Rabies | Bavarian Nordic

Every year rabies causes 59,000 deaths worldwide¹

What is Rabies?

A vaccine-preventable zoonotic viral disease caused by Rabies lyssavirus – a neurotropic virus of the Rhabdoviridae family²
Widespread disease occurring in more than 150 countries and territories, mainly in Asia and Africa¹

Rabies is still present and almost always fatal if left untreated.^1,4

Did You Know?

Rabies causes 59,000 deaths annually but can be prevented through vaccination^1,4

Vaccination

70% of rabies cases acquired in the US are attributed to bat exposure³

Preventing rabies

Rabies pre-exposure prophylaxis (PrEP) can provide protection before exposure to rabies²

PrEP and PEP

Post-exposure prophylaxis (PEP) aims to stop the onset of rabies after exposure to the virus^2,4

PrEP and PEP

Untreated rabies is almost always fatal but 100% vaccine-preventable^4,5

How is Rabies Transmitted?

Rabies is transmitted in the saliva of rabid animals and generally enters the body when individuals are exposed to virus-laden saliva via scratches or bites⁴

Animals that Transmit Rabies

Globally, 99% of human rabies deaths are caused by dogs.⁴

In the Americas, bats are now the major source of human rabies deaths as dog-mediated transmission has mostly been eliminated in this region⁴
Other common carriers include Racoon, Monkey, Fox, Mongoose and Cat²

Common Carriers

Dog

Raccoon

Cat

Fox

Monkey

Bat

Mongoose

Skunk

Rabies in the US

Wild animals accounted for 92.7% of reported cases of rabies in the US in 2018⁷

Who is at Risk?

Veterinarians, animal handlers, wildlife officers in areas where animal rabies is enzootic, certain laboratory workers, and persons spending time in foreign countries where rabies is endemic are at higher risk of rabies exposure.⁸

Pre-exposure vaccination should be offered to persons in high-risk groups and whose activities bring them into contact with potentially rabid dogs, cats, foxes, skunks, bats, or other species at risk of having rabies.⁸

International travelers might be candidates for pre-exposure vaccination if they are likely to come in contact with animals in areas where dog rabies is enzootic and immediate access to appropriate medical care, including biologics, might be limited.⁸

Finally, immunization should also be considered for children living in, or visiting remote areas with a high rabies exposure. As they play with animals, they may receive more severe bites, or may not report bites.^4,9

Rabies pre-exposure prophylaxis guide¹⁰

Risk Category	Nature of Risk	Typical Population	Pre-exposure Recommendations
Continuous	Virus present continuously Specific exposures likely to go unrecognized	Rabies research laboratory workers Rabies biologics production workers	Primary course. Serologic testing every 6 months; booster vaccination if antibody titer is below acceptable level.
Frequent	Exposure usually episodic, with source recognized, but exposure also might be unrecognized	Rabies diagnostic lab workers Spelunkers Veterinarians and staff Animal-control and wildlife workers in rabies-enzootic areas Persons who frequently handle bats	Primary course. Serologic testing every 2 years; booster vaccination if antibody titer is below acceptable level.
Infrequent	Exposure nearly always episodic with source recognized	Veterinarians and terrestrial animal-control workers in areas where rabies is uncommon to rare. Veterinary students Travelers visiting areas where rabies is enzootic and immediate access to appropriate medical care including biologics is limited	Primary course. No serologic testing or booster vaccination.
Rare	Exposure always episodic with source recognized	U.S. residents, including persons living in rabies-epizootic areas.	No vaccination necessary.

Adapted from: https://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html

Clinical Manifestations of Rabies

Infection with this neurotropic virus results in neurological and psychological manifestations⁴
The incubation period is usually 2–3 months, but can vary from 1 week to 1 year depending upon factors such as the location of virus entry and viral load⁴
Initial symptoms include a fever with pain and unusual or unexplained tingling, pricking, or paraesthesia at the wound site⁴
As the virus spreads to the central nervous system, there is paralysis and coma, and finally death⁴

Furious rabies⁴	Paralytic rabies⁴
~80% of rabies cases	~20% of rabies cases
Characterised by signs of CNS irritation: Hyperactivity Excitable behaviour Hydrophobia Aerophobia	Characterised by weakness and paralysis: Often misdiagnosed, leading to disease under-reporting
Rapidly progressing disease, with death due to cardio-respiratory arrest	Slower disease progression

Furious rabies⁴

Paralytic rabies⁴

~80% of rabies cases

~20% of rabies cases

Characterised by signs of CNS irritation:

Hyperactivity
Excitable behaviour
Hydrophobia
Aerophobia

Characterised by weakness and paralysis:

Often misdiagnosed, leading to disease under-reporting

Rapidly progressing disease, with death due to cardio-respiratory arrest

Slower disease progression

Rabies vaccination before a potential exposure primes the immune response so treatment after a suspected exposure can be effective more quickly. Pre-exposure vaccination also reduces the number of vaccinations and simplifies treatment, should an exposure occur.¹⁰

View References

World Health Organization (WHO). Rabies: Epidemiology and burden of disease. Accessed March, 2024. https://www.who.int/teams/control-of-neglected-tropical-diseases/rabies/epidemiology-and-burden.
Plotkin S, Orenstein W, Offit P, Edwards K. Rabies. Plotkin’s Vaccines. 7^th Ed. Elsevier. 2018.p925
Center for Disease Control and Prevention (CDC). Rabies in the US. Accessed March, 2024. https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html.
World Health Organization (WHO). Rabies factsheet. Accessed March, 2024.https://www.who.int/news-room/fact-sheets/detail/rabies.
World Health Organization (WHO). Vaccinating against rabies to save lives. Accessed March, 2024. https://www.who.int/activities/vaccinating-against-rabies-to-save-lives.
World Health Organization (WHO). Wkly Epidemiol Rec 2018;93:201–20.
Ma X, et al. Rabies surveillance in the US during 2018. J Am Vet Med Assoc. 2020;256:195–208. https://avmajournals.avma.org/view/journals/javma/256/2/javma.256.2.195.xml
Manning SE, et al. MMWR Recomm Rep 2008;57(RR-3):1–28. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm
Centers for Disease Control and Prevention (CDC): Rabies prevention. Accessed March, 2024. https://www.cdc.gov/rabies/prevention/people.html.
Center for Disease Control and Prevention (CDC). Pre-exposure vaccinations. Accessed March, 2024. https://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html.
Based on World Health Organization (WHO). Distribution of risk levels for humans contacting rabies, 2018. Accessed March, 2024. https://www.who.int/ith/rabies2018.png?ua=1.