World Rabies Day: Stronger Together

 

Rabies is one of the world’s oldest known infectious diseases, yet it remains a significant public-health problem, particularly in Africa and Asia.

It is also one of the most preventable fatal diseases.

Rabies is a viral infection that affects the central nervous system. Once clinical symptoms develop, the disease is almost invariably fatal. However, death can be prevented when appropriate post-exposure prophylaxis (PEP) is administered promptly following exposure. 

This makes rabies unusual: the critical opportunity to save a life comes before symptoms begin.

Understanding rabies

Rabies is caused by viruses of the Lyssavirus genus and is transmitted primarily through the saliva of infected mammals.

Dogs remain the major source of human rabies transmission, accounting for approximately 99% of human rabies cases. Transmission usually occurs through bites, but scratches contaminated with saliva or saliva contacting broken skin or mucous membranes can also constitute an exposure. 

After entering the body, the virus travels through peripheral nerves towards the central nervous system. Once the virus reaches the brain and clinical disease develops, treatment is rarely successful.

This is why post-exposure treatment must begin before symptoms appear.

The global burden

Rabies causes tens of thousands of deaths every year, with approximately 40% of victims being children under 15 years of age. The disease occurs in more than 150 countries and territories, with the majority of deaths occurring in Africa and Asia. 

The burden is also substantially underestimated because rabies surveillance and laboratory confirmation remain limited in many endemic areas.

Nigeria is among the countries where rabies remains an important public-health concern. WHO reported in 2025 that rabies continues to cause an estimated 10,000 human deaths annually in Nigeria, although this figure is likely an underestimate because of underreporting and weaknesses in surveillance. 

The disease is particularly concerning in communities where dog vaccination coverage is low and access to timely PEP is limited.

Rabies in Nigeria

Rabies prevention in Nigeria faces challenges across both human and animal health systems.

Dogs are common household and community animals, while free-roaming dogs remain present in many communities. Inadequate vaccination coverage, limited surveillance, gaps in responsible animal ownership and inconsistent access to PEP can allow transmission to persist.

Another problem is delayed presentation after animal bites.

A person may sustain what appears to be a minor wound and treat it at home, seek traditional remedies or wait to see whether the animal develops symptoms.

This is unsafe.

The severity of the wound does not determine whether rabies prevention is necessary. A minor scratch or abrasion can constitute an exposure requiring vaccination, depending on the circumstances.

What should you do after an animal bite?

The first step is simple and should happen immediately:

• Wash the wound for at least 15 minutes.
• Thoroughly wash and flush the wound with soap and running water. If available, povidone-iodine or another agent known to inactivate rabies virus can be used. 
• Do not apply irritants or harmful substances to the wound.
• After washing, seek medical attention immediately for a rabies exposure assessment.
• Do not wait for symptoms to develop.
• Do not wait to see whether the animal becomes sick before seeking care.

In rabies-endemic settings, observation of an apparently healthy animal should not delay appropriate medical assessment and PEP when indicated. 

Understanding rabies exposure

WHO classifies potential rabies exposures into three categories.

Category I

Examples include:

• touching or feeding an animal;
• being licked on intact skin.

There is no exposure to rabies virus in these circumstances, and PEP is not required. 

Category II

This includes:

• nibbling of uncovered skin;
• minor scratches or abrasions without bleeding.

These exposures require immediate wound care and rabies vaccination. 

Category III

This includes:

• single or multiple bites that penetrate the skin;
• scratches that break the skin;
• saliva contacting broken skin;
• saliva contacting the eyes, mouth or other mucous membranes;
• certain direct exposures to bats.

These are severe exposures and require immediate wound care, rabies vaccination and rabies immunoglobulin or an appropriate rabies monoclonal antibody when indicated. 

The important point is that rabies PEP is determined by the nature of the exposure, not simply by whether the wound looks serious.

Post-Exposure Prophylaxis (PEP)

Rabies post-exposure prophylaxis consists of interventions designed to prevent the virus from reaching the central nervous system.

It includes:

1. Wound management

Immediate and thorough washing and flushing of the wound for at least 15 minutes.

2. Rabies vaccination

A recommended course of modern rabies vaccine should be administered according to the applicable PEP regimen.

3. Rabies immunoglobulin or monoclonal antibodies

For Category III exposures, rabies immunoglobulin or an appropriate rabies monoclonal antibody should be administered as recommended, particularly by infiltrating the wound and surrounding area. 

PEP is highly effective when administered appropriately before clinical disease develops.

Importantly, WHO states that rabies PEP can be safely administered to infants, pregnant women and immunocompromised individuals when indicated. 

What about the animal?

If the animal is available, its vaccination history and circumstances of the exposure should be assessed.

A healthy dog or cat involved in an exposure may be placed under appropriate veterinary observation, while animals suspected of having rabies may require further veterinary assessment and laboratory investigation.

However, the exposed person should not delay seeking PEP while waiting to see what happens to the animal, particularly in rabies-endemic areas.

People should also avoid attempting to capture or handle a potentially rabid animal themselves.

Recognising rabies

Early symptoms of rabies can be nonspecific and may include:

• fever;
• headache;
• weakness;
• fatigue;
• pain, tingling or unusual sensations around the bite site.

As the disease progresses, neurological symptoms can develop, including:

• agitation and confusion;
• hallucinations;
• difficulty swallowing;
• excessive salivation;
• hydrophobia;
• muscle spasms;
• paralysis;
• seizures;
• coma.

Rabies can present in both encephalitic (furious) and paralytic forms. 

However, recognising these symptoms is not the goal of rabies prevention.

Once clinical symptoms develop, rabies is fatal in essentially 100% of cases. 

The objective is therefore to intervene before symptoms appear.

Preventing rabies at its source

Human PEP saves lives, but it does not eliminate rabies.

The most effective long-term strategy is to control rabies in dogs.

WHO recommends sustained vaccination of at least 70% of dogs in at-risk areas as the most effective way of preventing human deaths from dog-mediated rabies. 

This requires:

Vaccinating dogs

Dog vaccination programmes need to achieve and maintain high coverage rather than relying solely on occasional campaigns.

Responsible dog ownership

Owners should ensure that dogs are vaccinated, appropriately confined and prevented from roaming freely.

Improving access to PEP

Healthcare facilities should have reliable referral pathways for people exposed to potentially rabid animals, with timely access to rabies vaccines and rabies immunoglobulin or appropriate alternatives.

Strengthening surveillance

Animal bites, suspected animal rabies and human rabies cases need to be identified and reported accurately.

WHO’s recent guidance emphasises the importance of integrating human bite-management data with animal surveillance, dog vaccination coverage and other One Health information.

Public education

Communities need clear information about animal-bite prevention and what to do immediately after an exposure.

Children should be taught not to approach unfamiliar dogs, disturb animals while eating or caring for young, or play roughly with animals.

Most importantly, children should be encouraged to tell an adult immediately after any bite or scratch.

Rabies and the One Health Approach

Rabies cannot be eliminated through the healthcare system alone.

It is a One Health problem involving humans, animals and the environment.

Effective control requires collaboration between:

• healthcare professionals;
• veterinary services;
• public-health authorities;
• local governments;
• communities;
• animal owners; and
• surveillance and laboratory systems.

Vaccinating dogs prevents transmission at its source, while accessible PEP protects people after exposure.

Both approaches are necessary.

Nigeria’s experience also demonstrates the importance of stronger surveillance. In Cross River State, for example, WHO has supported systems that integrate information on dog vaccination, animal bites and human and animal rabies cases.

What Nigeria Needs to Do

Reducing rabies deaths in Nigeria requires sustained investment rather than isolated interventions.

We need to:

• Increase and sustain dog vaccination coverage, particularly in high-risk communities.
• Improve availability and affordability of human PEP, especially outside major urban centres.
• Strengthen veterinary and public-health surveillance to identify outbreaks and high-risk areas.
• Improve responsible dog ownership and dog population management.
• Train healthcare workers to recognise and appropriately manage rabies exposures.
• Educate communities, particularly children and dog owners, about bite prevention and immediate wound care.
• And importantly, human and animal health programmes need to work together rather than operating independently.

Every Bite Deserves Attention

Rabies is unusual among fatal infectious diseases because we have highly effective tools to prevent death after exposure.

The critical steps are straightforward:

• Wash the wound immediately for at least 15 minutes.
• Seek medical assessment promptly.
• Receive rabies vaccination when indicated.
• Receive rabies immunoglobulin or an appropriate alternative when indicated for severe exposure.
• Do not wait for symptoms.

At the population level, the most important intervention remains vaccinating dogs and maintaining high vaccination coverage.

Rabies is preventable.

The challenge is ensuring that prevention reaches every community, every dog and every person who is exposed.

References

1. World Health Organization. Rabies. Fact sheet. 17 September 2026. (World Health Organization)
2. World Health Organization. Rabies: Vaccinations and immunization. Recommendations for post-exposure prophylaxis and wound management. (World Health Organization)
3. World Health Organization. Vaccinating against rabies to save lives. Dog vaccination and rabies elimination strategies. (World Health Organization)
4. World Health Organization. Rabies surveillance in action: Saving lives in Cross River State, Nigeria. 4 September 2025. (World Health Organization)
5. World Health Organization. Routine health information system and health facility data for neglected tropical diseases: Rabies. 2025. (World Health Organization)

 

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