prevalence of rabies prevalence of rabies almost all human deaths caused by rabies occur in asia and africa. there are an estimated 59,000 human deaths annually from rabies worldwide. 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. 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, mongoose, 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 initiated on a large scale in belgium and that has successfully reduced rabies in rural areas of canada, france, the united states, and elsewhere. for example, in montreal baits are successfully ingested by raccoons in the mount royal park area. 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 vietnam and thailand, the virus is primarily transmitted through canines (feral dogs and other wild canine species). 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. it wasn't until the 1990s that death rates decreased, 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 surveillance system (nndss) 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 has been 1 reported case of rabies transmission through organ donation 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. 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, 29 people have been reported dead from rabies in israel. 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. rabies is not endemic to israel, but is imported from neighbouring countries. the areas of highest prevalence are along the northern region, which are close to lebanon and syria. since the early 2000s, the ministry of agriculture and israel nature and national parks protection authority (ila) have dropped oral vaccines from planes in open and agricultural areas. the vaccine comes in the form of 3 by 3 cm. dumplings, made with an ingredient preferred by wild animals, and which contain a transgenic rabies virus. cases of animal rabies dropped from 58 in 2009 to 29 in 2016. japan rabies existed in japan with a particular spike in the mid-1920s, but a dog vaccination campaign and increased stray dog control reduced cases. the rabies control act was enacted in 1950, and the last human and animal cases were reported in 1954 and 1957, and japan is believed to have been rabies-free since 1957. there have been four imported cases since then, a college student who died in 1970, two elderly men who had traveled to the philippines and been bitten there by rabid dogs, and then died after returning to japan, and a man in his 30s who also was bitten by a rabid dog in the philippines and died in 2020. africa approximately 24,000 people die from rabies annually in africa, which accounts for almost half the total rabies deaths worldwide each year. south africa in south africa, about a dozen cases of human rabies are confirmed every year and it is particularly widespread in the north-eastern regions of the eastern cape, the eastern and south-eastern areas of mpumalanga, northern limpopo and kwazulu-natal. dogs are the main vector (especially in the east of the country) for the disease but also wildlife, including the bat-eared fox, yellow mongoose and black-backed jackal. the death rate of 13 per annum over the decade 2001–2010 is a rate of approximately 0.26 per million population. this is approximately 30 times the rate in the united states but 1/90 of the african average. the number of cases per province over the last decade is as follows: year eastern cape free state gauteng kwazulu-natal limpopo mpumalanga northern cape north-west western cape south africa 2001 6 1 7 2002 8 1 1 10 2003 1 9 1 11 2004 7 1 8 2005 3 1 3 7 2006 4 4 22 1 31 2007 6 8 1 15 2008 8 5 3 1 17 2009 7 4 2 2 15 2010 2 1 3 3 1 1 1 12 2001 to 2010 31 1 1 57 31 6 2 2 2 133 2011 1 2 3 6 2012 1 1 4 3 1 10 2013 2 1 3 1 7 2014 3 1 1 5 2015 3 1 1 3 8 average 2.6 0.3 0.1 5.4 2.9 0.5 0.1 0.2 0.1 11.3 north america united states the united states as with other developed countries have seen a dramatic decrease in the number of human infections and deaths due to the rabies virus. according to the centers for disease control and prevention (cdc) the stark reduction in the number of rabies cases is attributable to the elimination of canine rabies through vaccination, the vaccination of wildlife, education about the virus, and timely administration of post exposure prophylaxis. currently, in the u.s. only one to three cases of rabies are reported annually. since 2008 there have been 23 cases of human rabies infection, eight of which were due to exposures outside of the u.s. human exposures to the virus is dependent on the prevalence of the virus in animals, thus investigations into the incidence and distribution of animal populations is vital. a breakdown of the results obtained from animal surveillance in the u.s. for 2015 revealed that wild animals accounted for 92.4% and domestic animals accounted for 7.6% of all reported cases. in wild animals, bats were the most frequently reported rabid species (30.9% of cases during 2015), followed by raccoons (29.4%), skunks (24.8%), and foxes (5.9%). southern united states rabies was once rare in the united states outside the southern states, but raccoons in the mid-atlantic and northeast united states have had a rabies epidemic since the 1970s, that is now moving westwards into ohio. most westward expansion has been prevented via the action of oral rabies vaccination (orv) programs. cases of animal rabies in the united states in 2001 the particular variant of the virus has been identified in the southeastern united states raccoon population since the 1950s, and is believed to have traveled to the northeast as the result of infected raccoons being among those caught and transported from the southeast to the northeast by human hunters attempting to replenish the declining northeast raccoon population. as a result, urban residents of these areas have become more wary of the large but normally unseen urban raccoon population. whether as a result of increased vigilance or only the common human avoidance reaction to any other animal not normally seen, such as a raccoon, there has only been one documented human rabies case as a result of this variant. this does not include, however, the greatly increasing rate of prophylactic rabies treatments in cases of possible exposure, which numbered fewer than one hundred humans annually in the state of new york before 1990, for instance, but rose to approximately ten thousand annually between 1990 and 1995. at approximately $1,500 per course of treatment, this represents a considerable public health expenditure. raccoons do constitute approximately 50% of the approximately eight thousand documented non-human rabies cases in the united states. domestic animals constitute only 8% of rabies cases, but are increasing at a rapid rate. midwestern united states a rabid dog, with saliva dripping out of the mouth in the midwestern united states, skunks are the primary carriers of rabies, composing 134 of the 237 documented non-human cases in 1996. the most widely distributed reservoir of rabies in the united states, however, and the source of most human cases in the u.s., are bats. nineteen of the twenty-two human rabies cases documented in the united states between 1980 and 1997 have been identified genetically as bat rabies. in many cases, victims are not even aware of having been bitten by a bat, assuming that a small puncture wound found after the fact was the bite of an insect or spider; in some cases, no wound at all can be found, leading to the hypothesis that in some cases the virus can be contracted via inhaling airborne aerosols from the vicinity of bats. for instance, the centers for disease control and prevention (cdc) warned on may 9, 1997, that a woman who died in october 1996 in cumberland county, kentucky and a man who died in december 1996 in missoula county, montana were both infected with a rabies strain found in silver-haired bats; although bats were found living in the chimney of the woman's home and near the man's workplace, neither victim could remember having had any contact with them. similar reports among spelunkers led to experimental demonstration in animals. this inability to recognize a potential infection, in contrast to a bite from a dog or raccoon, leads to a lack of proper prophylactic treatment, and is the cause of the high mortality rate for transmission from bats. on september 7, 2007, rabies expert dr. charles rupprecht of atlanta-based u.s. centers for disease control and prevention said that canine rabies had disappeared from the united states. rupprecht emphasized that the disappearance of the canine-specific strain of rabies virus in the us does not eliminate the need for dog rabies vaccination as dogs can