Rabies is the world’s deadliest zoonotic disease. Over 99 percent of human rabies cases are transmitted from dogs to humans via dog bites, posing a significant global health challenge (World Health Organisation, 2024a). It is prevalent across all continents except Antarctica, with Asia and Africa experiencing the highest burden. In these regions, dog-mediated rabies leads to tens of thousands of human deaths annually. Shockingly, India alone accounts for 35 percent of global human rabies fatalities (Hampson et al., 2015).
While statistically someone dies from rabies at least every nine minutes, the true impact of rabies is likely much greater than reported statistics suggest. For instance, a comprehensive study in Tanzania revealed that the actual number of rabies-related deaths was 100 times higher than official records indicated (Cleaveland et al., 2002). Similarly, in Haiti, it was discovered that only 10 percent of people bitten by rabid dogs sought hospital care (Wallace et al., 2017).
WHO has set an ambitious goal to eliminate human deaths from dog-mediated rabies by 2030
The World Health Organization (WHO) has classified rabies as a neglected tropical disease (NTD). In collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), WHO has set an ambitious goal to eliminate human deaths from dog-mediated rabies by 2030.
Over two-thirds of human rabies cases are in children under the age of 15 (World Health Organisation, 2024b). Children are particularly vulnerable, as they are less likely to recognise the signs of rabies in dogs and, in many high-risk countries, are more likely to interact with or care for these animals.
Rabies is transmitted through direct contact with the saliva of an infected animal, typically via a bite or scratch, or when the virus comes into contact with an open wound or mucous membranes.
Once the virus enters the body, it attaches to a nerve cell at the site of infection and travels along peripheral nerves to the central nervous system, progressing at a rate of up to 100 millimetres per day. Tragically, if post-exposure prophylaxis is not sought by a victim of a rabid dog bite, and if clinical symptoms manifest, the virus has already infiltrated much of the central nervous system, rendering the disease almost invariably fatal. There is no cure at this stage and death is inevitable.
Spotting the signs of rabies
Rabies manifests in two distinct forms: furious and paralytic.
Furious rabies in dogs
The furious form of the disease is the more commonly recognised and can be identified by the following symptoms in dogs:
- Restlessness: a noticeable increase in agitation and inability to remain calm
- Change in bark: an unusual alteration in the dog’s vocalisations, often becoming hoarse or altered in pitch
- Heightened sensitivity: dogs may become overly sensitive to sounds and movements around them
- Uncontrollable aggression: sudden and irrational aggression, often without provocation
- Throat paralysis or hanging jaw: difficulty in swallowing or a visible drooping of the jaw
- Excess saliva: an accumulation of saliva due to the inability to swallow, leading to the characteristic foaming at the mouth
Paralytic rabies in dogs
The paralytic form of rabies, also known as dumb rabies, presents differently:
- Increasing muscle weakness: a gradual loss of strength, beginning in the limbs
- Lethargy: noticeable fatigue and lack of energy, even during normally stimulating activities
- Ataxia: a loss of coordination, leading to staggering or difficulty walking
- Gradual paralysis: progressive paralysis, which eventually affects the entire body
For both humans and dogs, the onset of symptoms signals a grim prognosis. Once rabies symptoms appear, there is no effective treatment. The disease rapidly progresses, leading to coma and, typically, death within 10 days.
Stopping the spread of rabies
Vaccination
In regions where rabies poses the greatest threat, the human vaccine is often prohibitively expensive and inaccessible to those who need it most. Therefore, the most effective strategy is to focus on canine vaccination.
By preventing dogs from contracting the disease, we can also prevent it from spreading to humans. This not only halts the transmission of rabies but also reduces the fear and stigma associated with dogs, which in turn lowers the risk of unnecessary culls and mistreatment.
Canine vaccination is also a far more cost-effective solution. For the price of vaccinating a single person after a bite, approximately 42 dogs can be vaccinated, making it a significantly more efficient use of resources.
Achieving at least 70 percent vaccination coverage in canine populations within rabies-endemic areas creates herd immunity. By achieving this level of coverage, we can ensure that dogs do not contract rabies, stopping them transmitting it to humans, and effectively stopping the disease in its tracks. We employ a variety of methods to reach this goal, including mass vaccination drives, door-to-door campaigns and setting up static point clinics.
For the price of vaccinating a single person after a bite, approximately 42 dogs can be vaccinated, making it a significantly more efficient use of resources
Through collaboration with global partners, we are building capacity to enable the vaccination of 1 million dogs a year in rabies-endemic areas, working to eliminate the disease across 19 project sites in 12 different countries.
Education
While canine vaccination is the cornerstone of prevention, education remains critical until the disease is fully eradicated. Teaching people, especially children, how to recognise the signs of rabies and what to do if they are bitten is essential for saving lives.
Children are particularly vulnerable to rabies, so we work closely with governments to integrate our rabies education materials into school curricula. Our goal is to ensure that as many children as possible receive these lifesaving lessons.
Teaching people, especially children, how to recognise the signs of rabies and what to do if they are bitten is essential for saving lives
Key lessons for children include:
- How to identify a dog that may have rabies
- The importance of not disturbing dogs that are eating or sleeping
- What actions to take if a dog growls or shows signs of aggression
- What to do if they or someone they know is bitten by a dog
Through our international projects, over 10 million people have received rabies prevention education.
Surveillance
Effective surveillance is crucial for tracking and tracing rabies outbreaks back to their source. This can be achieved through hotlines where the public can report sightings of potentially rabid dogs, partnerships with animal welfare organisations that may encounter rabid animals and collaborations with hospitals that report human rabies cases. This approach is known as Integrated Bite Case Management (IBCM).
By pinpointing the origin of a rabies outbreak, we can ensure that anyone who has been in contact with a rabid animal is identified and provided with the necessary advice to protect themselves. Surveillance also helps us identify areas where vaccination and education efforts need to be intensified to prevent future outbreaks.
Rabies control in action: Goa
In June 2021, Goa became the first state in India to be declared a “rabies-controlled area”. The declaration was the result of an eight-year partnership by the government of Goa and Mission Rabies, a project of Worldwide Veterinary Service.
The campaign began with vaccinating 61,143 dogs against rabies in just 30 days. At this time, the charity’s surveillance teams were picking up approximately one rabid dog every three days in Goa. Through large-scale vaccination of owned and stray dogs, that number has now been reduced to one rabid dog being detected every other month, with most of those animals having arrived in Goa from other states (Gibson et al., 2022).
The declaration was a significant breakthrough in the fight against rabies in India as it provides the state government with the authority to enforce dog vaccination and reporting of suspect cases.
In June 2021, Goa became the first state in India to be declared a ’rabies-controlled area’ […] a significant breakthrough in the fight against rabies in India as it provides the state government with the authority to enforce dog vaccination and reporting of suspect cases
Since 2021, the focus in Goa has shifted from rabies elimination to long-term maintenance of freedom from rabies. This includes a focus on community engagement and intensifying surveillance, especially at the state border to keep the disease under control in Goa, while continuing our rabies education programmes to communities across the state (Gibson et al., 2022).
