What is Rabies?

Most people in the United States know rabies as a rare and terrifying disease, ending in almost certain death. However, it’s not usually something they think about, except when the reminder card arrives from their veterinarian that their pet needs its rabies vaccine booster. Even then, they probably are not considering how important that shot is to not only keep their pet safe, but also as a barrier from exposure to rabid wildlife. In addition, that single shot is a critical tool in an international battle to prevent the tens of thousands of human deaths from this disease every year.

I occasionally hear stories from friends and family members who worry about rabies. I once talked to a woman who didn’t give rabies a second thought until she was deployed to Senegal as part of the Peace Corps. Her biggest fear was getting bitten by a stray dog and contracting a disease she might not be able to recover from.

Or consider the young professional who told me a story about traveling abroad and getting bitten by a stray dog on a beach. He panicked and didn’t know if that bite was his death sentence. Thanks to decades of public health interventions, canine rabies has been eliminated in the United States. However, what most people do not realize is that approximately three quarters of the world’s population currently lives in a country where rabies is an ever-present threat.

As the Veterinary Medical Officer for the CDC Rabies team, I’ve seen the toll rabies has taken on families around the world. In Taiwan, I had the difficult task of assessing a young puppy that was attacked by a wild ferret badger during a rabies outbreak. While there were no visible wounds, we could not rule out that the puppy had been exposed to rabies. The unfortunate recommendation was to either euthanize the puppy or quarantine it for six months. The family was poor, subsiding on a small farming plot; the cost for quarantine was seemingly out of reach. Yet the family scraped together the funds and paid for the quarantine. Unfortunately, four weeks later the puppy developed signs of rabies and was euthanized. The compassion this family showed for their puppy was amazing, but in the absence of qualified rabies control officials, the consequences could have been dire if the dog had remained at home.

Earlier this year I was in Haiti helping the local government train veterinary staff on humane euthanasia of suspected rabid animals. During the training, a veterinarian received a call from a young man who was bitten by his dog. Like many dogs in Haiti, this family pet was allowed to roam freely around the community. Three months prior to the call, the pet came home with a bite wound to his back leg. The family thought nothing of it; dog fights are common, especially among young male dogs in the neighborhood. It was now three months later and the dog was in a full rage. When the young man opened his door on this particular morning his dog lunged at him, leaving two deep bite wounds in his hand. The family was trapped inside their house for several hours until we arrived to safely euthanize the animal. Even though this animal was obviously ill, and had bitten two people, the family was still distraught by the thought of losing their beloved pet.

In Ethiopia, while assisting with a rabies vaccination clinic for dogs, we saw that people had walked for hours to get their dogs vaccinated. In particular, two boys waited more than six hours to have their dogs protected from this deadly disease. In all of the places I have traveled, I have witnessed the same truth: the human-animal bond is deep and universal, but dog-transmitted rabies is a far too familiar story for those of us who work in this field.

So what is rabies? To people in the United States, it may be something that is rarely considered. To most of the world, it is likely something they have intimately experienced. In the public health world, rabies is defined as a neglected tropical disease (NTD). Why is this? How does it happen? Some NTDs don’t cause enough deaths to be a priority to many. Some NTDs are found only in poor parts of the world, where other public health issues take priority. Some NTDs, for various reasons, do not attract international attention. Those of us working on preventing NTDs often spend more time advocating for elimination of the disease than we do actually fighting it.

What is often frustrating for those of us who are passionate about preventing NTDs like rabies is that, unlike many NTDs, rabies is vaccine-preventable. In fact, there are over 20 different approved rabies vaccines for more than six animal species (and people too!). In addition to those vaccines, there are also step-by-step recommendations developed by world experts that have been proven, when followed, to successfully eliminate canine rabies. Yet despite the existence of effective vaccines and proven successful interventions, more than 55,000 people die each year from an easily preventable disease. 95% of these deaths can be attributed to a bite from a rabid dog. All of these deaths at the jaws of rabid dogs, even though in most parts of the world it costs less than one U.S. dollar to protect a dog against rabies.

World Rabies Day was created in 2007 as a way to raise awareness for this NTD. As a veterinarian working in the public health field, I cannot imagine a more rewarding NTD to fight against and advocate for prevention. I am fortunate enough to have the opportunity to travel the world, not only to save human lives, but also to advocate for healthier, happier animals. In my travels, I am reminded of how important and loved animals are to the families with whom they share homes.

So this Word Rabies Day please take a moment to thank all of the hard-working people who spend every day to prevent you and your pets from catching this fatal disease. Thank your veterinarian for keeping your pets healthy. Thank your local animal control officer, who just tussled with that rabid fox in your backyard. Thank that doctor who reminded you to get those rabies shots before your vacation to any one of the 150 rabies-endemic countries. Hug your dogs if they are vaccinated, and get them vaccinated if they are not! (Then hug them.)

Finally, in honor of World Rabies Day, I’d like to highlight some of the many great stories about how the rabies work of CDC and our collaborators impacts the lives of families around the world:

• Moving Haiti Closer to Rabies Control
• Rabies is a disease that has no boundaries!
• The effects of unregulated trade and consumption of dog meat on rabies control in Southeast Asia
• Rabies in Ethiopia and the initiated elimination project in North Gondar

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