"Overview of Rabies

Epidemiology, prevention

and control worldwide"

WHO-MZCP/OIE Intercountry Expert

Workshop on "Protecting Humans from

Domestic and Wildlife Rabies in the

Middle East"

23-25 June 2008, Amman, Jordan

By F.-X. Meslin, World Health

Organization, Geneva

Large variety of reservoir species

rabies cannot be eradicated

Genotypes and geographic distribution

RABIES

RABIES

RABIES

RABIES

RABIES

DUVENHAGE

LAGOS BAT

MOKOLA

ABLV

EBLV-1

EBLV-2

RABIES

RABIES

RABIES

RABIESRABIES

C.ASIANC.ASIAN

Rabies – excluding

bat rabies - 2005

USA: total number of

animal cases - 2005

USA: animal host

compartments - 2005

Bat rabies has emerged as a public

health risk in the USA:

from 1980 to 2002, 29

indigenous cases of human rabies

cases were reported in the USA -

90% of those were caused by bat

rabies virus strains.

USA: bat rabies - 2005

Rabies in CanadaIn spite of large numbers of cases of animal rabies in Canada, human

rabies is rare. From 1945 to 2000 only 22 cases were reported for the

whole of Canada. Last case March 2, 2007 in Alberta.

Rabies control: fox-rabies

dropped to 34 cases in

2005 from 1500 before

1989 – 1 raccoon rabies

case from 45 in 2001.

Raccoon rabies

epidemic -

Rabies in the USA and Canada

� Genotype 1 viruses including in bats.

� Many terrestrial species involved in well delimited compartments.

� Bats rabies reported in almost all US States and Canadian provinces.

� Small number of human cases per year. Half of more of them during the past ten years associated with exposure to bats.

� Costs of rabies prevention and control is estimated at $300 million per year in the USA.

Total numbers of rabies cases in dogs

and humans, Latin America, 1982 to

2005

0

50

100

150

200

250

300

350

400

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

0

5000

10000

15000

20000

25000

Human cases Dog cases Dog cases Linear (Human cases Dog cases)

Fonte: SIRVERA, OPAS, 2006

7.1 7.5

9.1 9.39.7

10.6 10.9 11.1

12.613.3

13.7

14.9

15.9 16.2

14.5

29

76105

1600

1382

3049

2106

2253

1387

852

523

335 317244

117

0

2

4

6

8

10

12

14

16

18

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

0

500

1000

1500

2000

2500

3000

3500Vaccinateddogs

(Millions)

Rabies cases in dogs

Tendencia de la RabiaCases of rabies in dogs and number ofvaccinated dogs in Mexico

1990 – 2004

Countries with human rabies cases following dog

bites – latin America 2003

Human/dog rabies in 6

(28.6%) out of 21 countries of

Latin America

Rabies in

wildlife

particularly in

bats has

emerged as a

public health

risk

63%

18%

4%

15%Cães

Animais

Silvestres

Outros

Não

identificados

In 2004 for the first time the number of human cases following contact with wild animals exceeded the number of cases due to dog bites.

Changes in epidemiological situation – Latin America

17%

81%

2%

Cães

AnimaisSilvestres

NãoIdentificados

19951995 20052005

Rabies in Latin America

� All viruses including those originating from bats belong to genotype 1

� Dog and dog mediated human rabies are being brought under control after 20 years of PAHO/WHO coordinated activities in Latin America

� Dog immunization has been the main focus of the international control programme

� Wildlife rabies is emerging as a public health problem: more than half the human cases reported in 2004 were due to contact with wildlife especially vampire bats in Brazil and Peru.

1717

Epidemiological situation of Wildlife rabies in Epidemiological situation of Wildlife rabies in

EurasiaEurasia

Western Europe: Western Europe: startingstarting

wavewave in 1938in 1938

EpizooticEpizootic fox fox rabiesrabies

wavewave fromfrom 1938 to 1938 to

19891989

European Countries eliminated dog rabies

during first half of 20th century

1978 1980 1982 1984 1986 1988 1990 1992 1994 1996

The Netherlands

Switzerland

Slovenia

Luxembourg

Italy

Hungary

Finland

Belgium

Croatia

Austria

Slovak Republic

France

Czech Republic

Poland

Germany

Number of rabies vaccine baits (in million) applied in Europe

20

12

8

4

16

WHO/EMC/ZDI/KS 6/8/98

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

1978 1980 1982 1984 1986 1988 1990 1992 1994 1996

Italy

Finland

Luxembourg

The Netherlands

Switzerland

Belgium

Czech.

Austria

France

Germany

Number of rabies cases in animals in European countries

where oral immunization of foxes against rabies has been

conducted

2020

Wildlife rabies in Europe Wildlife rabies in Europe -- 20062006

Rabies in raccoon dogs(Nyctereutes procyonoides),Europe

IRaccoon dogs are the second most important wildlife species infected with rabies:

Number of raccoon dog Number of raccoon dog Number of raccoon dog Number of raccoon dog rabies cases per year in rabies cases per year in rabies cases per year in rabies cases per year in Europe 1990Europe 1990Europe 1990Europe 1990----2002,2002,2002,2002,total number: 4,555 casestotal number: 4,555 casestotal number: 4,555 casestotal number: 4,555 cases

Bats rabies in Europe: 2002-2006

Rabies in Europe

� Viruses circulating in carnivora belong to genotype 1

and to genotypes 5 & 6 in bats and new genotypes (8

etc..) are identified in Central Asia

� Domestic and Wild carnivora rabies has been brought

under control in most of Western Continental Europe

through WHO and EU coordinated activities

� The main tool has been the oral vaccination of foxes

� Autochthonous bat rabies and imported rabies is

posing a new public health threat in western Europe

where terrestrial rabies has been eliminated.

Animal rabies cases by country 2003

The first confirmed outbreak of

rabies in Africa, believed to have

followed the importation of an

infected dog from England in 1892,

occurred in the eastern Cape

Province of South Africa, and was

brought under control in 1894

Different genotypesGenotype, geographical distribution, reservoir speciesGenotype, geographical distribution, reservoir species

An increasing incidence of reported rabid bite injuries in

Tanzania

Bites from suspected rabid dogs

per million, 2001-2004

Large scale spread Large scale spread

across Tanzania from across Tanzania from

2000 to 20042000 to 2004

Cattle deaths

25.1312.34

Average

incidence*

0.006.16072006

0.009.020102005

22.5637.0310402004

100.689.5043102003

2.430.00102002

PastoralAgropastoralPastoralAgropastoralYear

Incidence/100,000 cattleCattle deaths

Rabies in Africa

� Circulating viruses belong to genotype1as well as genotypes 2, 4 (in bats) and 3 (reservoir unknown)

� Dog rabies remains the main problem

� Incidence of the disease in humans and animals is underestimated in most parts (except north Africa and Southern tip)

� Little animal rabies control activities ongoing

� Quantities of human rabies vaccines used are sub-optimal

Rabies is

maintained and

transmitted by

dogs in Asia ABLV

Rab

ies: a disease o

f child

ho

od

Rab

ies a disease

of ru

ral & p

oor

com

munities)

•Ch

ildren

aged

less than

15

years are

inv

olv

ed in

40

% o

f the cases

0

10

20

30

40

50

60

70

Et hio pia ( 8) a

N ige ria (1 6) a

La tin Americ a ( 17 ) a

Am e ricas (1 8) a

P aki stan (10 ) d

P aki stan (19 ) d

B ang aldesh (11 ) d

In dia (20) d

In dia (21) d

In dia (22) d

M yan mar (23) d

S ri L anka (2 4) e

Th ail and (9) c

Th ailan d (25 ) b

C ambo dia (26) a

C am bodia (27) d

C hina ( 28) e

P hilippi nes ( 29) d

Vietn am (30 ) d

0 10

20

30

40

50

60

70

PAKISTAN

IND

IA

THAILAND

CAMBODIA

CHINA

Rabies in Asia

� Viruses belong to genotype 1 with the exception of ABLV (genotype 7) found in bats

� Dog rabies is the main problem in Asia and bat rabies is only reported in Australia

� Some dog rabies control activities ongoing in most countries although none has freed itself of rabies during the past 35-40 years.

� Large number of PEP are administered using both imported and locally manufactured human vaccines.

� Rabies has re-emerged as a public health problem in some Asian countries.

Year

010002000300040005000600070008000

50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 年

No of cases

发病数死亡数casesdeaths

Incidence of human dog-mediated rabies in China by Region and by Year (1950-2004)

Lack of dog rabies control: human rabies

re-emerging in China

690.0650.0

362.9 401.7466.9

567.0

652.6709.9

728.7 741.6

696.5

767.7

796.1

791.2

0.52

0.103 0.106

0.65

0.56

0.19

0.15

0.1 0.08

0.71

0.35

0.060.075

0.037

0

100

200

300

400

500

600

700

800

900

Va

ccin

ate

d

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

De

ath

Vaccinated Death

Incidence of human dog-mediated rabies in Viet Nam by Region and by Year (1992-2003)

2005

Lack of dog rabies control: human rabies re-emerging in Vietnam

1997

2003

2004

Rabies spreading in Indonesia

Worldwide more Worldwide more

than 98 % of the than 98 % of the

human rabies human rabies

deaths follow deaths follow

exposure to a exposure to a

rabid dog!rabid dog!

animal (genotype 1) rabies

Countries/areas free of genotype 1 animal rabies Countries/areas free of genotype 1 animal rabies

If rabies is present on all continents the

burden of human rabies is not.

23,700

31,500

Urban

17%

Rural

83%

Estimated Annual Human Rabies Deaths in Africa Estimated Annual Human Rabies Deaths in Africa

and Asiaand Asia

Knobel et al., Bulletin

WHO, 83: 360-368,2005

India: ~ 19,000

China: ~ 2,500

Thank you for your attention