• Rabies is primarily transmitted through the bite or scratch of an infected animal, as the virus is present in the saliva. It can also be transmitted if infected saliva comes into contact with mucous membranes (eyes, mouth, nose) or broken skin.
• Rabies is not transmitted by petting an animal, or contact with its blood, urine, or faeces.
• Globally, dogs are the main source of human rabies cases, accounting for over 99% of infections, especially in Asia and Africa. In the Americas, bats are the most common source of rabies infections in humans.
• For Australian travellers, Indonesia, Thailand, India and Nepal are common destinations and areas of risk for possible rabies exposure.
• Rabies was first reported in Bali at the end of 2008 and despite government efforts to control the infection though awareness campaigns and dog vaccination programs, the disease is now endemic.
• The incubation period (time from exposure to symptoms) typically ranges from 1 to 3 months but can vary from less than a week to over a year, depending on factors like the bite location and virus travel distance to the central nervous system
• Early symptoms resemble flu-like signs such as fever, headache, weakness, and abnormal sensations (tingling, burning, or pain) at the site of exposure.
• As the virus spreads to the brain, neurological symptoms develop. Rabies has two clinical forms:
  • Furious rabies: Characterized by hyperactivity, agitation, hallucinations, seizures, hydrophobia (fear of water), and aerophobia (fear of drafts). Death usually occurs within days due to cardio-respiratory arrest.
  • Paralytic rabies: Characterized by gradual paralysis starting from the bite site, progressing to coma and death over a longer period. This form accounts for about 20% of cases and is often misdiagnosed.
• Once clinical symptoms appear, rabies is almost always fatal, with death typically occurring within 1 to 2 weeks after symptom onset

 

Countries with High Rabies Mortality

• Rabies is a significant public health problem in over 150 countries, mainly in Asia and Africa, causing an estimated 59,000 deaths annually, with children under 15 years old disproportionately affected.
• Australia is free of classical rabies but has related lyssaviruses in bats, such as the Australian bat lyssavirus, which can cause a similar fatal disease