Your Guide to
Neglected Tropical Diseases

Rabies is a viral infection that affects the central nervous system and is almost always fatal once symptoms develop. It typically spreads through bites or scratches from infected animals, usually dogs. After infection, symptoms appear anywhere from a few weeks to several months. Early symptoms resemble those of the flu, along with unusual sensations like tingling or itching at the bite site. As the disease progresses, it causes severe brain inflammation leading to confusion, hallucinations, aggressive behaviors, and excessive saliva production. A characteristic symptom is hydrophobia: extremely painful throat spasms triggered by attempts to swallow liquids, making infected people avoid water despite intense thirst. Without treatment before symptom onset, rabies is virtually 100% fatal. The disease is entirely preventable through prompt medical care after exposure and through vaccination of dogs.

Dogs are responsible for 99% of human rabies cases worldwide. Other animals that can carry rabies include bats, raccoons, skunks, foxes, and other mammals. The virus spreads via saliva when an infected animal bites or scratches a person. Transmission can also occur if infectious saliva reaches the eyes, mouth, or open wounds. The virus does not spread through casual contact like petting an animal or touching dried blood or urine. In countries with widespread dog vaccination programs, most rabies cases occur in wild animals rather than domestic dogs.

Geographic scope:

• Rabies occurs in more than 150 countries and territories worldwide, present on all continents except Antarctica.
• About 95% of human deaths occur in Africa and Asia, where dog rabies is poorly controlled.
• India accounts for about 35% of all rabies deaths globally.
• Many regions have successfully eliminated dog-mediated rabies.
• The disease primarily affects poor rural communities where dog vaccination programs and access to post-exposure treatment are limited or nonexistent.

Population affected:

• An estimated approximately 60,000 people die from rabies each year worldwide, although this is likely an underestimate due to underreporting.
• About half of all cases occur in children under 15 years old, who are more likely to be bitten and may not report bites.
• Every year, more than 15 million people receive post-exposure vaccination, preventing hundreds of thousands of deaths.

Rabies is preventable through post-exposure prophylaxis (PEP): immediately wash the wound with soap and water, then receive a series of rabies vaccine injections and sometimes rabies immunoglobulin injections. PEP is almost 100% effective when given before symptoms appear. WHO-prequalified vaccines include RABIVAX-S, VaxiRab N, and VERORAB.

People at high risk (veterinarians, animal handlers, travelers to endemic areas) can receive pre-exposure vaccination. The most effective prevention is mass dog vaccination. Vaccinating at least 70% of dogs stops transmission and has eliminated dog-mediated rabies in many developed countries.