Rabies is a vaccine-preventable viral zoonotic disease responsible for an estimated 59, 000 human deaths every year. The majority of cases occur in Africa and Asia, and more than 40% of cases occur in children less than 15 years of age. Dogs are responsible for over 95% of all rabies transmissions to humans.
Rabies prevention involves two main, non-exclusive strategies: (i) dog vaccination to interrupt virus transmission to humans; and (ii) human vaccination i.e. post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) using purified cell-culture and embryonated egg-based vaccines (CCEEVs).
PEP is administered promptly following exposure to rabies, and consists of timely, rigorous wound care, administration of rabies immunoglobulin (RIG) in severe exposures, and a series of intradermal (ID) or intramuscular (IM) rabies vaccines. Long, complicated PEP regimens and the high cost, low availability, uncertain quality and short shelf life of RIG are barriers to PEP implementation.
PrEP is indicated for individuals who face occupational and/or travel-related exposure to rabies virus in specific settings or over an extended period. PrEP consists of a series of rabies vaccines, followed by booster vaccinations in case of exposure.
Gaps exist between the current WHO recommendations and the present practice of PrEP and PEP administration in many rabies-endemic countries. This update addresses this mismatch using new evidence on rabies vaccine and RIG use, including: (i) shorter, more feasible PrEP and PEP protocols; (ii) cost-effectiveness of implementation; and (iii) the potential of new vaccines to improve access to care.
- SAGE background document