The World Health Organization (WHO) estimates there are 59,000 human deaths annually in over 150 countries, with 95% of cases occurring in Africa and Asia, and this is likely a underestimation. Rabies is present on all continents, except Antarctica.
The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year, according to the Centers for Disease Control and Prevention (CDC).
According to Public Health England (PHE), human rabies is extremely rare in the UK, in fact, the last case of classical rabies acquired in this country was more than a century ago, in 1902.
Cases occurring since then have all been acquired abroad, usually through dog bites (PHE offers advice for travelers below).
Since 1946, 25 cases have been reported in the United Kingdom, all imported. Five cases occurred between 2000 and 2017:
- two in 2001 from the Philippines and Nigeria
- one in 2005 followed a dog-bite in Goa
- one in 2008 resulted from a dog bite in South Africa
- one in 2012 developed after a dog bite in India
In 2002 a man who was a licensed bat handler died in Scotland from infection with EBLV-2, a rabies-like virus present in bats in the UK.
Concerning animal rabies, rabies has been eliminated from terrestrial animal populations. The last rabid terrestrial animal in the UK was a puppy in quarantine which had been imported from Sri Lanka and found to be rabid in 2008.
Rabies-like viruses have been found in bats in the UK. These viruses are known as European Bat Lyssaviruses (EBLVs), types 1 and 2. They very rarely cross the species barrier from bats to humans and are different from the ‘classical’ rabies virus found in dogs and other animals. These viruses do however cause clinical rabies in humans.
EBLVs are found more commonly in bats elsewhere in Europe than the UK. There have only been 4 documented cases of transmission of EBLVs to humans in Europe from bats.
Advice for travelers:
- seek advice before travel about whether rabies vaccine is required
- when travelling, stay away from stray or unattended animals
- if bitten or scratched in a country where rabies is present, clean the wound thoroughly with soap and plenty of water and seek medical advice immediately
- If treatment is not obtained while in that country, seek medical advice immediately on return, even if the bite was weeks before.
Rabies is a fatal condition but it is preventable by vaccination. Post-exposure treatment is extremely effective at preventing rabies after being bitten when started promptly. Once clinical rabies develops, it is almost always fatal (Survival is extremely rare, rabies is almost invariably fatal, but it has been documented in 15 cases, albeit with severe sequelae in most of those cases).