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WHO|Rabies

Mediacentre
Rabies
FactSheetN99
UpdatedSeptember2015

Keyfacts
Rabiesisavaccinepreventableviraldiseasewhichoccursinmore
than150countriesandterritories.
Dogsarethesourceofthevastmajorityofhumanrabiesdeaths.
Rabieseliminationisfeasiblebyvaccinatingdogs.
Infectioncausestensofthousandsofdeathseveryyear,mostlyin
AsiaandAfrica.
40%ofpeoplewhoarebittenbysuspectrabidanimalsarechildren
under15yearsofage.
Immediatewoundcleansingwithsoapandwateraftercontactwitha
suspectrabidanimalcanbelifesaving.
Everyyear,morethan15millionpeopleworldwidereceiveapostbite
vaccinationtopreventthediseasethisisestimatedtoprevent
hundredsofthousandsofrabiesdeathsannually.

Rabiesisaninfectiousviraldiseasethatisalmostalwaysfatalfollowing
theonsetofclinicalsigns.Inmorethan99%ofhumancases,the
rabiesvirusistransmittedbydomesticdogs.Rabiesaffectsdomestic
andwildanimals,andisspreadtopeoplethroughbitesorscratches,
usuallyviasaliva.
RabiesispresentonallcontinentswiththeexceptionofAntarctica,but
morethan95%ofhumandeathsoccurinAsiaandAfrica.
Rabiesisaneglecteddiseaseofpoorandvulnerablepopulationswhose
deathsarerarelyreportedandwherehumanvaccinesand
immunoglobulinarenotreadilyavailableoraccessible.Itoccursmainly
inremoteruralcommunitieswherechildrenbetweentheageof514
yearsarethemostfrequentvictims.
Theaveragecostofrabiespostexposureprophylaxis(PEP)canbethe
costofcatastrophicexpensesforpoorpopulations,sinceacourseof
PEPcancostUS$40inAfricaandUS$49inAsia,wheretheaverage
dailyincomeisaboutUS$12perperson.
Prevention
Eliminatingrabiesindogs

Rabiesisavaccinepreventabledisease.Vaccinatingdogsisthemost
costeffectivestrategyforpreventingrabiesinpeople.Dogvaccination
willdrivedownnotonlythedeathsattributabletorabiesbutalsothe
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needforPEPasapartofdogbitepatientcare.
Preventiveimmunizationinpeople

Thesamesafeandeffectivevaccinescanbeusedforpreexposure
immunization.Thisisrecommendedfortravellersspendingalotoftime
outdoors,especiallyinruralareas,involvedinactivitiessuchas
bicycling,camping,orhikingaswellasforlongtermtravellersand
expatriateslivinginareaswithasignificantriskofexposure.
Preexposureimmunizationisalsorecommendedforpeopleincertain
highriskoccupationssuchaslaboratoryworkersdealingwithliverabies
virusandotherrabiesrelatedviruses(lyssaviruses),andpeople
involvedinanyactivitiesthatmightbringthemprofessionallyor
otherwiseintodirectcontactwithbats,carnivores,andothermammals
inrabiesaffectedareas.Aschildrenareconsideredathigherrisk
becausetheytendtoplaywithanimals,mayreceivemoreseverebites,
ormaynotreportbites,theirimmunizationcouldbeconsideredifliving
inorvisitinghighriskareas.
Symptoms
Theincubationperiodforrabiesistypically13months,butmayvary
from<1weekto>1year.Theinitialsymptomsofrabiesarefeverand
oftenpainoranunusualorunexplainedtingling,prickingorburning
sensation(paraesthesia)atthewoundsite.Asthevirusspreadsthrough
thecentralnervoussystem,progressive,fatalinflammationofthebrain
andspinalcorddevelops.
Twoformsofthediseasecanfollow.Peoplewithfuriousrabiesexhibit
signsofhyperactivity,excitedbehaviour,hydrophobiaandsometimes
aerophobia.Afterafewdays,deathoccursbycardiorespiratoryarrest.
Paralyticrabiesaccountsforabout30%ofthetotalnumberofhuman
cases.Thisformofrabiesrunsalessdramaticandusuallylonger
coursethanthefuriousform.Themusclesgraduallybecomeparalyzed,
startingatthesiteofthebiteorscratch.Acomaslowlydevelops,and
eventuallydeathoccurs.Theparalyticformofrabiesisoften
misdiagnosed,contributingtotheunderreportingofthedisease.
Diagnosis
Notestsareavailabletodiagnoserabiesinfectioninhumansbeforethe
onsetofclinicaldisease,andunlesstherabiesspecificsignsof
hydrophobiaoraerophobiaarepresent,theclinicaldiagnosismaybe
difficult.Humanrabiescanbeconfirmedintravitamandpostmortemby
variousdiagnostictechniquesaimedatdetectingwholevirus,viral
antigensornucleicacidsininfectedtissues(brain,skin,urineorsaliva).
Transmission
Peopleareusuallyinfectedfollowingadeepbiteorscratchbyan
infectedanimal.Dogsarethemainhostandtransmitterofrabies.They
arethecauseofhumanrabiesdeathsinAsiaandAfrica.
BatsarethesourceofmosthumanrabiesdeathsintheAmericas.Bat
rabieshasalsorecentlyemergedasapublichealththreatinAustralia
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andwesternEurope.Humandeathsfollowingexposuretofoxes,
raccoons,skunks,jackals,mongoosesandotherwildcarnivorehost
speciesareveryrare.
Transmissioncanalsooccurwheninfectiousmaterialusuallysaliva
comesintodirectcontactwithhumanmucosaorfreshskinwounds.
Humantohumantransmissionbybiteistheoreticallypossiblebuthas
neverbeenconfirmed.
Rarely,rabiesmaybecontractedbyinhalationofviruscontaining
aerosolorviatransplantationofaninfectedorgan.Ingestionofrawmeat
orothertissuesfromanimalsinfectedwithrabiesisnotasourceof
humaninfection.
Postexposureprophylaxis(PEP)
Postexposureprophylaxis(PEP)meansthetreatmentofabitevictim
thatisstartedimmediatelyafterexposuretorabiesinordertoprevent
rabiesinfection.Thisconsistsof:
localtreatmentofthewound,initiatedassoonaspossibleafter
exposure
acourseofpotentandeffectiverabiesvaccinethatmeetsWHO
standardsand
theadministrationofrabiesimmunoglobulin,ifindicated.
Effectivetreatmentsoonafterexposuretorabiescanpreventtheonset
ofsymptomsanddeath.
Localtreatmentofthewound

Thisinvolvesfirstaidofthewoundthatincludesimmediateand
thoroughflushingandwashingofthewoundforaminimumof15
minuteswithsoapandwater,detergent,povidoneiodineorother
substancesthatkilltherabiesvirus.
RecommendedPEP

Dependingontheseverityofthecontactadministeringwiththe
suspectedrabidanimal,administrationofPEPisrecommendedas
follows(seetable):

Table:Categoriesofcontactandrecommendedpostexposure
prophylaxis(PEP)

Categoriesofcontactwithsuspect
rabidanimal

Postexposure
prophylaxismeasures

CategoryItouchingorfeeding
animals,licksonintactskin

None

CategoryIInibblingofuncoveredskin, Immediatevaccination
minorscratchesorabrasionswithout
andlocaltreatmentof
bleeding
thewound

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CategoryIIIsingleormultiple
transdermalbitesorscratches,lickson
brokenskincontaminationofmucous
membranewithsalivafromlicks,
contactswithbats.

WHO|Rabies

Immediatevaccination
andadministrationof
rabiesimmunoglobulin
localtreatmentofthe
wound

AllcategoryIIandIIIexposuresassessedascarryingariskof
developingrabiesrequirePEP.Thisriskisincreasedif:
thebitingmammalisaknownrabiesreservoirorvectorspecies
theanimallookssickordisplaysanabnormalbehaviour
awoundormucousmembranewascontaminatedbytheanimals
saliva
thebitewasunprovokedand
theanimalhasnotbeenvaccinated.
Indevelopingcountries,thevaccinationstatusofthesuspectedanimal
aloneshouldnotbeconsideredwhendecidingwhethertoinitiate
prophylaxisornot.
TheOrganizationcontinuestopromotehumanrabiespreventionthrough
theeliminationofrabiesindogsaswellasawideruseofthe
intradermalrouteforPEPwhichreducesvolumeandtherebythecostof
cellculturedvaccineby60%to80%.
WHOresponse
WHO,inclosecollaborationwiththeFoodandAgricultureOrganization
oftheUnitedNations(FAO),theWorldOrganisationforAnimalHealth
(OIE)andtheGlobalAllianceforRabiesControl,israisingawarenessof
andcommitmenttoovercomingthispersistentzoonosisinendemic
countries.
GreatstrideshavebeenmadeinthePhilippines,SouthAfricaand
TanzaniawhereaprojectisunderwayaspartofaBill&MelindaGates
FoundationprojectledbyWHO.Thekeytowardssustainingand
expandingtherabiesprogrammestonewterritoriesandcountrieshas
beentostartsmall,demonstratesuccessandcosteffectiveness,and
ensurecommunityengagement.
Stockpilesofdogandhumanrabiesvaccinehavehadacatalyticeffect
onrabieseliminationeffortsincountries.
RabiestransmittedbydogshasbeeneliminatedinmanyLatinAmerican
countries,includingChile,CostaRica,Panama,Uruguay,mostof
Argentina,thestatesofSoPauloandRiodeJaneiroinBrazil,and
largepartsofMexicoandPeru.
ManycountriesintheWHOSouthEastAsiaRegionhaveembarkedon
eliminationcampaignsinlinewiththetargetofregionaleliminationby
2020.Bangladeshlaunchedaneliminationprogrammein2010and,
throughthemanagementofdogbites,massdogvaccinationand
increasedavailabilityofvaccinesfreeofcharge,humanrabiesdeaths
decreasedby50%during20102014.

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Formoreinformationcontact:
WHOMediacentre
Telephone:+41227912222
Email:mediainquiries@who.int

WHO'sworkonrabies
WHOExpertConsultationon
Rabies:firstreport,2005[pdf
514kb]
Moreaboutrabies

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