Every year rabies causes 59,000 deaths worldwide1


What is Rabies?

  • A vaccine-preventable zoonotic viral disease caused by Rabies lyssavirus – a neurotropic virus of the Rhabdoviridae family2
  • Widespread disease occurring in more than 150 countries and territories, mainly in Asia and Africa1


Rabies is still present and almost always fatal if left untreated.1,4

Did You Know?

59K Annually
Rabies causes 59,000 deaths annually but can be prevented through vaccination1,4
Bat Image
70% of rabies cases acquired in the US are attributed to bat exposure3
Rabies pre-exposure prophylaxis (PrEP) can provide protection before exposure to rabies2
Post-exposure prophylaxis (PEP) aims to stop the onset of rabies after exposure to the virus2,4
Untreated rabies is almost always fatal but 100% vaccine-preventable4,5




How is Rabies Transmitted?

  • Rabies is transmitted in the saliva of rabid animals and generally enters the body when individuals are exposed to virus-laden saliva via scratches or bites4


Animals that Transmit Rabies

Globally, 99% of human rabies deaths are caused by dogs.4

  • In the Americas, bats are now the major source of human rabies deaths as dog-mediated transmission has mostly been eliminated in this region4
  • Other common carriers include Racoon, Monkey, Fox, Mongoose and Cat2


Common Carriers


















Rabies in the US

Wild animals accounted for 92.7% of reported cases of rabies in the US in 20187

Who is at Risk?

Veterinarians, animal handlers, wildlife officers in areas where animal rabies is enzootic, certain laboratory workers, and persons spending time in foreign countries where rabies is endemic are at higher risk of rabies exposure.8

Pre-exposure vaccination should be offered to persons in high-risk groups and whose activities bring them into contact with potentially rabid dogs, cats, foxes, skunks, bats, or other species at risk of having rabies.8

International travelers might be candidates for pre-exposure vaccination if they are likely to come in contact with animals in areas where dog rabies is enzootic and immediate access to appropriate medical care, including biologics, might be limited.8

Finally, immunization should also be considered for children living in, or visiting remote areas with a high rabies exposure. As they play with animals, they may receive more severe bites, or may not report bites.4,9


Rabies pre-exposure prophylaxis guide10

Risk Category

Nature of Risk

Typical Population

Pre-exposure Recommendations


Virus present continuously
Specific exposures likely to go unrecognized

Rabies research laboratory workers
Rabies biologics production workers

Primary course. Serologic testing every 6 months; booster vaccination if antibody titer is below acceptable level.


Exposure usually episodic, with source recognized, but exposure also might be unrecognized

Rabies diagnostic lab workers
Veterinarians and staff
Animal-control and wildlife workers in rabies-enzootic areas
Persons who frequently handle bats

Primary course. Serologic testing every 2 years; booster vaccination if antibody titer is below acceptable level.


Exposure nearly always episodic with source recognized

Veterinarians and terrestrial animal-control workers in areas where rabies is uncommon to rare. Veterinary students
Travelers visiting areas where rabies is enzootic and immediate access to appropriate medical care including biologics is limited

Primary course. No serologic testing or booster vaccination.


Exposure always episodic with source recognized

U.S. residents, including persons living  in rabies-epizootic areas.

No vaccination necessary.

Adapted from: https://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html


Clinical Manifestations of Rabies

  • Infection with this neurotropic virus results in neurological and psychological manifestations4
  • The incubation period is usually 2–3 months, but can vary from 1 week to 1 year depending upon factors such as the location of virus entry and viral load4
  • Initial symptoms include a fever with pain and unusual or unexplained tingling, pricking, or paraesthesia at the wound site4
  • As the virus spreads to the central nervous system, there is paralysis and coma, and finally death4

Furious rabies4

Paralytic rabies4

~80% of rabies cases

~20% of rabies cases

Characterised by signs of CNS irritation:

  • Hyperactivity

  • Excitable behaviour

  • Hydrophobia

  • Aerophobia

Characterised by weakness and paralysis:

  • Often misdiagnosed, leading to disease under-reporting

Rapidly progressing disease, with death due to cardio-respiratory arrest

Slower disease progression


  1. World Health Organization (WHO). Rabies: Epidemiology and burden of disease. https://www.who.int/teams/control-of-neglected-tropical-diseases/rabies/epidemiology-and-burden, (accessed Oct 2021)

  2. Plotkin S, Orenstein W, Offit P, Edwards K. Rabies. Plotkin’s Vaccines. 7th Ed. Elsevier. 2018.p925

  3. Center for Disease Control and Prevention (CDC). Rabies in the US. https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html,  (accessed June 2021).

  4. World Health Organization (WHO). Rabies factsheet. https://www.who.int/news-room/fact-sheets/detail/rabies, (accessed October 2021).

  5. World Health Organization (WHO). Vaccinating against rabies to save lives. https://www.who.int/activities/vaccinating-against-rabies-to-save-lives ,  (accessed July 2021).

  6. World Health Organization (WHO). Wkly Epidemiol Rec 2018;93:201–20.

  7. Ma X, et al. Rabies surveillance in the US during 2018. J Am Vet Med Assoc. 2020;256:195–208. https://avmajournals.avma.org/view/journals/javma/256/2/javma.256.2.195.xml

  8. Manning SE,  et al. MMWR Recomm Rep 2008;57(RR-3):1–28. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm

  9. Centers for Disease Control and Prevention (CDC): Rabies prevention. https://www.cdc.gov/rabies/prevention/people.html, (accessed June 2021).

  10. Center for Disease Control and Prevention (CDC). Pre-exposure vaccinations. https://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html. (accessed Oct 2021).

  11. Based on World Health Organization (WHO). Distribution of risk levels for humans contacting rabies, 2018. https://www.who.int/ith/rabies2018.png?ua=1, (accessed June 2021).