The prevalence of rabies, a deadly viral disease affecting mammals, varies significantly across regions worldwide, posing a persistent public health problem. Rabies is caused by lyssaviruses, including the rabies virus, the Australian bat lyssavirus, the European bat 1 lyssavirus and the European bat 2 lyssavirus.
At a global level dog bites and scratches cause 99% of the human rabies cases, but in some countries, including the United States, most cases of human rabies are acquired from bats.
Almost all cases of human rabies are transmitted by animal bites or scratches, or other contact of animal saliva with the eyes, mouth, or open wounds. Although human-to-human transmission is theoretically possible, given that the rabies virus is present in the saliva, sperm and vaginal secretions of infected people and therefore could be transmitted through bites or sexual intercourse, no such case of transmission has ever been documented. There have been, however, rare cases of transmission of rabies through organ transplants. No case of rabies transmission from consuming the meat or milk of rabid animals has ever been documented, although the World Health Organization strongly discourages eating products from rabid animals.
Almost all human deaths caused by rabies occur in Asia and Africa. It is estimated that 60% of rabies human deaths occur in Africa. Outside of Africa, rabies is especially prevalent in India (which accounts for 36% of global rabies deaths) and in parts of Southeast Asia. Rabies is rare in Europe, although sporadic cases do occur in Eastern Europe, particularly in red foxes. In the Americas, bats are the primary vectors of the disease.
There are an estimated 59,000 human deaths annually from rabies worldwide. However, this data is not substantiated by the World Health Organization (WHO) reports registering numbers of death attributed by rabies, worldwide. Reported numbers often add up to less than 1,000 yearly.
Dog licensing, euthanasia of stray dogs, muzzling, and other measures contributed to the elimination of rabies from the United Kingdom in the early 20th century. More recently, large-scale vaccination of cats, dogs and ferrets has been successful in combating rabies in many developed countries, such as Turkey, where pre-exposure vaccinations have been used to combat the prevalence of rabies.
Rabies is a zoonotic disease, caused by the rabies virus. The rabies virus, a member of the Lyssavirus genus of the Rhabdoviridae family, survives in a diverse variety of animal species, including bats, monkeys, raccoons, foxes, skunks, wolves, coyotes, dogs, mongooses, weasels, cats, cattle, domestic farm animals, groundhogs, bears, and wild carnivores. However dogs are the principal host in Asia, parts of the Americas and large parts of Africa. Oral vaccines can be safely administered to wild animals through bait, a method first used in Switzerland in the 1970s, and that has successfully reduced rabies in rural areas of Canada, the United States, parts of Europe and elsewhere. For example in Montreal baits are successfully ingested by raccoons in the Mount Royal park area.
Dog-mediated rabies
Dog-mediated rabies is defined as "any case caused by rabies virus maintained in the dog population (Canis lupus familiaris) independently of other animal reservoir species, as determined by epidemiological studies". Most Western countries have eliminated dog-mediated rabies but it remains prevalent in developing countries.
Dog-mediated rabies represents a threat to human health, particularly in Asia and Africa, especially in areas where there are numerous stray dogs. In India rabies is primarily transmitted to humans from dogs (97% of human rabies cases), followed by cats (2%), jackals, mongooses and others (1%). In places where human consumption of dog meat is common, such as Vietnam, butchers who slaughter dogs are at risk of contracting rabies.
In Western countries illegal smuggling of dogs from other countries, or travelling with unvaccinated dogs abroad to countries where rabies is prevalent, can reintroduce rabies in the rabies-free Western countries. For instance in Spain in 2013 a rabid dog, which had been infected in Morocco, was discovered in Toledo.
Bats
Bats in most parts of the world carry lyssaviruses. In the Americas, bats carry the classical rabies virus (RABV), with vampire bats being the principal vector of human transmission of rabies in Latin America. In the United States, the silver haired bat and the tricolored bat are responsible for about 60% of human rabies infections in cases where the virus variant was identified.
The most common lyssaviruses carried by bats in Europe are European bat 1 lyssavirus and European bat 2 lyssavirus, although Bokeloh bat lyssavirus (BBLV), West Caucasian bat lyssavirus (WCBV), Lleida bat lyssavirus (LLEBV) and Kotalahti bat lyssavirus have also been discovered.
In Australia, bats carry Australian bat lyssavirus, which has caused four human deaths since its discovery in 1996, the most recent one being in 2025 in New South Wales.
In Asia, bats carry Aravan lyssavirus, Khujand lyssavirus, Irkut lyssavirus, West Caucasian bat lyssavirus and Gannoruwa bat lyssavirus.
In Africa, bats carry Lagos bat virus, Mokola virus, Duvenhage virus, Ikoma lyssavirus and Shimoni bat lyssavirus. In 2007, a Dutch woman died in Amsterdam, after she had contracted the Duvenhage virus from a bat while on a trip in Kenya.
It is understood that the rabies vaccine used to prevent infection with the classical rabies virus (RABV) also offers protection against lyssaviruses in Pylogroup I category (Australian bat lyssavirus (ABLV), Aravan virus (ARAV), Bokeloh bat lyssavirus (BBLV), Duvenhage virus (DUVV), European bat lyssavirus type 1 (EBLV-1), European bat lyssavirus type 2 (EBLV-2), Gannoruwa bat lyssavirus (GBLV), Irkut virus (IRKV), and Khujand virus (KHUV)), but does not offer protection against the more divergent lyssaviruses in Phylogroup II category (Lagos bat virus (LBV Lineages A–D), Mokola virus (MOKV), and Shimoni bat virus (SHIBV)) and the highly divergent lyssaviruses of Phylogroup III category (Ikoma lyssavirus (IKOV), Lleida bat lyssavirus (LLEBV), and West Caucasian bat virus (WCBV)).
Only 14 human deaths from lyssaviruses other than RABV have been reported as of 2021, although this is likely an underestimation of the total number, given the complexity of diagnosis and of distinguishing between different lyssavirus species. In Europe, there have been five such deaths documented: in Ukraine (1977, species not characterised), Russia (1985, EBLV‐1), Finland (1985, EBLV‐2), the United Kingdom (2002, EBLV‐2) and France (2019, EBLV‐1).
It is possible, albeit extremely rare, for lyssaviruses other than RABV to spillover from bats to terrestrial mammals. Such cases have occurred in Denmark in 1998 and 2002 (in sheep), in Germany in 2001 (in a stone marten), in France in 2003 and 2007 (in cats), in 2020 in Italy (in a cat), and in 2024 in the Netherlands (in a cat).
Asia
An estimated 31,000 human deaths due to rabies occur annually in Asia, with the majority – approximately 20,000 – concentrated in India. Worldwide, India has the highest rate of human rabies in the world primarily due to stray dogs. Because of a decline in the number of vultures due to acute poisoning by the anti-inflammatory drug diclofenac (vultures themselves are not susceptible to rabies), animal carcasses that would have been consumed by vultures instead became available for consumption by feral dogs, resulting in a growth of the dog population and thus a larger pool of carriers for the rabies virus. Another reason for the great increase in the number of stray dogs is the 2001 law that forbade the killing of dogs.
In many Asian countries which still have a high prevalence of rabies, such as Myanmar and Nepal, the virus is primarily transmitted through canines (feral dogs and other wild canine species). Countries with high canine rabies prevalence often lack robust national rabies surveillance/control programs and have limited canine rabies vaccine availability. Legalized dog consumption, in countries such as Vietnam, is another source of high rabies incidence in Southeast Asia. One study reported that 28.3% of dog butchers in Vietnam were at high risk of rabies infection, but only 8.1% were vaccinated. Another source of rabies in Asia is the pet boom.
Mainland China Historically rabies was highly endemic in China, with few/inconsistent attempts to control transmission due to the lack of healthcare infrastructure. More than 5,200 deaths were reported annually during the period 1987–1989. Infection is seasonal, with most cases reported during the winter and spring, with dogs being the most common animal vector. The highest number of recorded cases was recorded in 1981, with 7,037 human infections. Death rates did not decrease until the 1990s, as eradication efforts started being implemented on a nationwide level. The incidence of rabies decreased to fewer than 2,000 cases per annum by 2011. Despite this progress, rabies is still the fourth most common cause of death amongst category A and B infectious diseases, following HIV/AIDS, tuberculosis, and viral hepatitis in 2018.
Chinese law requires all diagnosed rabies cases to be recorded in the National Notifiable Disease Reporting System (NNDRS) within 24 hours of diagnosis. Additionally, a questionnaire is used to interview patients and family members, in order to collect demographic information, as well as the means of exposure.
Due to China's open organ transplant policy, an additional vector for the transmission of rabies is via donated organs. There have been 4 reported cases of rabies transmission through organ donation in China. The first occurred in 2015, where a previously healthy 2-year-old patient was checked in to a hospital with unspecified symptoms. Rabies virus antibody tests were performed on serum samples and yielded negative results, which allowed the body to be used for donations despite suspicions from the clinical staff. The donor's kidneys and liver were transplanted to three other patients, who eventually died due to the rabies virus.
In 2006 China introduced the "one-dog policy" in Beijing to control the problem. In 2021, the Law on Animal Epidemic Prevention was revised, and now requires dog owners to ensure routine vaccination and register the vaccine certificate.
+ Number of human rabies cases in mainland China Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Cases 2651 2537 3279 3300 2466 2213 2048 1917 1425 1172 924 801 644 516 422 290 202 157 133 122
Indonesia The island of Bali in Indonesia has been undergoing a severe outbreak of canine rabies since 2008, that has also killed about 78 humans as of late September 2010. Unlike predominantly Muslim parts of Indonesia, in Bali many dogs are kept as pets and strays are tolerated in residential areas. Efforts are under way to vaccinate pets and strays, as well as selective culling of some strays, to control the outbreak. As Bali is a popular tourist destination, visitors are advised to consider rabies vaccinations before going there, if they will be touching animals.
Israel Since 1948, 31 people have been reported dead from rabies in Israel. 55 rabies incidents were reported in 2024, and 45 rabies incidents were reported in 2023. The latest case of human rabies was in 2024, when a man became infected after being bitten by his pet dog. In 2023, a child died after being bitten by a rabid stray dog in the Jordan Valley. Prior to that, the last death was in 2003, when a 58-year-old Bedouin woman was bitten by a cat and became infected. She was not inoculated and later died.