Rabies story map

In both humans and animals, rabies virus causes encephalitis that is virtually fatal in 100% of all cases. 

After exposure, RABV migrates to the brain and no symptoms occur during this phase. The  incubation period  is typically 2–3 months, although it can range from one week to one year depending on: 

• Distance from the site of inoculation to the brain (the closer to the brain, the more quickly symptoms appear)
• Virus  strain 
• Viral dose 

In humans, during the prodromal (initial) phase, symptoms are non-specific:  

• Fever
• Weakness
• Discomfort
• Headache 

In addition, due to initial viral replication in the nervous system, other symptoms may be present, such as: 

• Prickling
• Itching at the infection site
•  Paraesthesia   

After a few days, rabies progresses to an acute neurological phase, which may appear in two forms:

• Furious or encephalitic form, characterised by hyperactivity, excitable behaviour, hallucinations, lack of coordination, hydrophobia, and aerophobia
• Paralytic form, characterised by muscle weakness and progressive paralysis

The factors influencing the development of the different forms are uncertain.  

Without pre- or post-exposure prophylaxis (see section “How to prevent”), survival is extremely uncommon and, when it occurs, often results in severe neurological damage. Typically, rabies leads to coma and subsequent death 2 to 10 days after symptoms appear. Despite this, full recovery, though exceptionally rare, has been documented. 

Globally, children are at higher risk of infection due to frequent interactions with domestic or free-roaming dogs. Moreover, their small size facilitates bites not only on their extremities, but also on the head, resulting in shorter incubation periods. 

Some categories are at higher risk, including: 

• Marginalised and poor populations with limited access to information, in countries where rabies is still prevalent
• Children
• Veterinary staff
• People handling animals that could have rabies (e.g. bats)
• Wildlife officers
• Laboratory personnel who work with live rabies virus
• International travellers in regions with a high risk of rabies 

Regarding animals, rabies can infect all species of mammals. The initial signs are non-specific and include: 

• Anorexia or increased appetite
• Dehydration
• Vomiting
• Diarrhoea
• Excessive salivation
• Signs suggestive of neurological damage (fearfulness, restlessness, behavioural changes, dilation of the pupils, hyper-reactivity to stimuli) 

The manifestations of the acute neurological phase in animals often resemble those seen in humans: 

• Furious or encephalitic form, characterised by an increase in aggression and restlessness. Sometimes, the animal may run without apparent reason and bite without provocation. Abnormal ingestion of objects may occur.
• Paralytic form, characterised mainly by profuse salivation and a change in vocalisation caused by throat muscle and laryngeal paralysis. In this form, biting is uncommon.

Rabies should always be considered in the differential diagnosis of unexplained neurological symptoms in any area, regardless of the rabies status of the location where exposure occurred. Symptomatic animals with clinical signs will invariably face death.

Burden of disease

According to estimates, rabies causes over 59,000 human deaths annually across more than 150 countries, with 95% of the cases concentrated in Africa and Asia. These figures are probably significantly underestimated due to incomplete reporting and uncertain data. The impact of the disease disproportionally affects impoverished rural communities, with nearly half of the infections occurring in children under the age of 15 years.  

Rabies has been recognised by the World Health Organization (WHO) as a neglected  zoonosis  and is part of a subset of  neglected tropical diseases (NTDs)  affecting marginalised, poor, and vulnerable populations, especially in resource-limited countries in Africa and Asia. Although effective human vaccines and  immunoglobulins  exist for rabies, they are often not readily available or accessible to those in need. 

Rabies occurs globally in different environments, affecting both urban and wild areas. Two main transmission cycles can be recognised:  

• The urban cycle, where the dog serves as the primary  reservoir  host
• The sylvatic (or wild) cycle, where various wild mammals maintain virus circulation 

In urban settings, the dog is considered the main reservoir and the most important source of infection for other domestic animals, such as cats, equids, cattle, camels, sheep, and goats, and for humans, in whom dog bites cause up to 99% of rabies cases globally. During the first half of the 20 ^th  century, canine rabies (the so-called urban cycle) was eliminated in Europe, the USA, Canada, and Japan. 

In rabies-free countries, cases reported in domestic animals are the result of the importing of pets from areas where canine rabies is  endemic . 

The sylvatic cycle is predominant in the northern hemisphere. In Europe, probably due to  spillover  from domestic animals during the Second World War, the main reservoir species have become: 

• Red fox (Vulpes vulpes)
• Raccoon dog (Nyctereutes procyonoides) (to a lesser extent) 

Cases reported in domestic animals are typically caused by transmission from a wild animal. 

Thanks to oral vaccination campaigns (ORVs), aimed at controlling rabies in wildlife, Europe has seen a significant decrease in the number of human and animal rabies cases in recent decades. However, wildlife can still pose a risk of infection in humans in Europe, particularly in territories bordering infected areas. Cases of rabies are also reported in Europe in domestic mammals (cats and dogs) and farmed mammals (cattle, horses, sheep, goats, and pigs). 

Depending on the geographical area, other species may also transmit the virus, such as members of the following biological families:  

• Canidae (jackal, coyote, wolf)
• Mustelidae (various skunks, ferret badger)
• Viverridae (mongoose, genet)
• Procyonidae (raccoon)
• The order Chiroptera (bat) 

In the United States, skunks and raccoons are the main reservoirs of rabies, and ORV campaigns are in place to control the disease in raccoons. Additionally, the cat is the domestic animal most frequently reported to be infected.

While different species of bat are involved in rabies transmission on some continents, like Central and South America, in Europe bat cases are reported mainly where specific surveillance activities are in place. However, transmission from bats to non-flying mammals is a rare occurrence in the European context.  

Humans can be infected with rabies primarily through direct exposure to saliva from rabid animals, most commonly via bites or, to a lesser extent, via contact with cuts, open wounds, scratches, abrasions, or mucous membranes of the eyes, nose, or mouth. The virus may also be transmitted through  aerosol  inhalation or via corneal or organ transplants, although these modes of transmission are extremely rare. The likelihood of contracting rabies through the consumption of an animals infected with rabies virus is exceedingly rare, as the virus has a limited survival time outside the infected host. Consequently, the associated risk is very low. 

It is important to note that the critical factor in rabies transmission is the presence of the virus in animal saliva, which can occur even before the onset of detectable clinical signs. Crucially, the virus does not spread through casual contact, such as touching or petting an infected animal, nor does it transmit through contact with its urine, faeces, or blood.  

Practically any mammalian species can transmit rabies, even those not recognised as reservoirs, but carnivores are often proven to be more efficient vectors than others. Among all carnivore host reservoirs, the domestic dog (Canis lupus familiaris) is responsible for over 99% of all human rabies fatalities globally, particularly in Africa and Asia. Cats are also reported to be capable of transmitting rabies to people. 

Occasional travel-associated human rabies cases have been reported in Europe. In regions where rabies is endemic, two types of travellers who are at increased risk can be identified:  

• Individuals who handle puppies and kittens, thus facing a higher risk of exposure
• Those who, despite being bitten or scratched by a dog or cat, fail to seek medical attention, significantly raising their risk of developing the disease  

In Europe, a significant risk is also posed by the illegal importing of infected pets, primarily dogs, from non-rabies-free countries. Travellers often lack adequate information regarding the risk of rabies when illegally importing animals from regions where the disease is prevalent. In many instances, the animals affected are non-vaccinated puppies or young dogs.  

In animals, as with humans, the most common route of rabies transmission is via a bite. Nonetheless, any contact between infectious saliva or neurological tissues and mucous membranes or wounds should be considered a possible transmission pathway.

• In 2023, European Union Member States reported no human lyssavirus infections acquired within the European Union. During the last 5 years (2018-2022), only one European Union-acquired non rabies lyssavirus infection was reported in 2019 and was caused by European bat lyssavirus 1 (EBLV-1).
• In animals excluding bats, a total of 71 cases of rabies of autochthonous origin were reported by three Member States: 7 cases in Poland (6 foxes and 1 dog), 49 cases in Romania (28 cattle, 16 foxes, 4 dogs and 1 badger) and 15 cases in Hungary (9 foxes, 3 dogs, 2 cattle and 1 cat). The total number of reported indigenous rabies cases in non-flying animals in the European Union is stable in 2023 compared with 2022 (71 cases) but was lower than in 2021 (118 cases) and higher than in 2020 (12 cases) and 2019 (5 cases).
• Surveillance data on lyssavirus in bats were reported by 18 European Union Member States. Seven Member States (Austria, France, Germany, Hungary, the Netherlands, Poland and Spain) reported 23 positive results for lyssavirus, 22 European bat 1 lyssavirus (EBLV-1) and one Bokeloh bat lyssavirus (BBLV). One non-Member State (Switzerland) reported a positive result in a bat for European bat lyssavirus 2 (EBLV-2).

For more information on rabies reported in humans and animals in the EU and other reporting countries in 2023, refer to the  2023 EU One Health Zoonoses Report .

• Recognising that preventing rabies in animals directly contributes to the protection of humans, underscoring the importance of rabies vaccination and control measures in animal species. Vaccinating dogs, including puppies, is recognised as the most cost-effective strategy for preventing rabies in people because it stops transmission at its source.
• Getting pre-exposure prophylaxis (PrEP) for people at risk (laboratory personnel who work with live rabies virus, veterinarians, people having direct contacts with animals that could be infected, travellers, or people living in high-risk areas). PrEP consists of a series of rabies vaccine doses given before exposure to the rabies virus. This prophylaxis is advised for individuals who face continual, frequent, or heightened risk of exposure to the rabies virus, due to their residence, occupation, or travelling schedules.
• Implementing post-exposure prophylaxis (PEP). All cases of suspected rabies exposure (e.g. contact with saliva from suspect or rabid animals by bite or scratch, or exposure to a bat, etc.) should be treated immediately to prevent the onset of clinical symptoms and death. Post-exposure prophylaxis (PEP) consists of wound treatment, administration of rabies vaccines based on WHO recommendations, and if indicated, administration of rabies  immunoglobulin . For further information, please visit the  WHO page on recommendations for post-exposure to rabies . Initiating PEP before any clinical signs appear is crucial for effectively preventing the disease and averting death.
• Promoting disease awareness within the population (for instance via information campaigns).
• Preventing contact with wildlife and domestic animals of unknown health status. 

• Ensuring vaccination of dogs and possibly cats, contingent on location and risk level, according to the WOAH Terrestrial Manual (not required in rabies-free countries, but crucial for traveling with animals and for countries affected by canine rabies, in accordance with Regulation (EU) No 576/2013). For more information on requirements when travelling with companion animals in the EU, visit the EU website ( Travelling with pets and other animals in the EU ).
• Conducting oral rabies vaccination campaigns using vaccine-laden bait in wildlife (such as the fox and raccoon dog in Europe) in countries affected by sylvatic rabies, to interrupt disease transmission, according to the  WOAH Terrestrial Manual .
• Ensuring stray dog population control, to decrease the number of free-roaming domestic animals that can serve as reservoirs, through ethical methods in accordance with the measures listed in the  WOAH Terrestrial Animal Health Code . 

 ^{Click on the plus sign in the right-hand panel for more information on each element.} 

Surveillance in humans

• Commission Implementing Decision (EU) 2018/945 provides case definitions for a range of communicable diseases, including rabies.
• Regulation (EU) 2022/2371 establishes rules on relevant cross-border threats to health, including epidemiological surveillance, monitoring, early warning and response actions.
• ECDC collects, analyses and disseminates data on human cases ( ECDC’s Surveillance Atlas of Infectious Diseases ) in compliance with Regulation (EU) 2022/2371 and uses indicator-based surveillance data to produce its  Annual Epidemiological Reports . 

 Surveillance in animals 

• Regulation (EU) 2016/429 (the Animal Health Law) lays down rules for the prevention and control of animal diseases transmissible to animals or humans. The EU has specific legislation covering several animal diseases according to their potential social and economic impact, including infection with rabies virus. This includes notification obligations, diagnostic methods, and measures to be applied in case of suspicion and confirmation of disease.
• Rabies is included in the list of zoonoses and zoonotic agents to be monitored according to the epidemiological situation, as laid down in Annex I - part B of Directive 2003/99/EC. In accordance with this Directive, EU Member States report the available data on rabies in animals to EFSA.
• Passive rabies surveillance aims to assess the presence and geographical distribution of the virus over time, to allow timely dissemination of information for immediate integrated control actions among the public health and veterinary sectors. For rabies-free countries, passive surveillance aims to confirm the absence of the disease for early detection. Passive rabies surveillance is carried out by sampling and testing wild or domestic ‘indicator animals’ (fox, raccoon dog, jackal, badger, dog, cattle, cat, sheep, etc.) that are found dead (including roadkill), as well as suspect animals, and most animals showing clinical signs or abnormal behaviour compatible with rabies.
• Active rabies surveillance is designed to monitor the efficacy of oral rabies vaccination campaigns. Within the framework of active surveillance, healthy animals of the wild species targeted by oral vaccination (e.g. fox, raccoon dog and golden jackal) are hunted and their carcases are used to determine rabies immunity and oral vaccine bait uptake.
• Imported or travel-related companion animals (primarily dog and cat) from territories and non-EU countries not listed in Annex II of Commission Implementing Regulation (EU) 577/2013 are currently tested for rabies virus neutralising antibodies.
• Pursuant to Commission Implementing Regulation (EU) 2020/2002, EU Member States must, within 24 hours, notify outbreaks of infection with the rabies virus in non-flying animals to the EU Animal Disease Information System (ADIS) managed by the European Commission. This requirement covers the following animal species and groups of species: Carnivora, Bovidae, Suidae, Equidae, Cervidae and Camelidae, but excludes Chiroptera (bats). 

Data on the occurrence of rabies in animals and humans are collected by EFSA and ECDC, respectively, and analysed in the annual  EU One Health Zoonoses report  prepared by EFSA and ECDC.

EFSA has a crucial role in: 

• Collecting and analysing EU-wide data on the occurrence of rabies in animals
• Supplying independent scientific advice and assistance on public and animal health aspects relating to rabies through EFSA’s Panel on Biological Hazards and EFSA’s Panel on Animal Health and Welfare
• Supporting European and national risk managers in monitoring and evaluating the occurrence of rabies in animals and suggesting control measures when needed
• Developing and assessing tools that contribute to disease and risk situation awareness, such as the dashboard on ' Monitoring Rabies in the Media ' that is publicly available online. This dashboard enables authorities involved in rabies risk assessment and management to monitor the daily distribution of media articles related to rabies published worldwide. Further details on this dashboard are described in EFSA’s report “Syndromic surveillance: developing an early warning system for rabies” (2022)
• Developing and assessing tools and measures for the prevention and control of animal diseases
• Reporting on surveillance activities carried out within the EU 

EFSA is assisted by its network on zoonoses monitoring data, a pan-European network of national representatives and international organisations that support EFSA by gathering and sharing information on zoonoses in their respective countries. 

The European Union Reference Laboratories (EURLs) 

The European Union Reference Laboratories (EURLs) are appointed by the European Commission and aim to ensure high-quality methods of analysis, as well as uniform testing and diagnosis within the area of animal health in the EU. EURLs also aim to coordinate the activities of national reference laboratories and provide necessary support to EFSA in monitoring zoonoses (guidance for reporting, advice, etc.).  

The EURL for rabies is hosted by the  French Agency for Food, Environmental and Occupational Health & Safety  (ANSES) in Malzéville (France)