Prevention
Vaccinating dogs
Vaccinating dogs, including puppies, through mass dog vaccination programs is the most cost-effective strategy for preventing rabies in people because it stops the transmission at its source.
Culling free roaming dogs is not effective in controlling rabies.
Awareness
Public education for both children and adults on dog behaviour and bite prevention, what to do if bitten or scratched by a potentially rabid animal, and responsible pet ownership are essential extensions of rabies vaccination programmes.
Vaccinating people
Effective vaccines are available to immunize people both before and after potential exposures. As listed under the WHO – Prequalification of Medical Products, as of 2024, there are only 3 WHO pre-qualified human rabies vaccines available globally: RABIVAX-S by Serum Institute of India Pvt. Ltd., VaxiRab N by Zydus Lifesciences Limited, and VERORAB by Sanofi Pasteur.
Pre-exposure prophylaxis (PrEP) is recommended for people in high-risk occupations (laboratory workers handling live rabies and related viruses) and people whose professional or personal activities might lead to direct contact with infected animals (animal disease control staff and wildlife rangers).
PrEP might be indicated before recreation or travel in some areas, and for people living in remote, highly rabies-endemic areas with limited local access to rabies biologicals.
Note that PrEP does not replace the need for PEP. Any person exposed to a suspected rabid animal should still seek post exposure care.
Post-exposure prophylaxis (PEP) is the emergency response to a rabies exposure. This prevents the virus from entering the central nervous system. A well performed wound risk assessment and PEP protocol consists of:
- extensive wound washing with water and soap for at least 15 minutes soon after an exposure;
- a course of rabies vaccine; and
- administration of rabies immunoglobulin or monoclonal antibodies into the wound, if indicated.
Exposure risk and indications for PEP
Depending on the severity of exposure, administration of a full PEP course is recommended as follows:
| Categories of contact with suspect rabid animal | Post-exposure prophylaxis measures |
|---|---|
| Category I – touching or feeding animals, animal licks on intact skin (no exposure) | Washing of exposed skin surfaces, no PEP |
| Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure) | Wound washing and immediate vaccination |
| Category III – single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposures due to direct contact with bats (severe exposure) | Wound washing, immediate vaccination and administration of rabies immunoglobulin/monoclonal antibodies |
NB: Category II and III exposures require human rabies vaccination.
Vaccine quality
WHO recommends that all human rabies vaccines comply with WHO standards.
Deployment of poor-quality rabies vaccines has led to public health failures in several countries.
Vaccine administration – intradermal (ID) vs intramuscular (IM)
As detailed in the guidance on PEP administration, WHO recommends moving from intramuscular (IM) to intradermal (ID) administration of human rabies vaccines.
Intradermal administration reduces the amount of necessary vaccine and number of doses, therefore reducing costs by 60–80%, without compromising safety or efficacy.
Fewer doses also promote patient compliance with the recommended regimen.
WHO response
Rabies is included in WHO’s 2021–2030 Roadmap for the global control of NTDs, which sets regional, progressive targets for the global strategic plan to end human deaths from dog-mediated rabies by 2030 (see also: Zero by 30). This entails:
- improving access to human rabies vaccines through the efforts of the WHO and its partners, Gavi, the Vaccine Alliance, which had included human rabies vaccines in its Vaccine Investment Strategy for 2021–2025. Despite pandemic-related delays, WHO now collaborates with Gavi to implement the program in 2024;
- providing technical guidance to countries in developing and implementing their national rabies elimination plans, focusing on strengthening surveillance and reporting;
- encouraging countries to build the capacity of their One Health workforce by using rabies elimination programs as a platform for multisectoral collaborations; and
- encouraging the use of United Against Rabies (UAR) multi-stakeholder forum, which was launched in collaboration with WHO, Food and Agriculture Organization (FAO) and World Organisation for Animal Health (WOAH, formerly OIE), to advocate for action and investment in rabies control.
