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Types  (pre-existing subsection) 

Pre and Postexposure Prophylaxis

While rabies is an invariably fatal disease, modern vaccines have proven successful at preventing infection and are safe for human use. Pre and postexposure prophylaxis (PEP) contain the same rabies vaccination and can be administered to humans to prevent development of clinical rabies. Preexposure vaccinations are given before rabies exposure has occurred, and are typically are used by people who have a high likelihood of encountering rabies, for example veterinarians, researchers, or people planning to travel abroad to regions where rabies is prevalent. Preexposure prophylaxis consists of three doses of the rabies vaccine given on days zero, seven, and either twenty-one or twenty-eight. While the vaccine can last up to 10 years, people who frequently come into contact with rabies often have regular titer tests done to measure rabies antibody presence in the blood. Rabies booster can be administered if needed. Postexposure vaccinations are given after a person has been exposed to the rabies virus. One dose of human rabies immune globulin (HRIG) and an initial rabies vaccine are administered to the patient as soon as possible after the exposure and follow up vaccines are given again three, seven, and fourteen days later. For people who have previously received the preexposure prophylaxis, only a single dose of the rabies vaccine is required. PEP is neither a treatment nor a cure for rabies, it can only prevent the development of clinical rabies in the patient if given before the virus reaches the brain.

In addition to these developments, newer and less expensive purified chicken embryo cell and purified Vero cell rabies vaccines (CCEEV) are now available and are recommended for use by the WHO. The purified Vero cell rabies vaccine uses the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host. CCEEVs can be used in both pre and post exposure vaccinations. CCEEVs use inactivated rabies virus grown from either embryonated eggs or in cell cultures and are safe for use in humans and animals.

Wild animals (pre-existing subsection)

Wildlife species, primarily bats, raccoons, skunks, and foxes, act as reservoir species for different variants of the rabies virus. This promotes both endemic rabies and epizootic outbreaks. Approximately 90% of all reported rabies cases in the US are from wildlife.

Oral Rabies Vaccination Programs (to go under Wild animals)

Oral Rabies Vaccination (ORV) programs have been used in many countries around the world in an effort to control the spread of rabies and limit the risk of human contact with the rabies virus. ORV programs were initiated in Europe in the 1980s, Canada in 1985, and in the United States in 1990. ORV programs typically use edible baits to deliver the oral rabies vaccination to targeted wildlife or feral dog populations. ORV baits consist of a small packet containing the oral vaccine which is then either coated in a fishmeal paste or encased in a fishmeal-polymer block. When an animal bites into the bait, the packets burst and the vaccine is administered. Current research suggest that if adequate amounts of the vaccine is ingested, immunity to the virus should last for upwards of one year. By immunizing wild or stray animals, ORV programs work to create a buffer zone between the rabies virus and potential contact with humans, pets, or livestock. The effectiveness of ORV campaigns in specific areas is determined through trap-and-release methods. Titer tests are preformed on the blood drawn from the sample animals in order to measure rabies antibody levels in the blood. Baits are usually distributed by aircraft to more efficiently cover large, rural regions. In order to place baits more precisely and to minimize human and pet contact with baits, however, they are distributed by hand in suburban or urban regions. The potential for human contact with baits is a present concern for OPV programs, but the oral vaccine does not contain the whole rabies virus and has been proven safe in over 60 animal species including cats and dogs.

In the United States, the National Rabies Management Program was established in response to a growing rabies problem with the goal of eventually eliminating terrestrial rabies. Specifically, US ORV programs are used to target wildlife populations, as mandatory rabies vaccination of domestic animals has caused wildlife to slowly replace dogs as the primary reservoir of the rabies virus. Most ORV programs are carried out through the Wildlife Services (WS) program of the United States Department of Agriculture (USDA) and Animal and Plant Health Inspection Services (APHIS) in collaboration with local, state, and federal governments as well as universities and volunteer groups. Currently, raccoon rabies is the largest target for ORV programs in the US, with over 6.5 million baits carrying raccoon variant rabies vaccines being distributed every year. ORV programs are especially prevalent in the eastern United States where they are used in 16 different states in an effort to reinforce the natural barrier of the Appalachian mountains and stop the westward spread of raccoon rabies. ORV campaigns have decreased the cases of rabies in places such as Long Island, New York and Cape Cod, Massachusetts. Additionally, ORV programs have already proven successful in Texas where they were employed against canine rabies in coyotes and gray fox variant rabies. In 2008 the domestic dog-coyote variant rabies was declared to have been successfully eliminated from the contiguous United States. ORV programs are still used in the south western United States to combat gray fox rabies and have been able to reduce the original treatment area for the virus by approximately 50%.

Approximately 55,000 people receive PEP treatment every year which costs an estimated $200 million. ORV programs are projected to reduce this cost by up to $50 million annually through preventative measures. The USDA estimates that ORV programs in Texas saved between $4 and $13 for ever $1 spent.