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close this bookWHO Recommended Surveillance Standards (WHO; 1999; 157 pages)
View the documentAcknowledgements
View the documentAcronyms
View the documentIntroduction
View the documentNational Coordination of Communicable Disease Surveillance
View the documentExplanatory notes
View the documentSurveillance activities: criteria and WHO Department
View the documentCommunicable disease contacts in Regional Offices
close this folderDiseases
View the documentB20-B21-B22-B23-B24 AIDS
View the documentA22 Anthrax
View the documentA23 Brucellosis
View the documentA00 Cholera
View the documentA81.0 Creutzfeldt-Jakob disease
View the documentA90, A91 Dengue fever (A90) including Dengue haemorrhagic fever (DHF) & Dengue shock syndrome (DSS, A91)
View the documentA36 Diphtheria
View the documentB72 Dracunculiasis (Guinea worm disease)
View the documentA98.3, A98.4 Ebola-Marburg viral diseases
View the documentA83.0 Japanese encephalitis
View the documentB74 Lymphatic filariasis
View the documentB96.3 Haemophilus influenzae type b
View the documentB15-B17 Acute viral hepatitis
View the documentB20-B24 HIV infection
View the documentJ10, J11 Influenza
View the documentA96.2 Lassa fever
View the documentA48.1 Legionellosis
View the documentB55.1, B55.2 Cutaneous leishmaniasis
View the documentLeishmania / HIV co-infections
View the documentB55.0 Visceral leishmaniasis
View the documentA30 Leprosy
View the documentA27 Leptospirosis
View the documentB50-54 Malaria
View the documentB05 Measles
View the documentA39 Meningococcal disease
View the documentA87 Viral meningitis
View the documentB73 Onchocerciasis
View the documentA37.0 Pertussis
View the documentA20 Plague
View the documentA36 Poliomyelitis
View the documentA82 Rabies
View the documentA02.0 Salmonellosis
View the documentB65 Schistosomiasis
View the documentA50-52 Syphilis
View the documentA33 Tetanus, neonatal
View the documentB56-0, B56-1 African trypanosomiasis
View the documentB57 American trypanosomiasis
View the documentA15-A19 Tuberculosis
View the documentA75.3 Scrub typhus
View the documentA95.9 Yellow fever
open this folder and view contentsSyndromes
View the documentAnnex 1 Software free and in the public domain
View the documentAnnex 2 Proposed surveillance definitions
View the documentAnnex 3 Role and use of Geographic Information Systems (GIS) and mapping for epidemiological surveillance
 

A82 Rabies

RATIONALE FOR SURVEILLANCE

Rabies, present on all continents and endemic in most African and Asian countries, is a fatal zoonotic viral disease, transmitted to humans through contact (mainly bites and scratches) with infected animals both domestic and wild. Over 40 000 human deaths are estimated to occur each year worldwide, most of them in the developing world (mainly in Asia), and an estimated 10 million people receive post-exposure treatment after being exposed to animals suspected of rabies.

WHO promotes:

 

• human rabies prevention through well-targeted post exposure treatment and increased availability of modern rabies vaccine

• disease elimination through mass vaccination of dogs and other animal reservoirs

Surveillance of both human and animal rabies is essential to detect high risk areas and outbreaks quickly and to monitor the use of vaccine.

RECOMMENDED CASE DEFINITION

Clinical description

An acute neurological syndrome (encephalitis) dominated by forms of hyperactivity (furious rabies) or paralytic syndromes (dumb rabies) that progresses towards coma and death, usually by respiratory failure, within 7 to 10 days after the first symptom if no intensive care is instituted. Bites or scratches from a suspected animal can usually be traced back in the patient medical history. The incubation period may vary from days to years but usually falls between 30 and 90 days.

Laboratory criteria for diagnosis

One or more of the following

 

• Detection of rabies viral antigens by direct fluorescent antibody (FA) in clinical specimens, preferably brain tissue (collected post mortem)

• Detection by FA on skin or corneal smear (collected ante mortem)

• FA positive after inoculation of brain tissue, saliva or CSF in cell culture, in mice or in suckling mice

• Detectable rabies-neutralizing antibody titre in the CSF of an unvaccinated person

• Identification of viral antigens by PCR on fixed tissue collected post mortem or in a clinical specimen (brain tissue or skin, cornea or saliva)

• Isolation of rabies virus from clinical specimens and confirmation of rabies viral antigens by direct fluorescent antibody testing


Case classification

HUMAN RABIES:

 

Suspected: A case that is compatible with the clinical description.
Probable: A suspected case plus history of contact with suspected rabid animal.
Confirmed: A suspected case that is laboratory-confirmed.

HUMAN EXPOSURE TO RABIES:

Possibly exposed:

 

A person who had dose contact (usually a bite or scratch) with a rabies-susceptible animal in (or originating from) a rabies-infected area.

Exposed:

 

A person who had a close contact (usually a bite or scratch) with a laboratory-confirmed rabid animal.

RECOMMENDED TYPES OF SURVEILLANCE

SURVEILLANCE IN HUMAN POPULATIONS:

Surveillance of human exposure to rabies:

At peripheral level, especially in rabies-infected areas, reports of patients with a history of animal contact (usually a bite/scratch) should be investigated at once; when required, they should be treated as an emergency. Case-based and aggregated data must be sent regularly from peripheral to intermediate and central level.

Surveillance of cases of human rabies:

Immediate reporting of suspected and confirmed cases from peripheral level (by diagnosing physician and laboratory) to intermediate and central level.

Rapid exchange of information with services in charge of animal rabies surveillance and control is required.

Epidemiological investigation of outbreaks: Investigation of all rabies foci, identifying sources of infection as will as humans and animals exposed or possibly exposed.

SURVEILLANCE IN ANIMAL POPULATIONS (EPIZOOTIC CONTROL): Where the disease is endemic or could be reintroduced, surveillance of animal rabies and similar conditions in wild and domestic species most likely to be reservoirs of disease must be undertaken. Surveillance is laboratory-based. Immediate submission of brain specimen of suspected animal for laboratory diagnosis when human exposure occurs. Suspected domestic animals at the origin of human exposure that cannot be killed must be kept under observation for 10 days. Rapid exchange of information between services in charge of human and animal rabies surveillance and control is required.

RECOMMENDED MINIMUM DATA ELEMENTS

HUMAN RABIES EXPOSURE

Case-based data: Unique identifier, name, age, geographical information, date(s) of bite/scratch, geographical information (location) of biting episode(s), category of exposure, local wound treatment, vaccination history, previous serum treatment, current treatment, outcome; details of biting animal, vaccination history, outcome.

Aggregated data: Exposures by geographical information on biting episode, biting animal, outcome in animal and human populations.

SURVEILLANCE OF DEATHS FROM HUMAN RABIES

Unique identifier, name, age, geographical information, date of onset of symptoms, date(s) of bite/scratch, geographical information (location) of biting episode(s), site of bite on the body, nature of bite, local wound treatment, vaccination history, previous serum treatment, hospital, treatment details, outcome, details of biting animal, samples taken, sample results.

RECOMMENDED DATA ANALYSES, PRESENTATION, REPORTS

Number of human rabies deaths and rabies cases in animals (by species), by date of presentation.

Human exposures by location and dates of biting/scratch episode, by animal species at the origin of exposure and by outcome in human and in animal populations.

Cases by geographical area (e.g., district) and dates of biting/scratch episode, type of animal, occupation and outcome.

PRINCIPAL USES OF DATA FOR DECISION-MAKING

 

• Detect outbreaks in endemic areas and new cases in rabies-free area.
• Determine high risk areas for intervention
• Rationalize the use of vaccine and immunoglobulin
• Evaluate effectiveness of intervention at the level of the animal reservoir and exposed human population

SPECIAL ASPECTS

Intersectoral cooperation of medical and veterinary services, community involvement and participation required for targeted response and control in animal reservoir.

CONTACT

Regional Offices

See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".

Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Communicable Disease Surveillance and Response (CSR)

 

E-mail: meslinf@who.ch /outbreak@who.ch
Tel: (41 22) 791 2575/2111
Fax: (41 22) 791 4893 attn CSR
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