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Cyprus may never have experienced rabies. Such countries as Japan, Norway, Sweden, the United Kingdom, Taiwan, and Iceland have eliminated it and maintain this situation by strict quarantine (American Public Health Association, 1985). Ninety-nine percent of human rabies is related to exposure to canine rabies.

Although the distribution of rabies is worldwide, human and animal cases occur more frequently in the tropical zones (Schneider and Bögel, 1983). Rabies has become a particular problem in the growing urban areas of developing countries. All age groups are susceptible, but a disproportionate number of cases occur in those under 15 years of age, perhaps because of increased contact with animals.

The World Health Organization (WHO Expert Committee on Rabies, 1984; World Health Organization, 1984) collects information on the number of reported rabies cases worldwide. There are about 100 human cases in Europe each year; the primary reservoir of disease is sylvatic (in foxes) with spread to humans via dogs. South America has about 300 human deaths per year. Again, canines are the primary source, with an estimated 18,000 canine cases per year in the 1970s (World Health Organization, 1984). Rabies also is transmitted to cattle by vampire bats and is a major economic problem in South America. Africa and Asia are estimated to have 5,000 and 30,000 human cases per year, respectively. Wild dogs, through contact with domesticated dogs, are the primary source. These figures may be underestimates because of inadequacies in disease surveillance and death registration in many countries.

Disease Burden Estimates

The estimated human deaths from rabies in the developing world, by continent, are shown in Table D-11.1. The estimate for Oceania is based on an assumed incidence of 1 per 100,000 population. Other figures are based on information from the World Health Organization (1984). Population figures for calculating rates are from the 1984 World Population Data Sheet (Population Reference Bureau, 1984). The breakdown of cases by age group is based on the assumption that the incidence rates in the two younger age groups are twice those in the two older age groups. Disease burden estimates for rabies in the developing world are shown in Table D-11.2. These estimates are based on reported cases and may therefore underestimate the total disease burden.

PROBABLE VACCINE TARGET POPULATION

A few identifiable groups are at high risk for rabies and warrant pre-exposure immunization. They include veterinarians, wildlife conservation personnel in endemic areas, animal quarantine facility personnel, and laboratory and field personnel working with rabies (American Public Health Association, 1985). Unfortunately, it is difficult to identify other well-defined risk groups in the general



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