[Transitory changes in public and physician behavior following the reappearance of human rabies in Israel]

Three Israelis died of rabies in a single year following a hiatus of almost 40 years since the last case of human rabies in Israel. These tragic deaths from a uniformly lethal disease, preventable by correct post-exposure treatment, were highly publicized in the mass media and led to substantial public anxiety and professional concern. In this investigation we examine public response, as well as changes in the behavior of public health physicians responsible for human rabies control, in the face of the reappearance of human rabies in Israel. In the weeks following each new case of human rabies, animal-contact visits to public health offices increased five-fold, and public health physicians initiated post-exposure prophylaxis in 25% of all applicants, compared to 10% in the no-rabies era. Together, these changes in public and professional behavior led to marked increases in rabies vaccine and rabies immune globulin consumption, and resulted in severe shortages necessitating strict rationing. Within four months of the last case, population and physician behavior had returned to baseline levels. Rabies prevention is a multi-level activity involving eliminating stray animals, immunization of pets, oral immunization of selected wild animal populations, pre-exposure immunization of persons at very high exposure risk and rapid evaluation and appropriate treatment of humans following exposure. Moreover, the public must be educated to avoid potentially dangerous animal contacts and to seek immediate professional guidance after an accidental exposure has occurred.