Neglected tropical diseases

WHO Expert Consultation on Rabies re-evaluates the burden and methods of treatment

Greater political support, increased awareness and enhanced country-level capacity crucial to eliminating human rabies transmitted by dogs
05 July 2013 | Geneva
© Larkvi
© Larkvi

The second report of a WHO Expert Consultation on Rabies calls for strong, effective and inter-sectoral collaboration to progress the elimination of rabies at all levels. Human rabies transmitted by dogs accounts for more than 95% of the estimated number of rabies deaths globally.

According to the report (WHO Technical Report Series, No. 982 [pdf 3.7Mb]) about 60000 people, mostly children, die from human dog-mediated rabies every year mostly in Africa and Asia. This poses a significant health and economic burden and incurs the annual use of 70 million doses of human rabies vaccines in an estimated 20 million people, mostly in developing countries.

The societal cost of rabies worldwide is a lot more, maybe in excess of US$ 6 billion per year” said Dr Bernadette Abela-Ridder, Team Leader, Neglected Zoonotic Diseases, WHO Department of Control of Neglected Tropical Diseases. “It includes an estimated US$ 1.6 billion spent on post-exposure prophylaxis.

Statistics show that the majority of human rabies deaths occur in poor, rural communities without dog bite management centres with access to PEP and rabies biologicals.

The TRS recommends that efforts to advocate for prevention of human rabies should be sustained through elimination of the disease in dogs and in promoting wider use of intradermal PEP, which reduces the volume and cost of cell-cultured vaccine by an estimated 60–80%. Effective measures to prevent the disease are available in its major animal host – the dog – but are often not implemented.

At present, under-reporting remains a main obstacle to assessing the incidence of the disease. Under-reporting also prevents mobilization of resources and undermines implementation of control and prevention measures, such as dog vaccination.

The WHO Technical Report Series (TRS No. 982) presents progress made in tools and current strategies forrabies with a focus on human dog-mediated rabies, which include:

  • new recommendations for pre- and post-exposure prophylaxis and management of rabid patients;
  • design and implementation of comprehensive dog and wildlife rabies control programmes;
  • the health and economic burden of the disease;
  • classification of rabies and other lyssaviruses;
  • laboratory diagnosis of rabies in humans and animals;

Other novel approaches relating to applied research on the health economics of dog vaccination for human rabies prevention, and the sustainability and cost-effectiveness of such programmes in various cultural, ecological and economic settings are also examined. Consideration is given to the potential for integrating dog rabies control with other dog-borne zoonoses such as echinococcosis and Leishmaniases.

National rabies control programmes would need to involve at a minimum the animal and public health sectors but also others such as the education sector, local government, police and civil society, animal welfare and conservation associations.

Elimination of rabies is technically feasible through dog immunization campaigns that achieve 70% coverage combined with humane dog population management, effective surveillance and coordinating disease control efforts across national and regional borders.

Key to attaining the elimination goal will be building awareness and securing political commitment to implement and disseminate available tools.

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