World Rabies Day 2009

Monday 28 September is World Rabies Day – a global initiative led by the Alliance for Rabies Control to raise awareness and understanding about the importance of rabies prevention worldwide. The Alliance for Rabies Control was formed in 2006, and the World Rabies Day initiative now involves human and animal health partners at the international, national, and local levels, veterinary and medical organizations, and other partners.
The primary message of World Rabies Day is that rabies is a preventable disease, and yet kills 55,000 people needlessly each year, of whom half are children under the age of 15 [1].

Rabies is transmitted to humans mainly by bites, but exposure may also occur through contamination of broken skin or mucous membranes with saliva from an infected animal or bat. Infection with rabies virus causes an acute nervous system disease; encephalomyelitis. It is a fatal condition but it is preventable by vaccination. In many countries rabies is primarily a disease of children, who are particularly at risk due to their close contact with dogs, the major global source. This is because children are more likely to suffer multiple bites and scratches to the face and head, both of which carry a higher risk of contracting rabies. In addition children are often unaware of the danger that dogs transmit rabies and may not tell their parents when a bite, lick, or scratch has occurred from an infected animal.

Since virtually all human rabies is caused by dog bites, vaccination of canine populations has proved extremely successful in reducing its incidence in humans. In Mexico, for example, a 92% reduction in the prevalence of canine rabies due to vaccination was accompanied by an 82% reduction in the number of reported human deaths from the infection [2]. And in India, following a “catch-spay-vaccinate and release” programme for the street dog popula tion in Chennai, for the first time since records began there have been no human rabies deaths for over a year [3].

For the UK population the key public health issue is for those who may be at risk because of their work (see below) or as a result of travelling to countries where rabies is circulating in animals. Travellers should stay away from stray or unattended animals and, if bitten in a country where rabies is present, wash the wound immediately and seek medical advice; if a person has not had treatment in that country they should still seek medical advice immediately on return, even if the bite was weeks before.

The UK has been free of indigenous classical animal rabies for over a century but occasional cases have occurred in quarantined animals creating a hazard that warrants vaccination of those working with imported animals. The last UK case of indigenously acquired classical rabies in a human was in 1902. Cases occurring since then have all been acquired abroad, usually through dog bites. European Bat Lyssavirus 2 (EBLV2), a rabies-like virus, has been isolated in bats in the UK, and in 2002 a man who was a licensed bat handler died in Scotland from infection with EBLV2 [3]. The Department of Health recommends that those who regularly handle bats, whether a licensed bat handler or not, should be vaccinated against rabies as a precaution. In addition individuals who are bitten or scratched by a bat within the UK should seek medical attention as soon as possible to determine whether they need post-exposure prophylaxis (PEP).

Further information

About PEP: see Chapter 27, Immunisation against infectious disease ("The Green Book") at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1216022456494).
Expert advice and supply of vaccine and immunoglobulin: from the HPA Centre for Infections (tel: 020 8200 4400).
About World Rabies Day: at the official web site www.worldrabiesday.org and in the Alliance for Rabies Control's September 2009 newsletter http://www.rabiescontrol.net/ARCnewsletter14.pdf

References

1. WHO. Human and Animal Rabies, Rabies: A neglected zoonotic disease. Available at: http://www.who.int/rabies/en/ [accessed on 24 September, 2009].
2. Fooks T and Harkess G. Rabies – a “one health approach”, Health Protection Matters, Spring 2008 (number 10), Health Protection Agency. Available at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1208245975751?p=1158945066420
3. The Newsletter of the Alliance for Rabies Control, September 2009. http://www.rabiescontrol.net/ARCnewsletter14.pdf
4. Fooks AR, McElhinney LM, Pounder DJ, Finnegan CJ, Mansfield K, Johnson N, et al. Case report: isolation of a European bat lyssavirus type 2a from a fatal human case of rabies encephalitis. J Med Virol 2003; 71(2): 281-9.

Last reviewed: 1 February 2010