WHO _ Rabies_factsheet Sept 15

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WHO _ Rabies_factsheet Sept 15

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  • 9/17/2015 WHO|Rabies

    http://www.who.int/mediacentre/factsheets/fs099/en/ 1/5

    MediacentreRabiesFactSheetN99UpdatedSeptember2015

    Keyfacts

    Rabiesisavaccinepreventableviraldiseasewhichoccursinmorethan150countriesandterritories.Dogsarethesourceofthevastmajorityofhumanrabiesdeaths.Rabieseliminationisfeasiblebyvaccinatingdogs.Infectioncausestensofthousandsofdeathseveryyear,mostlyinAsiaandAfrica.40%ofpeoplewhoarebittenbysuspectrabidanimalsarechildrenunder15yearsofage.Immediatewoundcleansingwithsoapandwateraftercontactwithasuspectrabidanimalcanbelifesaving.Everyyear,morethan15millionpeopleworldwidereceiveapostbitevaccinationtopreventthediseasethisisestimatedtopreventhundredsofthousandsofrabiesdeathsannually.

    Rabiesisaninfectiousviraldiseasethatisalmostalwaysfatalfollowingtheonsetofclinicalsigns.Inmorethan99%ofhumancases,therabiesvirusistransmittedbydomesticdogs.Rabiesaffectsdomesticandwildanimals,andisspreadtopeoplethroughbitesorscratches,usuallyviasaliva.

    RabiesispresentonallcontinentswiththeexceptionofAntarctica,butmorethan95%ofhumandeathsoccurinAsiaandAfrica.

    Rabiesisaneglecteddiseaseofpoorandvulnerablepopulationswhosedeathsarerarelyreportedandwherehumanvaccinesandimmunoglobulinarenotreadilyavailableoraccessible.Itoccursmainlyinremoteruralcommunitieswherechildrenbetweentheageof514yearsarethemostfrequentvictims.

    Theaveragecostofrabiespostexposureprophylaxis(PEP)canbethecostofcatastrophicexpensesforpoorpopulations,sinceacourseofPEPcancostUS$40inAfricaandUS$49inAsia,wheretheaveragedailyincomeisaboutUS$12perperson.

    Prevention

    EliminatingrabiesindogsRabiesisavaccinepreventabledisease.Vaccinatingdogsisthemostcosteffectivestrategyforpreventingrabiesinpeople.Dogvaccinationwilldrivedownnotonlythedeathsattributabletorabiesbutalsothe

  • 9/17/2015 WHO|Rabies

    http://www.who.int/mediacentre/factsheets/fs099/en/ 2/5

    needforPEPasapartofdogbitepatientcare.

    PreventiveimmunizationinpeopleThesamesafeandeffectivevaccinescanbeusedforpreexposureimmunization.Thisisrecommendedfortravellersspendingalotoftimeoutdoors,especiallyinruralareas,involvedinactivitiessuchasbicycling,camping,orhikingaswellasforlongtermtravellersandexpatriateslivinginareaswithasignificantriskofexposure.

    Preexposureimmunizationisalsorecommendedforpeopleincertainhighriskoccupationssuchaslaboratoryworkersdealingwithliverabiesvirusandotherrabiesrelatedviruses(lyssaviruses),andpeopleinvolvedinanyactivitiesthatmightbringthemprofessionallyorotherwiseintodirectcontactwithbats,carnivores,andothermammalsinrabiesaffectedareas.Aschildrenareconsideredathigherriskbecausetheytendtoplaywithanimals,mayreceivemoreseverebites,ormaynotreportbites,theirimmunizationcouldbeconsiderediflivinginorvisitinghighriskareas.

    Symptoms

    Theincubationperiodforrabiesistypically13months,butmayvaryfrom1year.Theinitialsymptomsofrabiesarefeverandoftenpainoranunusualorunexplainedtingling,prickingorburningsensation(paraesthesia)atthewoundsite.Asthevirusspreadsthroughthecentralnervoussystem,progressive,fatalinflammationofthebrainandspinalcorddevelops.

    Twoformsofthediseasecanfollow.Peoplewithfuriousrabiesexhibitsignsofhyperactivity,excitedbehaviour,hydrophobiaandsometimesaerophobia.Afterafewdays,deathoccursbycardiorespiratoryarrest.

    Paralyticrabiesaccountsforabout30%ofthetotalnumberofhumancases.Thisformofrabiesrunsalessdramaticandusuallylongercoursethanthefuriousform.Themusclesgraduallybecomeparalyzed,startingatthesiteofthebiteorscratch.Acomaslowlydevelops,andeventuallydeathoccurs.Theparalyticformofrabiesisoftenmisdiagnosed,contributingtotheunderreportingofthedisease.

    Diagnosis

    Notestsareavailabletodiagnoserabiesinfectioninhumansbeforetheonsetofclinicaldisease,andunlesstherabiesspecificsignsofhydrophobiaoraerophobiaarepresent,theclinicaldiagnosismaybedifficult.Humanrabiescanbeconfirmedintravitamandpostmortembyvariousdiagnostictechniquesaimedatdetectingwholevirus,viralantigensornucleicacidsininfectedtissues(brain,skin,urineorsaliva).

    Transmission

    Peopleareusuallyinfectedfollowingadeepbiteorscratchbyaninfectedanimal.Dogsarethemainhostandtransmitterofrabies.TheyarethecauseofhumanrabiesdeathsinAsiaandAfrica.

    BatsarethesourceofmosthumanrabiesdeathsintheAmericas.BatrabieshasalsorecentlyemergedasapublichealththreatinAustralia

  • 9/17/2015 WHO|Rabies

    http://www.who.int/mediacentre/factsheets/fs099/en/ 3/5

    andwesternEurope.Humandeathsfollowingexposuretofoxes,raccoons,skunks,jackals,mongoosesandotherwildcarnivorehostspeciesareveryrare.

    Transmissioncanalsooccurwheninfectiousmaterialusuallysalivacomesintodirectcontactwithhumanmucosaorfreshskinwounds.Humantohumantransmissionbybiteistheoreticallypossiblebuthasneverbeenconfirmed.

    Rarely,rabiesmaybecontractedbyinhalationofviruscontainingaerosolorviatransplantationofaninfectedorgan.Ingestionofrawmeatorothertissuesfromanimalsinfectedwithrabiesisnotasourceofhumaninfection.

    Postexposureprophylaxis(PEP)

    Postexposureprophylaxis(PEP)meansthetreatmentofabitevictimthatisstartedimmediatelyafterexposuretorabiesinordertopreventrabiesinfection.Thisconsistsof:

    localtreatmentofthewound,initiatedassoonaspossibleafterexposureacourseofpotentandeffectiverabiesvaccinethatmeetsWHOstandardsandtheadministrationofrabiesimmunoglobulin,ifindicated.

    Effectivetreatmentsoonafterexposuretorabiescanpreventtheonsetofsymptomsanddeath.

    LocaltreatmentofthewoundThisinvolvesfirstaidofthewoundthatincludesimmediateandthoroughflushingandwashingofthewoundforaminimumof15minuteswithsoapandwater,detergent,povidoneiodineorothersubstancesthatkilltherabiesvirus.

    RecommendedPEPDependingontheseverityofthecontactadministeringwiththesuspectedrabidanimal,administrationofPEPisrecommendedasfollows(seetable):

    Table:Categoriesofcontactandrecommendedpostexposureprophylaxis(PEP)

    Categoriesofcontactwithsuspectrabidanimal

    Postexposureprophylaxismeasures

    CategoryItouchingorfeedinganimals,licksonintactskin

    None

    CategoryIInibblingofuncoveredskin,minorscratchesorabrasionswithoutbleeding

    Immediatevaccinationandlocaltreatmentofthewound

  • 9/17/2015 WHO|Rabies

    http://www.who.int/mediacentre/factsheets/fs099/en/ 4/5

    CategoryIIIsingleormultipletransdermalbitesorscratches,licksonbrokenskincontaminationofmucousmembranewithsalivafromlicks,contactswithbats.

    Immediatevaccinationandadministrationofrabiesimmunoglobulinlocaltreatmentofthewound

    AllcategoryIIandIIIexposuresassessedascarryingariskofdevelopingrabiesrequirePEP.Thisriskisincreasedif:

    thebitingmammalisaknownrabiesreservoirorvectorspeciestheanimallookssickordisplaysanabnormalbehaviourawoundormucousmembranewascontaminatedbytheanimalssalivathebitewasunprovokedandtheanimalhasnotbeenvaccinated.

    Indevelopingcountries,thevaccinationstatusofthesuspectedanimalaloneshouldnotbeconsideredwhendecidingwhethertoinitiateprophylaxisornot.

    TheOrganizationcontinuestopromotehumanrabiespreventionthroughtheeliminationofrabiesindogsaswellasawideruseoftheintradermalrouteforPEPwhichreducesvolumeandtherebythecostofcellculturedvaccineby60%to80%.

    WHOresponse

    WHO,inclosecollaborationwiththeFoodandAgricultureOrganizationoftheUnitedNations(FAO),theWorldOrganisationforAnimalHealth(OIE)andtheGlobalAllianceforRabiesControl,israisingawarenessofandcommitmenttoovercomingthispersistentzoonosisinendemiccountries.

    GreatstrideshavebeenmadeinthePhilippines,SouthAfricaandTanzaniawhereaprojectisunderwayaspartofaBill&MelindaGatesFoundationprojectledbyWHO.Thekeytowardssustainingandexpandingtherabiesprogrammestonewterritoriesandcountrieshasbeentostartsmall,demonstratesuccessandcosteffectiveness,andensurecommunityengagement.

    Stockpilesofdogandhumanrabiesvaccinehavehadacatalyticeffectonrabieseliminationeffortsincountries.

    RabiestransmittedbydogshasbeeneliminatedinmanyLatinAmericancountries,includingChile,CostaRica,Panama,Uruguay,mostofArgentina,thestatesofSoPauloandRiodeJaneiroinBrazil,andlargepartsofMexicoandPeru.

    ManycountriesintheWHOSouthEastAsiaRegionhaveembarkedoneliminationcampaignsinlinewiththetargetofregionaleliminationby2020.Bangladeshlaunchedaneliminationprogrammein2010and,throughthemanagementofdogbites,massdogvaccinationandincreasedavailabilityofvaccinesfreeofcharge,humanrabiesdeathsdecreasedby50%during20102014.

  • 9/17/2015 WHO|Rabies

    http://www.who.int/mediacentre/factsheets/fs099/en/ 5/5

    Formoreinformationcontact:

    WHOMediacentreTelephone:+41227912222Email:[email protected]

    WHO'sworkonrabies

    WHOExpertConsultationonRabies:firstreport,2005[pdf514kb]

    Moreaboutrabies


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