Rabies is a zoonotic viral disease maintained in domestic and wild carnivores and bats all over the world. It is transmitted to other animals and humans through close contacts with saliva from infected animals (i.e. bites, scratches, licks on broken skin and mucous membranes). Once symptoms of the disease develop, rabies is fatal to both animals and humans.
Rabies has been eliminated as a significant public health risk in most parts of the developed world. However, annually 55,000 deaths are reported, most of them in the developing world. Once infected in the absence of post-exposure prophylaxis the disease is fatal. Although post-exposure prophylaxis using modern vaccines and whenever required rabies immunoglobulin is effective in most situations, many people still die. Most of them are children and most of the patients do not receive the necessary rabies immunoglobulin because of a perennial global shortage and because of its high price, so that it is unaffordable or unavailable in countries where canine rabies is endemic.
The animal hosts that maintain rabies virus in nature are carnivores and bats. Other animals do not play a role in the maintenance of the disease, but are victims of the disease. Humans become infected by the bite of an infected animal, mostly a rabid dog. After a bite immediate post-exposure treatment is needed.
In many countries in which the dog is the reservoir of the virus, few activities are underway to prevent rabies occurrence in humans and to control rabies in dogs, even when the number of human deaths is high. Prevention of human rabies must be a community effort involving both veterinary and public health officials. Rabies elimination programmes focused mainly on mass vaccination of dogs are largely justified by the future savings of discontinuing prevention programmes. If rabies is not eliminated, expenses related to prevention of the disease in both humans and animals are likely to increase dramatically in developing countries.
Role of WHO
WHO is working on at least five requirements that need to be fulfilled to control and prevent human rabies:
- consistent availability of modern effective cell culture rabies vaccines for humans and for animals;
- an increased awareness in the public, and in the medical profession of rabies and effective methods of control and prevention;
- implementation of dog control programmes and elimination of canine rabies;
- eliciting political support;
- improved surveillance.
WHO promotes activities for the control and elimination of dog rabies particularly in Asia and Africa. A number of WHO documents dealing with the various aspects of a comprehensive dog rabies control programme have been developped over time.