Rabies - Emergence - Your Guide to Transboundary & Emerging Diseases
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13
Total Reported Outbreaks
10
Total Affected Countries
7
Total Affected Species
Key Facts
Clinical Signs
Treatment and Management
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Rabies is one of the most lethal viruses on earth, with almost 60,000 people dying of this terrible disease every year. Almost half of these deaths are children, mostly in Africa and Asia. However, rabies is preventable and there is a global goal of achieving zero human dog-mediated rabies deaths by 2030.

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Rabies

Asia and Africa are the main regions affected by rabies in dogs, whilst wildlife may be affected in many parts of the world. Find out where the latest reported outbreaks are with this map.

Key Facts
Clinical Signs

Clinical signs in dogs with rabies include aggression/unusual behaviour, excessive salivation, and choking/gagging. In animals and humans the disease is 100% fatal once clinical signs/symptoms occur. As such rabies has one of the highest mortality rates of any disease.

Treatment

Prevention is the key to controlling and eliminating rabies, with dog vaccination the main tool. People that are bitten by a dog should take appropriate action to wash and clean the wound and seek medical attention.

Management

The disease is 100% preventable. In recent decades countries across Latin America and the Caribbean have made strides towards rabies elimination, and in November 2019, Mexico proved that human canine-mediated deaths can be eliminated when it became the first country in the world to obtain WHO validation for no human rabies deaths. Mexico achieved this by having a national rabies strategy based on mass dog vaccination, raising public awareness, and post-exposure prophylaxis. The cooperation of human and animal health sectors is important in achieving rabies elimination, and rabies is a good example of how a One Health approach can be very effective.

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Focus On…Dog Bites and How to Prevent Them
Latest Articles and Events
Knowledge Hub
Rabies Hero Prof. Anthony R. Fooks – work in pictures
Our latest Rabies Hero Award recipient, Professor Anthony R. Fooks, has a long history of commitment to rabies elimination globally, collaborating across regions and organisations. See here a fascinating account of some of his achievements in pictures. Prof. Anthony R. Fooks (left) and Dr David Hayman (right; presently at Massey University, New Zealand) undertaking wing, body and weight measurements of Eidolon helvum bats (Straw-coloured fruit bat) in Accra, Ghana. The purpose of this programme was to investigate the presence of rabies-related viruses, specifically Lagos bat virus, and other bat-borne viruses in Eidolon helvum bats and the risks posed to human health. This project was co-funded by the European Union FP7-funded Project: ANTIGONE; Anticipating the Global Onset of Pandemics Network-of-Excellence and the Research and Policy for Infectious Disease Dynamics (RAPIDD), Fogarty International USA. Prof. Anthony R. Fooks participating in the 1st OIE Global Conference on Biological Threat Reduction, Paris, France as an invited speaker. The first OIE Global Conference on Biological Threat Reduction was convened in close collaboration with WHO, to strengthen links between the human health, animal health and the security sector; promote international human and animal health frameworks as a key to reducing natural biological threats including dog-mediated human rabies; and develop a road map focused on enhancing and coordinating existing mechanisms for outreach and the strengthening of health systems. From left to right, Dr Ash Banyard (APHA, UK), Dr Karen Mansfield (APHA, UK), Prof. Anthony R. Fooks (APHA, UK), Dr Abdul Rahman (KVAFSU/CVA/Crucell Rabies Diagnostic Laboratory, Bangalore, India) and Dr Shrikrishna Isloor (KVAFSU/CVA/Crucell Rabies Diagnostic Laboratory, Bangalore, India) opening a training workshop on rabies diagnostic tests and quality management systems as part of an OIE-funded Twinning Project involving APHA-UK and CDC-USA providing international training and capability-building to the KVAFSU/CVA/Crucell Rabies Diagnostic Laboratory. In 2020, the World Assembly of Delegates of the OIE confirmed the designation of the KVAFSU-CVA Rabies Diagnostic Laboratory, Veterinary College, KVAFSU, Bangalore as an OIE Reference Laboratory for rabies with Dr Isloor as the designated expert. Prof. Anthony R. Fooks (hosted by Prof. Sarah Cleaveland, University of Glasgow, UK) discussing the rabies studies that were being undertaken to children in Tanzania as part of an educational engagement programme. Prof. Anthony R. Fooks (2nd from left) highlighting rabies as part of the educational outreach for World Rabies Day in 2009 by climbing Mount Snowdon, the highest mountain in Wales, at an elevation of 1,085 metres above sea level, and the highest point in the British Isles outside the Scottish Highlands. To go back to Rabies Heroes homepage and read more click here.
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The story of Rabies Hero Dr. Mashair Ismail
This month, our first Rabies Hero Award goes to a “local” recipient Dr. Mashair Ismail recognising her groundbreaking achievements in rabies control in Iraq. We spoke to Dr. Dan Horton, her long-term collaborator at the University of Surrey, to learn more about Dr. Ismail’s work and we are delighted to share this inspiring story: After the political turmoil in 2003, rabies became a major health threat in Iraq. Human fatalities resulting from dog bites appeared to be increasing, associated with a growth in the number of free-roaming, ownerless dogs. Therefore, it became crucial to understand the burden of disease and its epidemiology by implementing specific diagnostic laboratory testing, that was not previously available. This was extremely challenging in the circumstances: Dr. Ismail had to gather diagnostic samples during periods of unrest and access the relevant reagents and equipment. Then in 2011, Dr. Ismail sought further international training and collaboration, visiting the United Kingdom twice for training under her own initiative at the Animal and Plant Health Agency (APHA) and the University of Surrey. As a result, Dr. Ismail has been able to characterize the rabies viruses circulating in Iraq, first in the capital Baghdad and continued to include all other governorates in 2014. Her work has not only demonstrated the burden of disease but provided information vital to improve control efforts. Rabies Hero Award recipient Dr. Mashair Ismail in rabies laboratory Rabies Hero Award recipient Dr. Mashair Ismail presenting at a rabies meeting. Dr. Ismail’s work has been published here: Quantifying and mapping the burden of human and animal rabies in Iraq Rabies in Iraq: Trends in Human Cases 2001–2010 and Characterisation of Animal Rabies Strains from Baghdad To go back to Rabies Heroes homepage and read more click here. The views expressed in this article are those of the author(s) and do not necessarily represent those of MSD Animal Health.
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Rabies Hero Awards – Celebrating Saving Lives
The Rabies Hero Awards recognize those who make a difference in the fight against this disease. We want the world to hear about their amazing efforts to bring us closer to the rabies elimination goal.
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Focus on… Using Models to Help Control Infectious Disease
COVID-19 is not the first and won’t be the last zoonosis Tackling the human health consequences of diseases that originate in animals is not a new problem. Long before the global COVID-19 crisis, efforts were being made globally to fight zoonotic diseases. One of the oldest known zoonoses is rabies, which has a uniquely high mortality rate killing over 60,000 people every year. Although also caused by a virus, there are important differences between rabies and COVID-19: we know that dogs are the primary source of human rabies and therefore dog vaccination will eventually stop human cases (Fig 1.). It should therefore be possible to eliminate dog mediated rabies, and there is a global effort to do so by 2030, supported by WHO, FAO and OIE. The COVID-19 pandemic has the potential to derail these efforts in some areas, through diversion of resource or restrictions. However, there are some reasons to remain optimistic. One of these is that public awareness of the complexity of disease control methods has increased, which gives us the opportunity to build public trust in how, where and when we use models to help control diseases. Fig 1. Schematic depicting the role of domestic dogs in rabies transmission (shown by solid red lines) to other host species (other domestic animals, livestock and wildlife) which may become infected as a result of spill over transmission from dogs and act as routes of transmission of rabies virus to human communities at risk (dotted red line). “All models are wrong, but some are useful” This expression, coined by the statistician George Box, describes the complexities associated with modelling the approximate representation of the truth that is provided by imperfect data. Models are useful to infer things we don’t yet know about from the things we think we do (so called ‘parameters’). The mechanisms involved in dog rabies transmission, i.e. from infected dog to susceptible human, are well understood, however transmission interactions throughout the two populations are complex and the large scale dynamics which impact disease spread can be difficult to disentangle without mathematical modelling. For example, if we considered just two dogs living alongside one another, and one of those dogs was infected with rabies, we could relatively easily predict the likelihood of it infecting the other dog without models. However, when there are hundreds of dogs living across interconnected villages, where hundreds of potentially susceptible people are living, it soon becomes complicated (Fig 2.). Here, we can use modelling to work with these large datasets to complete these predictions. Examples of this approach have come into the public eye recently for COVID-19, where  governments across the world have relied on predictions from mathematical models to make decisions during the pandemic (Adam, 2020; Poletto et al., 2020). Fig 2. Schematic detailing the role that domestic dogs in rabies transmission through a dog and human population (susceptible = yellow, exposed = orange, infected = red, black = disease related death). How do we use models to help rabies control? One early example of applying mathematical models to rabies control comes from attempts to understand fox rabies in Europe, developed by Anderson and May (1981). This compartmental modelling approach helps to explain the dynamics involved in the spread of rabies virus in a fox population by allocating foxes into one of several virtual groups , and using equations to simulate the rates at which foxes ‘move’ between the compartments based on what was known about the animals, and the virus at the time- a so called ‘susceptible, exposed, infectious, recovered’ (SEIR) model.  These models were considered important in supporting vaccination of foxes, which is the pre-eminent worldwide example of successful control of an infectious disease in a wildlife population. Within the current all-important dog rabies control efforts, mathematical modelling has also contributed to policy development, and provided evidence to inform progress towards the “Zero by 30” strategic plan to end human deaths from dog-mediated rabies by 2030 (Hampson, 2020; Kleczkowski et al., 2019). The current World Health Organisation Technical Guidance specifically recognises the contribution of modelling in controversial and complex subjects such as the relative benefits of sterilisation of dogs in addition to vaccination, and accurately quantifying the burden of rabies where data are missing (World Health Organization, 2018). Despite rabies in people being 100% preventable, progress towards control is challenging due to, for example the lack of data available on dog demographics, lack of awareness to the risk, poor resource allocation and lack of consistent surveillance. With the support of my supervisors Dr Dan Horton, and Dr Joaquin Prada at the University of Surrey, UK, and in collaboration with Centre for Disease Control, Atlanta (CDC), and the Global Alliance for Rabies Control (GARC), we are applying a combination of modelling approaches, which capture disease dynamics and the economic impact of rabies control, to create a new tool to improve strategic risk management and resource allocation for rabies programmes. Establishing new approaches and adapting current strategies The COVID-19 pandemic has heightened public awareness to the importance of surveillance, vaccination access, and resource allocation. It is likely that COVID-19 will continue to impact efforts towards control and elimination of other diseases, including rabies, it is thus imperative to establish new approaches to rabies control, and adapt current ones. Considerations such as how to deliver dog vaccination while accommodating COVID-19 restrictions and planning for interruptions to current campaigns, become more important as the COVID-19 situation evolves. References Adam, D., 2020. Special report: The simulations driving the world’s response to COVID-19. Nature 580, 316–318. https://doi.org/10.1038/d41586-020-01003-6 Hampson, K., 2020. Zero human deaths from dog-mediated rabies by 2030: perspectives from quantitative and mathematical modelling. Gates Open Res 3. https://doi.org/10.12688/gatesopenres.13074.2 Kleczkowski, A., Hoyle, A., McMenemy, P., 2019. One model to rule them all? Modelling approaches across OneHealth for human, animal and plant epidemics. Philosophical Transactions of the Royal Society B: Biological Sciences 374, 20180255. https://doi.org/10.1098/rstb.2018.0255 Poletto, C., Scarpino, S.V., Volz, E.M., 2020. Applications of predictive modelling early in the COVID-19 epidemic. The Lancet Digital Health 2, e498–e499. https://doi.org/10.1016/S2589-7500(20)30196-5 World Health Organization (Ed.), 2018. WHO Expert Consultation on Rabies: third report, WHO technical report series. World Health Organization, Geneva, Switzerland. The views expressed in this article are those of the author(s) and do not necessarily represent those of MSD Animal Health.
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Change can be challenging, but together, as a community, we can support each other and reach our goal of One Health One Welfare.
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Podcast Episode 2 - 2021 - The One About Paraprofessionals
A discussion with Mr Benson Ameda about the role of paraprofessionals for animal health in Africa. Acronyms: OIE: World Organisation for Animal Health SDG: Sustainable Development Goals
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Rabies Hero Dr. Charles E. Rupprecht - work in pictures
Here's an impression of some of the activities of our latest Rabies Hero Award recipient, Dr. Charles E. Rupprecht in India, the United states and Taiwan. Dr. Charles E. Rupprecht - investigating a rabid dog bite to a child in a local neighborhood, India. Dr. Charles E. Rupprecht - oral vaccination of free-ranging dogs, Navajo Nation reservation in Arizona. Dr. Charles E. Rupprecht conducting a necropsy with colleagues on a rabid ferret badger, Taiwan. Read more about the Rabies Heroes here.
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Rabies Hero Dr. Beatriz Quiambao – work in pictures
Have a look at some of the work of our latest Rabies Hero Award recipient, Dr. Beatriz Quiambao, in the form of photos, such as training, field work, dog vaccination, research collaboration and international meetings she engaged in. AnimalBite training Rabies lab diagnosis Dog vaccination campaign Dog transport vehicle Signing of research collaboration for the JAPOHR project Field activity Field activity Field activity Waiting area for animal bite clinic WHO rabies expert panel Asian Rabies Advisory group of experts Read more about the Rabies Heroes here.
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