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Maximizing Human Rabies Case Detection: Understanding the Diagnostic Sensitivity of Antemortem Testing from 35 Years
Catherine Swedberg1, Shama Cash-Goldwasser1, Yasmeen Ross1
1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Summary
Antemortem rabies testing is highly sensitive when using multiple sample types and following CDC guidelines. Early illness favors virus detection in saliva and skin, while later illness favors antibody detection in serum and CSF.
Area of Science:
- Infectious Diseases
- Virology
- Clinical Diagnostics
Background:
- Human rabies diagnosis faces challenges due to under-testing, impacting timely interventions.
- Antemortem diagnosis offers advantages over postmortem testing for critical decision-making.
Purpose of the Study:
- To evaluate the diagnostic sensitivity of antemortem rabies testing.
- To characterize sensitivity based on specific sample types and collection timing.
Main Methods:
- Retrospective analysis of 69 confirmed human rabies cases (1990-2024) reported to the CDC.
- Evaluation of 382 antemortem samples (saliva, nuchal skin, serum, CSF) tested at CDC.
- Stratification of diagnostic performance by sample type and time since symptom onset.
Main Results:
- Combined diagnostic sensitivity reached 100% with four sample types, with <2% false negatives.
- Sensitivity was lower (<65%) when only one sample type was tested.
- Virus detection (saliva, skin) peaked early; antibody detection (serum, CSF) peaked later in illness.
Conclusions:
- Antemortem rabies testing demonstrates high sensitivity when adhering to CDC recommendations.
- Understanding sample type and timing is crucial for accurate interpretation of rabies test results.
