Epidemiology and burden of disease
Rabies is estimated to cause 59 000 human deaths annually in over 150 countries, with 95% of cases occurring in Africa and Asia. Due to widespread underreporting and uncertain estimates, it is likely that this number is a gross underestimate of the true burden of disease. 99% of rabies cases are dog-mediated and the burden of disease is disproportionally borne by rural poor populations, with approximately half of cases attributable to children under 15.
Dog-mediated rabies has been eliminated from Western Europe, Canada, the United States of America, Japan and some Latin American countries. Australia and many Pacific island nations have always been free from dog-mediated rabies. These countries may still report imported cases and incur costs for maintaining disease freedom or surveillance of endemic transmission in wildlife.
Latin America and the Caribbean
Due to a concerted effort by the Pan American Health Organization, sustained control in this region has led to a significant decrease in human and dog rabies cases. Between 2013 and 2016, dog-mediated rabies was reported in only 8 countries. Bat mediated rabies accounts for the majority of human rabies cases in Americas.
Rabies is a major burden in Asia, with an estimated 35 172 human deaths per year. India accounts for 59.9% of rabies deaths in Asia and 35% of deaths globally. The cost of Post Exposure Prophylaxis (PEP) is highest in Asia, with estimates up to US$ 1.5 billion per year. The Association of Southeast Asian Nations (ASEAN) have implemented a regional elimination strategy with an aim to eliminate human rabies in the Region by 2020.
An estimated 21 476 human deaths occur each year in Africa due to dog-mediated rabies. Africa is estimated to spend the least on PEP and have the highest cost of human mortality. With improved access to PEP and reduced prevalence of dog-mediated rabies, a significant number of lives could be saved.
Central Asia and the Middle East
There are estimated to be 1875 human deaths in Central Asia and 229 human deaths per year in the Middle East. Limited information is available on the burden of disease in these areas.
The overall economic cost of dog-mediated rabies is estimated to be US$ 8.6 billion. Major costs associated with dog-mediated rabies vary by region but include losses in productivity due to premature death, cost of PEP and direct costs to the medical sector and bite victims. Except for Latin America, the amount spent on dog vaccination in endemic areas is minimal. Rabies control programmes are being implemented in many countries, with great success being seen with improved dog vaccination coverage, improved accessibility to PEP and reduced human deaths. The global community aims to eliminate human deaths from dog mediated rabies by 2030.