Bats

In 2022, 1,218 bats tested positive for rabies, representing a 1.9% decrease compared to the 1,241 reported in 2021 (Table 1). The positivity rate of bats tested (5.2%) was significantly lower than the previous 5-year average (5.7%; 95% CI, 5.5% to 5.9%; Table 2). All jurisdictions, except Hawaii and Puerto Rico, reported rabid bats during 2022. Bats were the only animals that tested positive for rabies in 10 states (Iowa, Idaho, Illinois, Indiana, Louisiana, Mississippi, Nevada, Utah, Washington, and Wisconsin) in 2022. Six states together reported more than 50% of all reported rabid bats: California (189 [15.5%]), Texas (156 [12.8%]), Pennsylvania (100 [8.2%]), New York (85 [7.0%]), Illinois (61 [5.0%]), and Michigan (45 [3.7%]). About half (49.1%) of the bats tested for rabies in 2022 had genus and species identified and reported, which is an increase compared to 2021 (28.8%). Big brown bats (Eptesicus fuscus; n = 8,955; 3.9% positive) were the most frequently tested bat species, followed by Mexican free-tailed bats (Tadarida brasiliensis; 734; 25.7% positive; Supplementary Table S1). Rabies virus characterization results were reported for 28.7% of rabid bats (Table 3).

Raccoons

A total of 1,014 raccoons tested positive for rabies in 2022, representing a 1.6% decrease compared to the 1,030 reported in 2021 (Table 1). The positivity rate of raccoons tested in 2022 (9.6%) was significantly lower than the previous 5-year average (10.8%; 95% CI, 10.1% to 11.6%; Table 2). The number of raccoon rabies cases peaked in 1993 at 5,912.⁷

Eastern Raccoon (ERC) RVV was enzootic in 20 states in 2022. These states (Virginia [155 {15.3%} rabid racoons], Maryland [132 {13.0%}], Pennsylvania [120 {11.8%}], North Carolina [100 {9.9%}], New Jersey [99 {9.8%}], New York [86 {8.5%}], and 14 other ERC RVV–enzootic states [299 {29.5%}]) reported 98% of all rabid raccoons in 2022. Rabies virus characterization results were reported for 160 rabid raccoons, including 141 infected with ERC RVV and 19 infected with south central skunk (SCSK) RVV (Table 3).

Skunks

A total of 660 skunks tested positive for rabies in 2022, representing a 4.5% decrease compared to the 691 reported in 2021 (Table 1). The positivity rate of skunks tested in 2022 (21.8%) was significantly lower than the previous 5-year average (23.2%; 95% CI, 21.9% to 24.5%; Table 2). Over 50% of rabid skunks were reported from 5 states: Texas (151 [22.9%]), Virginia (70 [10.6%]), North Carolina (67 [10.2%]), California (40 [6.1%]), and New York (36 [5.5%]). Rabies virus characterization results were reported for 328 (49.7%) rabid skunks; 184 were infected with SCSK RVV, 105 were infected with ERC RVV, 22 were infected with California skunk RVV, 13 were infected with north central skunk (NCSK) RVV, and 4 were infected with bat RVVs (Table 3).

Foxes

In 2022, 269 foxes tested positive for rabies, representing a 14.3% decrease compared to the 314 reported in 2021 (Table 1). The positivity rate of foxes tested (16.5%) was significantly lower than the previous 5-year average (19.4%; 95% CI, 18.4% to 20.3%; Table 2).

Over 50% of fox rabies cases were reported from Virginia (47 [17.5%]), North Carolina (46 [17.1%]), New York (31 [11.5%]), and Pennsylvania (20 [7.4%]). Rabies virus characterization results were reported for 111 (41.3%) rabid foxes: 75 were infected with ERC RVV in states where the variant was enzootic; 17 from Texas were infected with SCSK RVV; 7 from Alaska were infected with Arctic fox RVV; 6 from Arizona, California, and New Mexico were infected with Arizona gray fox (AZ GF) RVV; 5 from California were infected with bat RVVs; and 1 from California was infected with California skunk RVV (Table 3).

Other wild animals

In 2022, other wildlife that tested positive for rabies included 16 bobcats (Lynx rufus), 8 coyotes (Canis latrans), 8 mongooses, 5 deer, 2 Virginia opossum (Didelphis virginiana), 1 river otter (Lontra canadensis), and 1 mountain lion (Puma concolor). Rabies virus characterization was performed on 18 (43.9%) of 41 other wild animals, including 6 infected with ERC RVV reported from Alabama, New Jersey, North Carolina, and Virginia; 5 with mongoose RVV reported from Puerto Rico; 4 with AZ GF RVV reported from Arizona and New Mexico; 2 with SCSK RVV reported from Oklahoma and Texas; and 1 with a bat RVV reported from California (Table 3). Reported rabid rodents and lagomorphs during 2022 included 28 groundhogs (Marmota monax), 2 beavers (Castor canadensis), 1 rabbit (Oryctolagus cuniculus), and 1 vole.

Dogs

In 2022, 50 dogs tested positive for rabies, representing a 38.9% increase from 36 reported in 2021 (Table 1). The positivity rate of dogs tested (0.2%) was similar to the previous 5-year average (0.3%; 95% CI, 0.2% to 0.3%; Table 2). Over 50% of rabid dogs were reported from Puerto Rico (10 [20.0%]) and Texas (17 [34.0%]). Variant typing results were reported for 43 rabid dogs, including 1 from California infected with California skunk RVV; 3 from Tennessee and Montana infected with NCSK RVV; 9 from Puerto Rico infected with mongoose RVV; 10 from Alabama, Georgia, North Carolina, and Virginia infected with ERC RVV; and 20 from Texas, Arkansas, and Oklahoma infected with SCSK RVV (Table 3).

Cats

In 2022, 222 cats tested positive for rabies, representing a 2.8% increase from 216 reported in 2021 (Table 1). The positivity rate of cats tested (1.3%) was similar to the previous 5-year average (1.3%; 95% CI, 1.1% to 1.5%; Table 2). Over 50% of rabid cats were reported from 4 states (Pennsylvania [47 {21.2%} rabid cats], Virginia [24 {10.8%}], New Jersey [22 {9.9%}], and Georgia [20 {9.0%}]) where ERC RVV was enzootic. Variant typing results were reported for 77 (34.7%) rabid cats, including 48 infected with ERC RVV, 25 with SCSK RVV, 1 with NCSK RVV, 1 with California skunk RVV, and 2 with mongoose RVV (Table 3).

Other domestic animals

A total of 42 cattle (Bos taurus) tested positive for rabies in 2022, representing a 5.0% increase from 40 reported in 2021 (Table 1). The positivity rate of cattle tested (6.2%) was significantly higher than the previous 5-year average (4.1%; 95% CI, 3.3% to 4.9%; Table 2). Over 50% of rabid cattle were reported from 4 states (Texas [9 {21.4%}], Pennsylvania [6 {14.3%}], Virginia [5 {11.9%}], and North Carolina [4 {9.5%}]) where SCSK and ERC RVVs were enzootic. Other rabid domestic animals included 18 horses (Equus caballus), 8 goats (Capra hircus), 4 sheep (Ovis aries), and 1 llama (Lama glama). Rabies virus characterization was performed on 21 cattle, 7 horses, and 3 goats, all of which were infected with local terrestrial enzootic RVVs (Table 3).

Canada

In 2022, the CFIA laboratories tested 2,535 samples, the majority of which came from animals with a history of human exposure (72.6%).¹⁰ All other samples had only domestic animal contact (17.8%) or no documented contact with people or animals (9.5%). Samples were received from all 13 provinces and territories, with the majority (1,435 [56.5%]) submitted from the province of Ontario. One hundred thirty-six (5.4%) tested positive; of these, 29 (21.3%) were confirmatory tests on wildlife surveillance samples, initially analyzed in provincial laboratories. An additional 6 cases positive on immunohistochemistry were reported but were not submitted to the CFIA for confirmatory testing. At the CFIA, animal samples were analyzed by the direct fluorescent antibody test (n = 2,529). Nunavut, Northwest Territories, and Newfoundland and Labrador had the highest rates of positive samples with 71.4% (15/21), 40.0% (4/10), and 33.3% (10/30), respectively. Additional animal rabies testing is conducted by wildlife and agriculture agencies; however, summary data were not available.

The 2015 Ontario rabies outbreak due to ERC RVV persisted with a higher case count in 2022 (n = 25) compared to 2021 (14), and the ERC RVV outbreak in New Brunswick reemerged (2) since the last case detected in July 2019. These 2022 cases were found approximately 130 km north of the closest cases in the 2014–2019 New Brunswick outbreak. This outbreak has continued in 2023, with 6 additional cases detected.¹¹ Rabies cases due to the Arctic fox RVV increased and were widely distributed in the northern regions in comparison to 2021 (40 cases in 2022, 12 in 2021), with cases detected in Northwest Territories (4), Nunavut (15), northern Manitoba (6), northern Quebec (5) and the mainland of Newfoundland and Labrador (10). Increased detection of ERC RVV and Arctic fox RVV cases accounted for the increase in proportion of samples testing positive in 2022 (5.4% compared to 4.3% in 2021). Although most rabies cases were in wildlife species (123/135 [90.4%]), domestic species accounted for 45.7% (1,158/2,535) of specimens analyzed. Bats accounted for the highest proportion of wildlife cases in 2022 (56 [41.2%]), followed by foxes (32 [23.5%]), skunks (28 [20.6%]), and raccoons (7 [5.1%]). Among domestic animals, rabies was detected in 10 dogs, 2 horses, and 1 bovine. These cases were the result of spillover of the Arctic fox RVV in northern regions (8 dogs) and skunk RVV (NCSK RVV in the US) in western Canada (1 dog, 2 horses, and 1 bovine). An imported dog in Toronto, Ontario, was found to be infected with a Middle East canine RVV.¹² The dog had received 1 dose of a rabies vaccine that is unlicensed in the US or Canada, had a prolonged incubation period of over 7 months, and had an atypical clinical presentation. This was the second case of imported dog rabies in as many years,¹³ which influenced the decision to introduce changes in import requirements for commercial dogs from countries considered high risk for dog rabies.¹⁴

Mexico

Rabies surveillance has been maintained in Mexico through the Network of State Public Health Laboratories and the Institute for Epidemiological Diagnosis and Reference. In 2022, a total of 10,340 samples were processed, with a positivity rate of 0.6%. Animals under surveillance were dogs (9,475 [91.6%]), cats, bats, skunks, and bovines (865 [8.4%]). Out of the processed samples, 25 tested positive for rabies, including 1 domestic feline, 21 bovines, 1 equine, 1 goat, and 1 coati. Likewise, the Secretariat of Agriculture reported rabies outbreaks in cattle and confirmed 296 rabies cases during 2022.

Rabies virus characterization results were reported for 2 rabies-positive animals, including 1 coati from Quintana Roo infected with vampire bat (Desmodus rotundus) RVV and 1 domestic cat from Zacatecas infected with skunk RVV (SCSK RVV in the US).¹⁵ The rabid cat was a 1-month-old kitten without rabies vaccination from Monte Escobedo in the state of Zacatecas. The kitten, along with the other 3 kittens in the litter, was reported to have fought with a skunk (species not identified) a month before showing clinical signs. Regarding the other cats in the litter, 1 died the day of the fight, while the other 2 had brain samples taken after being euthanized and were found to be negative for rabies. A total of 5 people associated with this case received postexposure prophylaxis.

Rabies in humans

In 2022, no human rabies cases were reported in the US (Supplementary Table S2) and Canada. Four animal-transmitted human rabies cases were reported in Mexico, including 3 cases transmitted by bats and 1 case by a domestic cat. The first case occurred in a 42-year-old male resident of the state of Jalisco, who was attacked by a bat in January 2022 in the municipality of Chapala and did not receive postexposure prophylaxis, resulting in his death in April 2022. The rabies virus characterization result was vampire bat RVV; however, the bat species was not determined. In December 2022, the second human rabies case occurred in the state of Nayarit. An unvaccinated domestic cat bit a 29-year-old female in November; the cat subsequently died and the body was cremated, making rabies diagnosis impossible. Thirty days after the bite incident, the patient began to show neurological symptoms compatible with rabies. Antirabies antibodies were found in this patient’s serum and cerebrospinal fluid samples, showing titers of 3.6 IU/mL, inferred to be caused by rabies virus infection. The patient remains alive to date with autonomous breathing but is in a vegetative state without other cognitive functions. The remaining 2 cases also occurred in December 2022. A 6-year-old boy and a 7-year-old girl in the state of Oaxaca were attacked by an unidentified wild animal while they slept and did not receive postexposure prophylaxis. The diagnosis of rabies was confirmed via postmortem samples for one of the siblings, while the other case was determined by epidemiological association. The identified rabies variant was vampire bat RVV. The boy and girl died on December 28, 2022, and January 7, 2023, respectively.