Community pharmacies may be key to preventing people exposed to the rabies virus from developing the fatal neurologic disease. 

Spread through the bites and scratches of mammals, rabies is preventable if people get the post-exposure vaccine before clinical symptoms appear. 

The first shot of the four-dose series is often given at an emergency department (ED), followed by doses administered on days three, seven, and 14. Needing so many shots can be burdensome, and some patients skip later doses, increasing the odds of the virus entering their central nervous system and killing them.

But a study published yesterday in the American Journal of Infection Control found that when a health system in the Appalachian Highlands gave people the option to get subsequent doses at a community pharmacy, the percentage of patients who completed their rabies vaccine series rose from 49.6% to 53.1%.

The statistically significant, though modest, bump is more consequential when considering that 80% of patients who used community pharmacies completed their rabies vaccine series, compared with just 47.9% of those who chose to get their subsequent shots at the ED. 

"Unnecessary ED visits increase costs for patients and strain ED providers and systems," said the authors, led by Jeffrey A. Gray, PharmD, of Eastern Tennessee University. 

The authors added that EDs often lack the infrastructure for follow-up care.

However, just 35 of the 367 patients in the study got their vaccines from community pharmacies. The authors said this low rate could be due to several factors, including issues with insurance coverage, inconsistent ED referrals to community pharmacies, and patients' awareness of community pharmacies as an option.

More Americans are getting exposed to rabies

While the United States reports fewer than 10 rabies deaths per year, the Centers for Disease Control and Prevention (CDC) reports that 2026 has seen increases in both animal rabies cases and human exposures.

Some 100,000 US residents receive post-exposure rabies preventive shots (prophylaxis) every year, according to the CDC. Bats, raccoons, skunks, foxes, and mongooses are the main animal reservoirs of the virus. 

Had lower-income and lower middle–income countries rolled out the COVID-19 vaccine at the same rate as their wealthy counterparts, they might have prevented up to half of deaths related to the virus by fall 2021, according to a model-based policy brief from Canada’s United Nations University Institute for Water, Environment and Health (UNU-INWEH) and international partners.

And rolling out the vaccine 100 days after the virus was sequenced could have saved more than 8 million lives around the world by 2022, mostly in poorer countries, the authors said.

“COVID-19 vaccines were developed and deployed faster than any before them, yet countries differed widely in their ability to finance, procure, distribute and administer them,” they wrote. Sharing supplies more fairly could have averted 1.3 million deaths worldwide by 2022 by more evenly disrupting transmission, reducing the risk of new SARS-CoV-2 variants, and speeding economic recovery, they added.

Global consensus on vaccine-sharing rules needed

By the end of 2021, wealthy countries had administered, on average, at least one COVID-19 vaccine dose per person, compared with one dose for every three people in lower middle–income countries and one for every 25 in low-income countries.

During the 2020 Olympic and Paralympic Games—which the COVID-19 pandemic delayed until 2021—stronger surveillance and mitigation efforts protected most athletes and team officials from contracting COVID-19, a study published last week in Eurosurveillance finds. 

“The results indicate that SARS-CoV-2 transmission into and within athletes and team officials was minimized by multiple infection prevention measures,” said the authors, led by researchers at the Japan Institute for Health Security in Tokyo. “This conclusion is supported first by the low attack rates among both Olympic and Paralympic athletes and team officials.”

Less than 1% of participants infected

For the 2020 Games, Japan enhanced its COVID-19 surveillance and mitigation in several ways. Country teams entering the nation needed to quarantine for 14 days. Following that, athletes were discouraged from interacting with people from outside of the venues. 

Those involved in Olympics and Paralympics events underwent regular COVID-19 testing, which found those with COVID-19 infections early and allowed them to enter isolation early. Those attending Olympic and Paralympic venues wore masks and physically distanced from one another. 

During the Olympic Games, only 0.6% of athletes and team officials (65 of 11,400) tested positive for COVID-19—the same rate as for the Paralympic Games (30/4,800). 

Low rates of infections, mainly affecting those from abroad shortly after their arrival in Japan indicate that the Games’ unique infection-control measures effectively minimized SARS-CoV-2 transmission.

Most people who tested positive (85/95) did so upon arrival or within two weeks of entering Japan. Sixty-eight of those infected with COVID-19 had the Delta variant, 66 people had a strain that originated outside of Japan, and two had a domestic strain. 

“Low rates of infections, mainly affecting those from abroad shortly after their arrival in Japan indicate that the Games’ unique infection-control measures effectively minimized SARS-CoV-2 transmission,” the authors said. 

• The Ebola outbreak in the Democratic Republic of the Congo (DRC) has now grown to 10,060 cases. Compared with the West African outbreak of 2014-2016, the current outbreak has at least three times the number of cases and number of deaths since it was declared on May 15, making it the fastest-growing Ebola outbreak in history. The European Centre for Disease Prevention and Control (ECDC) reported they are sending more experts to Nigeria this week to investigate how a woman in that country contracted the virus. The ECDC has also sent support to Kenya, where two people have died from the virus. Yesterday, 20 case contacts in Kenya were released from quarantine after finishing a 21-day monitoring period. Ninety-eight contacts remain in quarantine. In total,  nine people in Kenya have tested positive for the virus. 
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