Recently the World Health Organization (WHO) updated the fact sheet on Rabies.

Key Messages:

Rabies is an infectious disease caused by a virus.

It is almost always fatal after a person/ animal begins manifesting features (clinical signs) of the disease.

Human rabies is almost entirely (more than 99%) the result of virus transmission by domestic dogs.

The virus is transmitted by bites, scratches and saliva of rabid animals.

40% of people who are bitten by suspect rabid animals are children under 15 years of age.

More than 95% of human deaths occur in Asia and Africa, in remote rural communities where the most frequent victims are children between 5 and 14 years age.

Rabies can be prevented by vaccination.

Vaccination of dogs can help eliminate the disease. It is the most cost-effective strategy for preventing rabies in people.

When someone receives Anti-Rabies Vaccine (ARV) before exposure (bite/ lick/ scratch) to a rabid animal, it is termed Pre-Exposure Immunization.

When someone receives ARV after exposure (bite/lick/scratch) to a suspect rabid animal, it is included under Post-Exposure Prophylaxis (PEP).

The average cost of rabies post-exposure prophylaxis (PEP) can be the cost of catastrophic expenses for poor populations, since a course of PEP can cost US$ 40 in Africa and US$ 49 in Asia, where the average daily income is about US$ 1–2 per person.

“Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis (PEP) means the treatment of a bite victim that is started immediately after exposure to rabies in order to prevent rabies infection. This consists of:

• local treatment of the wound, initiated as soon as possible after exposure;
• a course of potent and effective rabies vaccine that meets WHO standards; and
• the administration of rabies immunoglobulin, if indicated.

Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.

Local treatment of the wound

This involves first-aid of the wound that includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

Recommended PEP

Depending on the severity of the contact administering with the suspected rabid animal, administration of PEP is recommended as follows (see table):

Table: Categories of contact and recommended post-exposure prophylaxis (PEP)
Categories of contact with suspect rabid animal	Post-exposure prophylaxis measures
Category I – touching or feeding animals, licks on intact skin	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, contacts with bats.	Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

All category II and III exposures assessed as carrying a risk of developing rabies require PEP. This risk is increased if:

• the biting mammal is a known rabies reservoir or vector species;
• the animal looks sick or displays an abnormal behaviour;
• a wound or mucous membrane was contaminated by the animal’s saliva;
• the bite was unprovoked; and
• the animal has not been vaccinated.

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

Useful Link:

Link to the updated factsheet:

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