Bhutan Eliminates Dog-Transmitted Rabies

Bhutan has become the first country in the WHO South-East Asia Region to eliminate dog-transmitted rabies as a public health problem.

Bhutan has maintained zero human deaths from dog-transmitted rabies since June 2023 through surveillance, vaccination, and a One Health approach.

Validation of Elimination

The validation was conducted according to the WHO Expert Consultation on Rabies (2018) criteria. Experts supported by the World Health Organization (WHO) and the World Organisation for Animal Health (WOAH) assessed Bhutan’s surveillance systems, laboratories, records and field-level implementation.

For elimination of dog-mediated human rabies as a public health problem, there must be no human deaths from dog-transmitted rabies for at least two years, along with effective surveillance, vaccination and disease-control mechanisms to prevent re-emergence.

Rabies

About Rabies

Rabies is a viral zoonotic disease caused by the rabies virus, a neurotropic virus belonging to the Lyssavirus genus.

The virus affects the central nervous system and can cause fatal encephalitis after the onset of clinical symptoms. Rabies is also classified as a Neglected Tropical Disease (NTD).

Once clinical symptoms appear, rabies is virtually 100% fatal.

Transmission

Rabies is primarily transmitted through the saliva of infected animals, particularly through bites and scratches.

Transmission can also occur when infected saliva comes into contact with broken skin or mucous membranes. Human-to-human transmission is extremely rare and has mainly been associated with organ transplantation.

Prevention and Treatment

Rabies deaths are completely preventable when appropriate post-exposure prophylaxis (PEP) is provided promptly.

PEP includes immediate washing of the wound with soap and water for 15 minutes, followed by a full course of rabies vaccine. For severe exposures, rabies immunoglobulin (RIG) or monoclonal antibodies may also be administered.

Symptoms

The incubation period is usually around 2–3 months, although it can range from approximately one week to one year.

Two major clinical forms are recognised:

Furious rabies is characterised by hydrophobia, hallucinations, hyperactivity and rapid progression to death.

Paralytic rabies involves gradual paralysis and may sometimes be misdiagnosed.

Rabies Burden

India continues to face a significant rabies burden, largely associated with dog bites.

Globally, rabies imposes an estimated economic cost of approximately US$8.6 billion annually, including healthcare expenditure, livelihood losses and the financial burden of post-exposure prophylaxis (PEP).