Infection with rabies virus

Article 8.15.1.

General provisions

Rabies is a disease caused by neurotropic viruses of the Genus Lyssavirus in the family Rhabdoviridae of the order Mononegavirales and is transmissible to all mammals. Populations of the orders Carnivora and Chiroptera are considered to be the main reservoir hosts.

Rabies virus, the taxonomic prototype species in the Lyssavirus Genus formerly referred to as 'classical rabies virus, genotype-1', is found in most parts of the world, and is responsible for the vast majority of reported animal and human rabies cases. The most common source of exposure of humans to rabies virus is the dog.

Other Lyssavirus species can cause clinical signs similar to those caused by rabies virus, but have more restricted geographical and host range, with the majority having been isolated only from bats, thus having limited public and animal health implications.

The aim of this chapter is to mitigate the risk to the public and animal health posed by infection with rabies virus and to prevent the international spread of rabies virus.

Official control programmes to reduce the economic and public health burden of rabies are recommended, even in those countries where only bat-mediated rabies or wild carnivore-mediated rabies are present.

The incubation period for rabies is highly variable depending on viruses, hosts and sites of entry, and the majority of infected animals will develop disease within six months of exposure.

The infective period for rabies virus is variable and can start before the onset of clinical signs. In dogs, cats and ferrets virus shedding can start up to ten days before the onset of the first clinical signs and last until death.

For the purposes of the Terrestrial Code
:

• a case is any animal infected with rabies virus;
  

• 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;
  

• the incubation period of infection with rabies virus shall be six months.
  

Standards for diagnostic tests and vaccines are described in the Terrestrial Manual.

Article 8.15.2.

Country or zone free from infection with rabies virus

1. A country or zone may be considered free from infection with rabies virus when:

   1. it has a record of regular and prompt animal disease reporting in accordance with Chapter 1.1.;

   2. infection with rabies virus is a notifiable disease in the entire country and any change in the epidemiological situation or relevant events are reported in accordance with Chapter 1.1.;

   3. all susceptible animals showing clinical signs suggestive of rabies are subjected to appropriate field and laboratory investigations;

   4. an ongoing system of surveillance in accordance with Chapter 1.4. and Article 8.15.13. has been in place for the past 24 months, with a minimum requirement being an early warning system to ensure investigation and reporting of animals suspected of being infected;

   5. regulatory measures for the prevention of infection with rabies virus are implemented in accordance with the relevant recommendations in the Terrestrial Code including Articles 8.15.5. to 8.15.10.;

   6. no case of indigenously acquired infection with rabies virus has been confirmed during the past 24 months;

   7. if an imported case is confirmed outside a quarantine station, epidemological investigations have ruled out the possibility of secondary cases.

2. Preventive vaccination of animals does not affect the free status.

3. An imported human case of rabies does not affect the free status.

Article 8.15.3.

Country or zone infected with rabies virus

A country or zone that does not fulfil the requirements of Article 8.15.2. is considered to be infected with rabies virus.

Article 8.15.4.

Country or zone free from dog-mediated rabies

1. A country or zone may be considered free from dog-mediated rabies when:

   1. it has a record of regular and prompt animal disease reporting in accordance with Chapter 1.1.;

   2. dog-mediated rabies is a notifiable disease in the entire country and any change in the epidemiological situation or relevant events are reported in accordance with Chapter 1.1.;

   3. an ongoing system of surveillance in accordance with Chapter 1.4. and Article 8.15.13. has been in place for the past 24 months, with a minimum requirement being an early warning system to ensure investigation and reporting of animals suspected of infection with rabies virus;

   4. regulatory measures for the prevention of infection with rabies virus are implemented in accordance with the relevant recommendations in the Terrestrial Code including Articles 8.15.5. to 8.15.10.;

   5. no case of indigenously acquired dog-mediated rabies has occurred during the past 24 months;

   6. a dog population control programme has been implemented and maintained in accordance with Chapter 7.7.

2. The following do not affect the status of a country or zone free from dog-mediated rabies:

   • preventive vaccination;

   • presence of rabies virus in wild animals;

   • imported human cases of rabies;

   • imported case outside a quarantine station whenever epidemological investigations have ruled out the possibility of secondary cases.

Article 8.15.5.

Recommendations for importation of domestic and captive wild mammals from countries or zones free from infection with rabies virus

Veterinary Authorities should require the presentation of an international veterinary certificate attesting that the animals:

1. showed no clinical sign of rabies the day prior to or on the day of shipment;

2. and either:

   1. were kept since birth or at least six months prior to shipment in a free country or zone; or

   2. were imported in accordance with Articles 8.15.7., 8.15.8., 8.15.9. or 8.15.10.

Article 8.15.6.

Recommendations for importation of wild and feral mammals from countries or zones free from infection with rabies virus

Veterinary Authorities should require the presentation of an international veterinary certificate attesting that the animals:

1. showed no clinical sign of rabies the day prior to or on the day of shipment;

2. and either:

   1. have been captured at a distance that precludes any contact with animals in an infected country or zone. The distance should be defined in accordance with the biology of the species exported, including home range and long distance movements; or

   2. have been kept in captivity for the six months prior to shipment in a country or zone free from infection with rabies virus.

Article 8.15.7.

Recommendations for importation of dogs, cats and ferrets from countries or zones infected with rabies virus

Veterinary Authorities should require the presentation of an international veterinary certificate complying with the model of Chapter 5.11. attesting that the animals:

1. showed no clinical sign of rabies the day prior to or on the day of shipment;

2. were permanently identified and their identification number stated in the certificate;

3. and either:

   1. were vaccinated or revaccinated in accordance with the recommendations of the manufacturer, with a vaccine that was produced in accordance with the Terrestrial Manual and were subjected not less than 3 months and not more than 12 months prior to shipment to an antibody titration test as prescribed in the Terrestrial Manual with a positive result of at least 0.5 IU/ml;

   or

   2. were kept in a quarantine station for six months prior to shipment.

Article 8.15.8.

Recommendations for importation of domestic ruminants, equids, camelids and suids from countries considered infected with rabies

Veterinary Authorities should require the presentation of an international veterinary certificate attesting that the animals:

1. showed no clinical sign of rabies the day prior to or on the day of shipment;

2. were permanently identified and the identification number stated in the certificate;

3. EITHER

   1. were kept for the 6 months prior to shipment in an establishment where there has been no case of rabies for at least 12 months prior to shipment;

   OR

   2. were vaccinated or revaccinated in accordance with the recommendations of the manufacturer. The vaccine was produced and used in accordance with the Terrestrial Manual.

Article 8.15.9.

Recommendations for importation of susceptible laboratory animals from countries or zones infected with rabies virus

Veterinary Authorities should require the presentation of an international veterinary certificate attesting that the animals:

1. showed no clinical sign of rabies the day prior to or on the day of shipment;

2. were born and kept since birth in a biosecure facility as described in the Terrestrial Manual chapter on Management of veterinary diagnostic laboratories, and where there has been no case for at least 12 months prior to shipment.

Article 8.15.10.

Recommendations for importation of wildlife from countries considered infected with rabies

Veterinary Authorities should require the presentation of an international veterinary certificate attesting that the animals:

1. showed no clinical sign of rabies the day prior to or on the day of shipment;

2. were kept for the six months prior to shipment in an establishment where separation from susceptible animals was maintained and where there has been no case of rabies for at least 12 months prior to shipment.

Article 8.15.11.

WOAH endorsed official control programme for dog-mediated rabies

The overall objective of a WOAH endorsed official control programme for dog-mediated rabies is for Member Countries to progressively improve their dog-mediated rabies situation and eventually be able to make a self-declaration in accordance with Chapter 1.6. as a country free from dog-mediated rabies. The official control programme should be applicable to the entire country even if certain measures are directed towards defined subpopulations only.

Member Countries may, on a voluntary basis, apply for endorsement of their official control programme for dog-mediated rabies when they have implemented measures in accordance with this article.

For its official control programme for dog-mediated rabies to be endorsed by WOAH, the Member Country should:

1. have a record of regular and prompt animal disease reporting in accordance with Chapter 1.1.;

2. submit documented evidence (including relevant legislation) of its capacity to control dog-mediated rabies. This evidence may be provided using data generated by the PVS Pathway;

3. submit a detailed plan of the programme to control and eventually eradicate dog-mediated rabies in the country including:

   1. the timeline;

   2. the performance indicators for assessing the effectiveness of the control measures to be implemented;

   3. documentation indicating that dog-mediated rabies is a notifiable disease and that the official control programme for dog-mediated rabies is applicable to the entire country;

4. submit a dossier on dog-mediated rabies in the country describing the following:

   1. the general epidemiology in the country highlighting the current knowledge and gaps in knowledge and the progress that has been made in controlling dog-mediated rabies;

   2. the measures implemented to prevent introduction of infection;

   3. the rapid detection of, and response to, dog-mediated rabies cases, to reduce the incidence and to eliminate transmission in at least one zone in the country;

   4. dog population control programme in accordance with Chapter 7.7.;

   5. collaboration agreements or programmes with other Competent Authorities such as those responsible for public health and management of wild and feral animals;

5. submit evidence that surveillance of dog-mediated rabies is in place:

   1. by taking into account provisions in Chapter 1.4. and Article 8.15.13.;

   2. by having diagnostic capability and procedures, including regular submission of samples to a laboratory that carries out diagnosis to support epidemiological investigation;

6. where vaccination is practised as part of the official control programme for dog-mediated rabies, provide:

   1. evidence (such as copies of legislation) that vaccination of selected populations is compulsory and the vaccines are produced in accordance with the Terrestrial Manual;

   2. detailed information on vaccination campaigns, in particular on:

      1. target populations;

      2. monitoring of vaccination coverage;

      3. technical specifications of the vaccines used and description of the regulatory procedures in place;

7. provide preparedness and contingency plans.

The Member Country's official control programme for dog-mediated rabies will be included in the list of programmes endorsed by WOAH only after the submitted evidence has been accepted by WOAH. Retention on the list requires an annual update on the progress of the official control programme and information on significant changes concerning the points above. Changes in the epidemiological situation and other significant events should be reported to WOAH in accordance with Chapter 1.1.

WOAH may withdraw the endorsement of the official control programme if there is evidence of:

• non-compliance with the timelines or performance indicators of the programme; or

• significant problems with the quality of the Veterinary Services as per Section 3 of the Terrestrial Code; or

• an increase in the incidence of dog-mediated rabies that cannot be explained or addressed by the programme.

Article 8.15.12.

Recommendations for dog-mediated rabies vaccination programmes

When developing and implementing vaccination programmes for dog-mediated rabies, in addition to provisions in Chapter 4.18., Member Countries should:

1. Prepare for the vaccination programme:

   1. consult with all relevant stakeholders, including target communities to define the most appropriate time to increase community participation and reduce the time required to complete vaccination;

   2. ensure safety of vaccination teams including training in humane dog capture and handling, and a strategy to manage exposure to suspect rabid animals.

2. Choose a vaccine and the vaccination strategy:

   1. Priority should be given to vaccinating free-roaming dogs, including puppies, to quickly interrupt the rabies virus transmission cycle.

   2. Vaccination campaigns should be conducted recurrently (usually annually). More frequent vaccination campaigns may be considered in especially high-risk areas, or to quickly interrupt the cycle of virus transmission.

   3. The vaccination strategy should take into account simultaneous dog population management programmes as described in Chapter 7.7.

3. Monitor the vaccination programme:

   1. To monitor the vaccination coverage, vaccinated dogs should be identified and registered in an animal identification system.

   2. Vaccination certificates which state identification of the dog, date of vaccination and product should be provided to dog owners as proof of vaccination.

   3. Vaccination coverage should be monitored at the smallest administrative level possible.

Article 8.15.13.

Surveillance

1. A Member Country should justify the surveillance strategy chosen in accordance with Chapter 1.4., as being adequate to detect the presence of infection with rabies virus, given the prevailing epidemiological situation. Surveillance should be under the responsibility of the Veterinary Authority.

   For the purposes of rabies surveillance a suspected case is a susceptible animal that shows any change in behaviour followed by death within ten days or that displays any of the following clinical signs: hypersalivation, paralysis, lethargy, abnormal aggression, abnormal vocalisation.

   In particular, Member Countries should have in place:

   1. a formal and ongoing system for detecting and investigating suspected cases;

   2. a procedure for the rapid collection and transport of samples from suspected cases to a laboratory for diagnosis;

   3. a system for recording, managing and analysing diagnostic and surveillance data.

   Rabies surveillance provides data that are indicators of the effectiveness of a rabies control programme and of the maintenance of freedom from infection with rabies virus in a country or zone.

2. In addition to principles in Chapter 1.4. the following are critical for rabies surveillance:

   1. Public awareness

      The Veterinary Services should implement programmes to raise awareness among the public, as well as veterinary paraprofessionals, veterinarians and diagnosticians, who should report promptly any cases or suspected cases.

   2. Clinical surveillance

      Clinical surveillance is a critical component of rabies surveillance and essential for detecting suspected cases. Therefore, a process should be in place and documented for the identification and investigation of suspected cases as well as for sample collection for laboratory diagnosis when rabies cannot be ruled out. Animals (especially carnivores and bats) found dead are recognised as an important source of information for rabies surveillance and should be part of the clinical surveillance.

      Laboratory testing should use the recommended sampling techniques, types of samples and tests described in the Terrestrial Manual.

   3. Sampling

      Surveillance should target suspected cases. Probability sampling strategies are not always useful, as sampling of healthy animals (e.g. not involved in human exposure) rarely returns useful surveillance data.

   4. Epidemiological investigation

      In all situations, especially in countries or zones considering self-declaration of freedom, routine epidemiological investigation of cases and molecular characterisation of virus isolates from human and animal cases is encouraged. Such an investigation allows identification of sources of infection, their geographic origin and their epidemiological significance.

Article 8.15.14.

Cooperation with other Competent Authorities

The Veterinary Authority should coordinate in a timely manner with public health and other Competent Authorities and share information to support the decision-making process for the management of human and animal exposure.

In all regions, Veterinary Authorities of neighbouring countries should cooperate in the control of dog-mediated rabies.

nb: first adopted in 1968; most recent update adopted in 2023.