Five Things to Know About Rabies

Nearly 60,000 people a year die from rabies around the world. The cause is almost always a bite by a rabid dog. Most of the deaths are in Africa and Asia. In Western Europe, the United States and other countries, the rabies variant that lives in populations of dogs has been eradicated, but people can still catch rabies from skunks, raccoons, bats and other animals.

Bats are now the most common cause of rabies in the United States, but less than one percent of bats have rabies, and their contact with humans is infrequent. Only one to three people die each year from rabies in the United States.

As a major public health problem rabies doesn’t measure up to other threats, like flu. It’s also relatively slight compared with other dangers posed by animal: Many more people — an estimated 40 in 2018 — die from dog attacks that have nothing to do with rabies.

The danger posed by rabies is greatest in poor regions of the world with large populations of free-roaming, unvaccinated dogs. Death by rabies is agonizing, and once symptoms appear, almost 100 percent certain.

The disease is caused by a virus, a bullet-shaped microscopic infectious agent that contains genetic material. In the case of rabies, that material is RNA, not DNA. Any rabies virus, and there are several variants, can cause the disease in any mammal. Common variants of the disease can establish themselves permanently in populations of dogs, bats, raccoons and other animals.

The virus is usually transmitted by the saliva of an infected animal through a bite. It then travels only through nerve tissue to the brain, and to salivary glands. Once it arrives at the brain it can cause convulsions, avoidance of water, excessive salivation and other symptoms. Eventually the brain infection causes coma and death.

No. Rabies in humans is considered completely preventable if the vaccine is administered after a bite but before symptoms appear. The vaccine can be administered protectively, for people who are handling animals where rabies is common, for example. But a series of shots after a bite will also stop the virus in its tracks.

Vaccination of humans after a bite is necessary if possible, but expensive and puts a drain on medical resources. Preventive vaccination of large populations of people is not feasible in terms of expense, discomfort, logistics and the small risk associated with vaccination.

But experts have shown that annual vaccinations of dogs can eliminate canine rabies, thus stopping almost all human rabies cases. Dog vaccination has eliminated rabies as a major public health problem in numerous countries.

The World Health Organization has set a goal to reach zero human deaths from canine rabies by 2030. That is not the same as, for example, eliminating the smallpox virus, which involved complete eradication.

It would mean eliminating most canine rabies by vaccinating dogs in combination with providing post-bite treatment. That in itself is a huge challenge.

But the rabies virus and lyssaviruses, which are closely related, live in a number of wild animal populations. There is no plan to attempt eliminating all these viruses.

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