a mobile petting zoo farm adventures out of North Carolina tested positive. for rabies, with a fourth goat presumed positive but not tested. All four goats were subsequently euthanized. The outbreak resulted in possible exposure of hundreds of people. The North Carolina Department of Health and Human Services advised more than 200 people who had been in contact with the goats to receive rabies vaccinations. The Petty and Zoo explained that the goats were too young for vaccination and had been bitten by a skunk that had gotten to their pen without staff. realizing it at the time. From July through August 2026, the CDC received a 17 % increase in rabies-related inquiries compared to the same period last year. Speaker 1 (3:15) Rabies is an acute viral infection of the central nervous system and has occurred in animals and humans since ancient times. Rabies' primary reservoir is wildlife such as bats, foxes, skunks, and raccoons, but is also seen in domestic animals, especially dogs. Humans are accidental hosts. Rabies presents in animals on every continent except Antarctica and with one notable asterisk, Australia. Australia has no classical rabies. virus circulating in land animals, but it isn't entirely free of related pathogens. A close cousin called Australian bat lissavirus is found in its bat population and causes an identical fatal disease in humans. Rabies itself is also non-existent in some island nations such as New Zealand and Cyprus. Due to strict control and quarantine measures, the United Kingdom Norway, Sweden, Iceland, and Japan have essentially eliminated rabies infections. There are also multiple other countries who have self-declared to be free from dog-mediated rabies, with Chile becoming the first country in South America to achieve this status, validated by the World Health Organization in 2026. In developing countries, particularly in Africa and Asia, rabies is considered a significant public health issue with 40 % of deaths occurring in children under 15. 50,000 to 59,000 rabies deaths occur annually worldwide with approximately 95 % of fatalities occurring in Africa and Asia. Domestic dogs cause up to 99 % of all human rabies deaths worldwide. In the U.S., rabies from dog bites is exceedingly rare. Two human rabies deaths were reported by the CDC in 2025. One was a child bitten by a dog in India before returning to the U.S. The other was a