Global epidemiology of canine rabies: past, present, and future prospects

Abstract

The rabies virus, a public health scourge from ancient times, is currently responsible for an estimated 59,000 human deaths a year, almost all transmitted via dog bites. It causes considerable economic impacts on developing countries, primarily in Africa and Asia, which can least afford these losses. However, despite its almost 100% case fatality rate, canine rabies is a completely preventable disease, and historic examples of canine rabies elimination in the developed world attest to this. Over the last decade, programs based on eliminating the source of the disease from dogs have shown success in reducing the public health burden of canine rabies in developing countries, notably across Latin America, and this has contributed to the growing evidence base necessary to change attitudes toward the feasibility of global canine rabies elimination. More recently, assessments of the current economic burden of canine rabies and the potential cost savings achievable through mass dog vaccinations have been added to this evidence base. Tools and support are available from the international community to help countries move progressively toward canine rabies elimination, and there is optimism that global freedom from canine rabies can be achieved within the next few decades.

Keywords: canine rabies; elimination; epidemiology; rabies virus; zoonosis.

Figure 1

Rabies cases in humans and dogs for (A) Latin America 1982–2013 and (B) KwaZulu Natal, South Africa 2007–2014. Notes: Red with diamonds, cases in humans from dogs; blue with triangles, cases in dogs; green with circles, cases in humans from bats. Graphs were drawn by the Pan American Health Organization with data from the SIEPI database. Reproduced with permission from Pan American Health Organization (A). Graph was redrawn from Figure 2 in the WHO/BMGF projects sixth meeting report. (B). Adapted from Pan American Health Organization. SIEPI Epidemiological Information System; 2015. Available from: http://siepi.panaftosa.org.br/Panel.aspx?Idioma=i; and from WHO/HTM/NTD/NZD/2015.3. Report of the Sixth Meeting of the International Coordinating Group of the World Health Organization and the Bill and Melinda Gates Foundation Project on Eliminating Human and Dog Rabies. Geneva, Switzerland: WHO. Copyright 2015. Abbreviations: BMGF, Bill and Melinda Gates Foundation; WHO, World Health Organization.

Figure 2

Distribution of the global burden of rabies estimated for 2010: (A) human rabies deaths, (B) per capita death rates (per 100,000 persons), and (C) expenditure on dog vaccination (US$ per 100,000 persons). Notes: Countries shaded in gray are free from canine rabies. Reproduced from Hampson K, Coudeville L, Lembo T, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 2015;9(4):e0003709.

Figure 3

Spending on rabies prevention through mass dog vaccination and costs that would be saved with rabies elimination. Abbreviation: PEP, postexposure prophylaxis.