NTDs: Rabies – nearly 100% fatal, but absolutely 100% preventable

This post is the 13th in a series highlighting the WHO’s list of 17 Neglected Tropical Diseases (now technically 18 as mycetoma was added to the list at the 69th World Health Assembly in May 2016). To read the previous posts in this series click here.

Rabies facts infographic from WHO

Rabies is classified as a Neglected Tropical Disease, although many folks in the global north probably don’t think of rabies as a common disease, nor a tropical one for that matter. In the global north rabies is most commonly linked with infected bats, skunks, raccoons, and maybe the occasional dog or cat; all of which rarely result in human infection.

In the global south on the other hand, rabies kills an estimated 59 000 people each year, 95% of whom live in Africa and Asia. Rabies is basically 100% fatal. I say “basically” because there have been very few cases where people have become symptomatic and survived their infection. However, these results have not been successfully replicated so, for all intents and purposes, human rabies is fatal.

Map of global presence of dog-transmitted rabies, 2010 - 2014. WHO.

According to the WHO, over 99% of human rabies deaths are caused by dogs transmitting the rabies virus to people. You may be wondering why it is that we in the global north don’t have such a big issue with human rabies infections, the answer is “vaccinating dogs and post-exposure prophylaxis”. Most global north countries have rabies vaccination requirements for domestic dogs, and even stray dogs who are caught and put in a shelter are frequently vaccinated before being adopted out. This is not always the case in the global south so mass vaccination campaigns aimed at vaccinating dogs against rabies is a major component of the WHO’s Global Framework for the Elimination of Rabies. The rational behind this is that rabies disproportionately affects poor rural communities, rabies is preventable yet continues to kill people, dog-mediated rabies can be prevented by vaccinating dogs, and rabies elimination is feasible. So focusing efforts on vaccinating dogs can have a major impact on human rabies transmission.

Post-exposure prophylaxis is the second half of the “solution” to preventing dog-mediated human rabies. Providing post-exposure prophylaxis before symptoms begin (ideally as soon as possible after exposure) can prevent rabies infection. However, post-exposure vaccination is incredibly expensive, even in the global north, making it almost impossible for people in the global south most impacted by rabies to afford vaccination. To help provide comprehensive rabies control programmes, including post-exposure prophylaxis, the WHO, FAO (Food and Agriculture Organization of the United Nations), Global Alliance for Rabies Control, OIE (World Organization for Animal Health) have partnered together.

Additionally, education is another component of combating rabies in affected areas. Many communications are aimed at children because the human rabies infection burden is highest in those 15 years and younger.

Poster teaching children how to behave around dogs to prevent being bitten. Courtesy WHO

Rabies may not pose a large threat to folks living in the global north, but the burden of disease is incredibly high in children living in poor, rural areas in Africa and Asia. Unlike many other of the NTDs I’ve covered, rabies is absolutely fatal. The near 100% fatality rate of rabies means that prevention becomes a crucial part of any rabies control programme. Luckily for humanity, rabies is also 100% preventable. The goal must be to expand rabies control programmes to all affected countries so kids don’t have to live in fear of getting rabies from dogs.

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