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From the paranormal world, there may be a possible explanation for vampires who roam the earth by night but reside in their graves by day; this would be the phenomenon of astral projection. In this procedure it is assumed there is a counterpart to the physical body which dwells on the astral plane, the plane of existence just above our three-dimensional, material world. The astral body may leave the physical body in an out-of-body (OBE) experience -- so the belief goes -- and travel back and forth from the body underground to the surface (in the case of the vampire, in a search for blood).
In addition to the occasional psychotic murderer who thinks he is a vampire and modern-day cultists who pretend to be vampires, there may be some scientific basis for what appears to be vampirism. Daniel C. Scavone has outlined several of these possibilities in his 1990 book Vampires.
Some writers in recent years have theorized that perhaps some persons who were falsely accused of vampirism in ancient times may have actually suffered from a medical disorder known today as porphyria. The bodies of people with this condition cannot produce the correct amount of red blood called "heme." Supposedly this disorder could produce symptoms which ignorant people during the Dark Ages might have concluded to be a case of vampirism. Needless to say, people with this disease do not become vampires; the porphyria theory (elaborated in McNally and Florescu's In Search of Dracula) appears to be merely an attempt to explain the irrational beliefs of the ignorant.
Another disorder which could cause people in olden days to suspect a case of vampirism was extreme anemia. In this event, the patient is low on red blood cells and hemoglobin (an element containing iron in the blood which carries oxygen). Such a severe condition could make the patient's skin appear pale -- clearly a sign of vampirism to the uninformed mind.
Catalepsy is another medical condition which could have been mistaken for evidence of vampirism. In this disorder the patient suffers a form of temporary paralysis and appears dead. It is quite possible that some people historically were actually buried alive while suffering from catalepsy. A person in this state has the ability to hear and has vision, but it is impossible to move a muscle, and the individual certainly cannot call for help. If this person came out of the paralytic state after a premature burial, the resulting confusion with vampirism would be obvious. Imagine witnessing a "corpse" struggling to free itself from a fresh grave or a coffin... Anyone unfamiliar with catalepsy (and this was probably most people) would immediately fear for his life and claim he had seen a vampire rising from the dead.
There very well may have been any number of other blood disorders or physical or mental ailments which produced some symptoms which the fearful in the past might have seen as signs of vampiric or demonic possession. One can imagine that any number of skin diseases or other disfigurements could cause primitive people to believe they had seen a vampire.
Then there is the psychological factor. If the population already believes in the vampire myth, because they are taught this myth as fact, and if the population knows almost nothing of science, then how would we expect these people to explain mysterious yet natural phenomena? The vampire belief would only be reinforced in the face of the otherwise inexplicable. Ignorance and fear would reinforce a belief based on superstition.
Whatever the case may be, whether vampires were actual supernatural beings (most unlikely) or legends based on some non-related facts (possible) or pure fabrications of fantasy, ignorance and anxiety mixed with superstition (most likely), the popular image of the vampire will probably reflect the sign of the times. How we view the vampire at any given point in our human history may be a Rorschach test for our society, revealing more about us than about the vampire.
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