Rabies--risk of exposure and current trends in prevention of human cases.

According to official WHO data more than 2.5 billion people are at risk in over 100 countries reporting the disease. Rabies mortality ranks ten in all infectious diseases worldwide. There are still about 50,000 to 60,000 human deaths annually although effective vaccines for post-exposure treatment are available. Most affected are the tropical countries in Africa, Asia, South America, and Oceania. The mortality figures range from about 0.001 per 100,000 for the US to 18 per 100,000 in Ethiopia. The vast majority (95-98%) of the 60,000 annual human death cases worldwide occur in canine (dog rabies) endemic regions with large stray dog population. Control of the disease is hampered by cultural, social and economic realities. In the rabies infested developing countries modern cell culture vaccines are hardly affordable. Dangerous neural tissue derived vaccines are still used. Three dose-saving treatment schedules have been developed: The reduced dose intramuscular 2-1-1 regimen, the two-site intradermal and the 8-site intradermal regimen. There is a critical shortage of human and purified equine rabies immunoglobulins, which are essential biologicals in the treatment of severe exposures.