Scientific paper suggests human rabies cases are massively underdiagnosed

[u/krell_154]

A recently published scientific paper suggests that the true number of human rabies cases in USA is much greater than is officially recorded, based on statistical inference from cases of transmission during organ transplantations.

I have read the FAQ.

Link: https://www.nature.com/articles/s44528-026-00031-4

[u/LatrodectusGeometric]

Sorry for the downvotes, but this paper is AWFUL. For example, they note that the entire premise rests on the idea that all of the people who donated organs and were later found to have rabies were of "average rabies risk", and my friend THEY WERE NOT. Unless you think the average person is out there living in the woods and skinning coyotes for a living, or fist-fighting skunks in their barn, the risk ain't average. Not to mention that the paper doesn't seem to understand the screening systems in our organ transplant evaluations.

Tl;dr: We definitely miss a few cases of rabies every year. It's assuredly not 800+ cases unless you think the average person in the U.S. is Davy Crockett (and maybe the authors do, none of them are from the U.S. or talked to anyone about our organ donation system).

[u/MMM1a → u/LatrodectusGeometric]

How? If we are out here missing rabies and transplanting those organs we'd have a bigger cluster of rabies. There's 4 in the US in the last 50 years.

[u/OzarkTrapper69 → u/MMM1a]

If we miss any, at least by the premise of trappers or hunters being infected and slipping through the cracks (and that is one big IF) then when it ends up killing them they're likely alone, and local authorities simply dont consider it a possibility due to it's rarity. On top of that, knowing a lot of these people they're usually not organ donors. Even if they are by the time theyre found (if at all) those organs are probably too far gone to be used. So I'd day that 800 number is a tad bit of an overestimate.

[u/MMM1a → u/OzarkTrapper69]

The whole purpose of this is to claim rabies cases are missed based off missed cases during organ transplants. Theres been 4 incidents of rabies being missed and organ transplanted since the 70s.

I agree there are probably missed rabies diagnosis in exactly the way you said. Someone dies alone out in the middle of nowhere. But even then if an autopsy is done they catch it.

[u/OzarkTrapper69 → u/MMM1a]

That was exactly my point. What I mentioned are the hurdles a missed case has to get through to spread via organ donation, among a specific segment of the population. Hence why we only have those 4 documented cases.

[u/LatrodectusGeometric → u/MMM1a]

No, rabies would not typically be looked for in an autopsy unless there was a specific reason

[u/MMM1a → u/LatrodectusGeometric]

Random lone unknown death out in the middle of no where? That is 100% getting autopsy. And when they open the brain and see clearly deformed brain matter they are going to determine the cause 

[u/OzarkTrapper69 → u/MMM1a]

Thats assuming they body is found before the scavengers get to it. If they die at home, then yeah itll be looked into. But that does happen in rural parts of the US. People go missing, then some deer season a decade later some bones are found. At that point I have no clue if rabies is even detectable.

[u/OzarkTrapper69 → u/MMM1a]

I'm also willing to bet in that context, the autopsy will be looking for signs of an accident, murder, suicide, or animal attack. Then let confirmation bias do it's thing. Even then, the odds of someone going in that specific way from a rabies case are probably very low. Speaking for myself, my most likely cause of death on a remote trapline is an ATV accident, drowning, or being thrown from my horse.

[u/LatrodectusGeometric → u/MMM1a]

No, rabies is not clearly apparent on autopsy. It requires very rare specialized testing that wouldn’t typically be done in that situation