Rabies

Fact sheet on Rabies

Rabies is a zoonotic disease (a disease that is transmitted from animals to humans) that is caused by a virus. Rabies is found on all continents except Antarctica.  When traveling, it is always prudent to avoid approaching any wild or domestic animal.
In certain areas of the world, including but not limited to parts of Africa, Asia, and Central and South America, rabies in dogs is still a major problem, and access to preventative treatment may be hard to get. The importance of rabid dogs in these countries, where tens of thousands of people die of the disease each year, cannot be overstated.
Unlike programs in developed countries, dog rabies vaccination programs in developing countries have not always been successful. Rates of post exposure prophylaxis in some developing countries are about 10 times higher than in the United States, and rates of human rabies are sometimes 100 times higher.

To view the global distribution of countries at risk, click here

Key facts

  • Rabies occurs in more than 150 countries and territories.
  • Worldwide, more than 55 000 people die of rabies every year.
  • 40% of people who are bitten by suspect rabid animals are children under 15 years of age.
  • Dogs are the source of 99% of human rabies deaths.
  • Wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death.
  • Every year, more than 15 million people worldwide receive a post-exposure preventive regimen to avert the disease – this is estimated to prevent 327 000 rabies deaths annually.

Consider pre-exposure vaccination if:

  1. Your planned activity will bring you into contact with wild or domestic animals, for example if you are a biologist, veterinarian, or agriculture specialist working with animals.
  2. You will be visiting remote areas where medical care is difficult to obtain or may be delayed, for example, hiking through remote villages where dogs are common.

Were you exposed to rabies?

The rabies virus is transmitted through saliva or brain/nervous system tissue. You can only get rabies by coming in contact with these specific bodily excretions and tissues.
People are infected through the skin following a bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies. They are the source of infection in all of the estimated 55 000 human rabies deaths annually in Asia and Africa.  In East Africa any bite from an animal or saliva on mucous membranes or cut skin, is considered potential exposure. If there is documented evidence that the animal is vaccinated against rabies from a reputable vetinary service, there is less risk.
It’s important to remember that rabies is a medical urgency but not an emergency. Decisions should not be delayed and medical advice sought same day
Effective treatment soon (within a few days, but as soon as possible) after exposure to rabies can prevent the onset of symptoms and death.
Post-exposure prevention consists of local treatment of the wound, administration of rabies immunoglobulin (if indicated), and immediate vaccination.

Wash any wounds immediately. One of the most effective ways to decrease the chance for infection is to wash the wound thoroughly with soap and water.
See your doctor for attention for any trauma due to an animal attack before considering the need for rabies vaccination. Whether the animal is vaccinated or not against rabies will be a consideration in deciding whether to start post exposure vaccination. Other factors that should be taken into consideration when deciding whether to initiate post-exposure prevention include:

  • The likelihood of the implicated animal being rabid
  • The clinical features of the animal and its availability for observation and laboratory testing.

In developing countries, the vaccination status of the suspected animal alone should not be considered when deciding whether to initiate prophylaxis or not.

In addition, contact with someone who is receiving rabies vaccination does not constitute rabies exposure and does not require post exposure prophylaxis.

Post-exposure vaccination

The first dose of rabies vaccine should be given by your health care provider as soon as possible after exposure. Additional doses or rabies vaccine should be given on days 3, 7, and 14 after the first vaccination. Current vaccines are relatively painless and are given in your arm, like a flu or tetanus vaccine.

 

Table: Recommended post-exposure prophylaxis for rabies infection

Category of exposure to suspect rabid animal

Post-exposure measures

Category I – touching or feeding animals, licks on intact skin (i.e. no exposure)

None

Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding

Immediate vaccination and local treatment of the wound

Category III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, exposures to bats.

Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

Updated in February 2011