WHO Expert Consultation on rabies

Abstract

More than 99% of all human rabies deaths occur in the developing world, and although effective and economical control measures are available, the disease has not been brought under control throughout most of the affected countries. Given that a major factor in the low level of commitment to rabies control is a lack of accurate data on the true public health impact of the disease, this report of a WHO Expert Consultation begins by providing new data on the estimated burden of the disease and its distribution in the world. It also reviews recent progress in the classification of rabies viruses, rabies pathogenesis and diagnosis, rabies pre- and post-exposure prophylaxis, the management of rabies patients, and canine as well as wildlife rabies prevention and control. Considering the emergence of new lyssaviruses and changes in animal and human rabies epidemiology observed on different continents, the definition of a rabies-free country or area has been revised to assist public health authorities in better assessing the risk of human rabies resulting from contact with animals. Measures aiming at preventing the spread of rabies through the international transfer of animals, mainly with regard to pets, are discussed as well as the new systems in place within and outside WHO to share rabies data and information. As certain tools currently used in rabies prevention and control, such as biologicals, tests for intra vitam and postmortem diagnosis, vaccines and immunoglobulin quality control, need improvement, the report ends by outlining the priorities for basic research, as well as those for operational research for sustainable canine rabies control, including dog population management schemes complying with animal welfare principles. Such operational research is necessary for removing or alleviating the main constraints to rabies control in dogs, as these are the source of most human rabies cases worldwide.