World Health Organization · 1st edition, 2025 · 32 pages
WHO normative guidance on collecting, analysing and reporting rabies surveillance and post-exposure prophylaxis data from health facilities.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Health-facility staff, rabies treatment centre clinicians, national NTD programme managers, epidemiologists, data managers, veterinary public health staff, ministry of health decision-makers, partner organizations, researchers
- Evidence
- WHO expert consensus (WHO Expert Consultation on Rabies, Third Report, 2018); normative guidance based on programmatic experience and evidence reviews
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO normative guidance provides health-facility and national rabies programme managers with standardised methods for collecting, analysing and reporting rabies case data and post-exposure prophylaxis (PEP) data through routine health information systems. It supports the global “Zero by 30” goal—zero human deaths from dog-mediated rabies by 2030—by strengthening surveillance, improving data quality, and enabling evidence-based rabies elimination programmes.
The document presents WHO case definitions (suspected, probable, confirmed rabies; wound categories I–III), core facility-level indicators (human rabies cases, dog-mediated cases, animal exposures, PEP recipients), and a case-based reporting framework that integrates wound-risk and PEP-risk assessment decision trees. It emphasises that PEP comprises immediate 15-minute wound washing with soap and water, rabies vaccine, and—for category III exposures in immunologically naive individuals—rabies immunoglobulin (RIG) or monoclonal antibodies (RmAbs) administered as soon as possible.
The guidance underscores that robust data collection allows programme managers to forecast biologicals, target interventions geographically, monitor PEP compliance, validate rabies-free zones, and report progress to WHO. It includes templates for individual patient tracking, data-quality metrics (completeness, timeliness, internal and external consistency), and procedures for validating elimination as a public health problem (no dog-mediated human rabies death for ≥24 months, adequate surveillance, effective control programmes).
Key points
For clinicians — doses and thresholds as stated in the guideline
- **Wound washing**: Immediately wash all rabies-exposure wounds with copious water and soap for 15 minutes; apply an antiseptic if available.
- **WHO wound categories**: Category I (intact skin, no exposure) requires no PEP; Category II (minor scratches/abrasions without bleeding) requires vaccine; Category III (transdermal bites, licks on broken skin or mucous membranes, bat contact) requires vaccine plus RIG/RmAbs if immunologically naive.
- **RIG/RmAbs dosing**: Maximum 20 IU/kg body weight for human RIG, 40 IU/kg for equine RIG, 3.33 IU/kg for single monoclonal antibody, 40 IU/kg for cocktail RmAbs; infiltrate into and around wounds; do not administer if any rabies vaccine was given >7 days earlier (except in immunocompromised patients).
- **Intradermal 1-week regimen**: WHO recommends 2-site intradermal vaccination on days 0, 3 and 7 for immunologically naive individuals (shorter, cost-effective); alternative intramuscular regimens (Essen, Zagreb) also acceptable.
- **Previously vaccinated patients**: Individuals who completed PEP <3 months ago need no PEP; those ever vaccinated require shortened schedule (1-site ID or IM on days 0 and 3) and no RIG/RmAbs (except if immunocompromised with category II or III exposure).
- **Animal observation**: In settings with advanced surveillance, PEP may be delayed pending 10-day observation of healthy domestic dogs/cats/ferrets or laboratory testing; if animal remains healthy 10 days post-bite, PEP can be discontinued.
- **Core surveillance indicators**: Total human rabies cases (disaggregated by sex, age, transmission source, confirmation status), dog-mediated rabies cases and mortality rate, number of animal exposures (by WHO category and species), number and proportion receiving PEP, proportion completing PEP schedule.
- **Validation criteria for elimination**: Zero dog-mediated human rabies deaths for ≥24 months, operation of adequate surveillance system as described in WHO TRS 1012, and demonstrable effective rabies control in human and animal populations.
Recommendations for PEP on the basis of surveillance capacity
Table extracted from the guideline
| Surveillance programme | Programme description | When to initiate PEP | When to discontinue PEP |
|---|---|---|---|
| No routine surveillance | No trained professionals for animal assessment; no lab capacity for timely testing | Initiate PEP immediately | Do not discontinue unless trained professional confirms animal healthy 10 days after bite |
| Limited surveillance | Some trained professionals available; lab testing may be delayed | Initiate PEP immediately | Discontinue only if lab gives negative result OR trained professional confirms animal healthy 10 days after bite |
| Advanced surveillance (integrated bite case management) | Trained professionals consistently available; lab can test and report within days | Initiate PEP immediately for bites to head/neck/highly innervated sites, multiple/deep wounds, children. May delay PEP when animal available and low risk determined by trained professional | Discontinue only if lab gives negative result OR trained professional confirms animal healthy 10 days after bite |
Source: World Health Organization, Routine health information system and health facility data for neglected tropical diseases: Rabies. Reproduced in summary form.
From the guideline
Verbatim
“PEP prevents virus entry into the central nervous system, which results in imminent death.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and WHO consultant, I recognise that rabies remains a real threat in Georgia and the South Caucasus, with sporadic dog-mediated cases still reported. This guidance is immediately actionable: every anti-rabies clinic in Tbilisi, Batumi, Kutaisi and district centres should display the PEP decision trees and train staff in the 1-week intradermal regimen, which can triple our vaccine doses and improve compliance. The recommendation I would stress most to Georgian colleagues is the absolute requirement for immediate, thorough 15-minute wound washing with soap—a life-saving step that costs nothing but is too often neglected. One realistic caveat: achieving the validation standard of zero dog-mediated deaths for 24 months will require us to strengthen laboratory confirmation capacity beyond Lugar Center, link veterinary and human surveillance in real time, and maintain RIG stocks in all regions—infrastructure investments that need Ministry of Health and Agriculture coordination and sustained funding.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia and neighbouring South Caucasus countries remain at risk for rabies; dog-mediated rabies has been reported in the region. This guidance is directly applicable: national rabies programmes in Georgia, Armenia and Azerbaijan should adopt the WHO case definitions, integrate the wound- and PEP-risk assessment decision trees into anti-rabies clinics, and establish routine reporting of core indicators to WHO. The intradermal 1-week regimen can significantly reduce vaccine costs and improve completion rates. Programmes will need to ensure RIG/RmAbs availability at least for high-risk exposures (head/neck bites, multiple wounds, immunocompromised patients), forecast biologicals based on exposure data, and link human health surveillance with veterinary services for integrated bite case management. Validation of rabies-free status will require demonstration of ≥24 months without dog-mediated human deaths, which necessitates sensitive, active surveillance and laboratory confirmation capacity.
Questions this guideline answers
Quick answers
What is the minimum post-exposure prophylaxis for a category III dog bite in an unvaccinated child?
Immediate thorough wound washing with soap and water for 15 minutes, rabies immunoglobulin (20 IU/kg for human RIG or 40 IU/kg for equine RIG) infiltrated into and around the wound(s) as soon as possible, and a course of rabies vaccine—WHO recommends the 1-week intradermal regimen (2-site ID on days 0, 3, 7) as shorter and cost-effective.
Can I stop rabies PEP if the dog is still alive and healthy 10 days after the bite?
Yes, but only in settings with advanced surveillance capacity where a trained professional confirms the dog remains healthy. In areas without routine surveillance or where the animal is unavailable for observation, complete the full PEP schedule. Bites to the head, neck or in children should receive PEP immediately regardless.
Does a patient who received full PEP two years ago need RIG for a new category III exposure?
No. Any person who ever received rabies vaccination (PEP or pre-exposure prophylaxis) requires only a shortened vaccine schedule (days 0 and 3) and no RIG/RmAbs, except immunocompromised patients with category II or III exposures who should receive RIG/RmAbs even if previously vaccinated.
How do we report rabies data to WHO and why does it matter?
National focal points should collate and validate data from health facilities, then submit aggregated annual indicators (human rabies cases, animal exposures, PEP recipients, dog vaccination coverage) via the WHO DHIS2 platform or Excel template by end of June each year. Accurate reporting enables forecasting of biologicals, demonstrates progress towards Zero by 30, informs global policy, and is a prerequisite for validation of elimination.
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-09-08
- Languages
- English (Arabic, Chinese, French, Russian, Spanish versions planned for selected companion documents)
- Scope
- Global; all endemic and rabies-free countries
- Audience
- Health-facility staff, rabies treatment centre clinicians, national NTD programme managers, epidemiologists, data managers, veterinary public health staff, ministry of health decision-makers, partner organizations, researchers
- Pages
- 32
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-010730-4
- Evidence
- WHO expert consensus (WHO Expert Consultation on Rabies, Third Report, 2018); normative guidance based on programmatic experience and evidence reviews
- Next review
- Not stated
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
World Health Organization. Routine health information system and health facility data for neglected tropical diseases: rabies. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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