Control of Neglected Tropical Diseases
We coordinate and support policies and strategies to enhance global access to interventions for the prevention, control, elimination and eradication of neglected tropical diseases, including some zoonotic diseases.
Vaccinations and immunization
Rabies
Rabies is a zoonotic viral disease which infects domestic and wild animals. It is transmitted to other animals and humans through close contact with saliva from infected animals (i.e. bites, scratches, licks on broken skin and mucous membranes). Once symptoms of the disease develop, rabies is fatal to both animals and humans. Rabies differs from many other infections in that the development of clinical disease can be prevented through timely immunization even after exposure to the infecting agent.
Two types of vaccines to protect against rabies in humans exist - nerve tissue and cell culture vaccines. WHO recommends replacement of nerve tissue vaccines with the more efficacious, safer vaccines developed through cell culture as soon as possible. Cell culture vaccines which are more affordable and require less vaccine have been developed in recent years.
Intradermal immunization using cell-culture-based rabies vaccines is an acceptable alternative to standard intramuscular administration. Intradermal vaccination has been shown to be as safe and immunogenic as intramuscular vaccination, yet requires less vaccine, for both pre- and post-exposure prophylaxis, leading to lower direct costs. This alternative should thus be considered in settings constrained by cost and/or supply issues.
Pre-exposure prophylaxis is recommended for anyone at continual, frequent or increased risk of exposure to rabies virus, either by nature of their residence or occupation.
Periodic booster injections are recommended as an extra precaution only for people whose occupation puts them at continual or frequent risk of exposure. If available, antibody monitoring of personnel at risk is preferred to the administration of routine boosters.
Rabies vaccines
Recommendations for post-exposure
All cases of suspected rabies exposure should be treated immediately to prevent the onset of clinical symptoms and death. Post-exposure prophylaxis (PEP) consists of wound treatment, the administration of rabies vaccines based on WHO recommendations, and if indicated, the administration of rabies immunoglobulin.
Local treatment of wounds
Elimination of rabies virus at the site of the infection by chemical or physical means is an effective mechanism of protection. Local treatment of wounds involving possible exposure to rabies is recommended in all exposures.
Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances of proven lethal effect on rabies virus.
If soap or an antiviral agent is not available, the wound should be thoroughly and extensively washed with water. If suturing after wound cleansing cannot be avoided, the wound should first be infiltrated with passive rabies immunization products and suturing delayed for several hours.
Other treatments, such as the administration of antibiotics and tetanus prophylaxis, should be applied as appropriate for other bite wounds.
The recommendations given here are intended as a general guide. It is recognized that, in certain situations, modifications of the procedures laid down may be warranted. Such situations include exposure of infants or mentally disabled persons and other circumstances where a reliable history cannot be obtained, particularly in areas where rabies is enzootic, even though the animal is considered to be healthy at the time of exposure. Such cases may be treated as category II or III (see recommendations below).
Rabies vaccine and rabies immunoglobulin
Recommendations for post-exposure depend on the type of contact with the suspected rabid animal.
- For category I exposure (touching or feeding animals, licks on intact skin), no prophylaxis is required;
- For category II (nibbling of uncovered skin, minor scratches or abrasions without bleeding), immediate vaccination; and
- For category III (single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks, licks on broken skin, exposures to bats), immediate vaccination and administration of rabies immunoglobulin are recommended.
WHO strongly recommends the discontinuation of production and use of nerve tissue vaccine and their replacement by modern cell culture vaccines. Intradermal vaccination is recommended as an alternative to intramuscular vaccination as it is safe, immunogenic and dose and cost sparing.
There are no contraindications to PEP; it can be safely given to infants, pregnant women and immunocompromised individuals. Life-saving PEP should not be withheld from these individuals.
Where possible, animals that conform to the definition of a suspected or probable rabies case should be euthanized humanely and sent for laboratory diagnosis. Animals that are deemed healthy by a trained professional, should be observed closely for 10 days. However, in rabies endemic areas the availability of the animal for observation should not delay the victim in seeking PEP.
Prompt administration of rabies vaccine after exposure, combined with proper wound management and administration of rabies immunoglobulins where indicated, is almost invariably effective in preventing rabies, even after high-risk exposure.
Relevant publications
19 April 2018
Rabies vaccines: WHO position paper – April 2018
Weekly epidemiological record, No 16, 2018, 93, 201–220
27 September 2019
Scientific and operational updates on rabies
This Special Issue on rabies presents the evidence reviews, modelling work, and in-country studies that informed the 2018 position paper update; and identifies...
14 April 2018
WHO Expert Consultation on Rabies: WHO TRS N°1012
Since the launch of the Global framework to eliminate human rabies transmitted by dogs by 2030 in 2015, WHO has worked with the Food and Agriculture Organization...
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