Current status of human rabies prevention: remaining barriers to global biologics accessibility and disease elimination

ABSTRACT

Introduction: Rabies is a serious, neglected tropical disease. Zoonotic agents are RNA viruses (Genus Lyssavirus, Family Rhabdoviridae), global in distribution. As an acute, progressive, incurable encephalitis, rabies has the highest case fatality of any infectious disease. Warm-blooded vertebrates are susceptible hosts. Major mammalian reservoirs include mesocarnivores and bats. Given wildlife perpetuation, rabies is not eradicable, but is preventable and controllable, especially under newly available international guidelines.

Areas covered: Literature review over the past 5 years reveals development of sensitive, specific diagnostic tests and safe and highly effective human and veterinary vaccines. Yet, tens of thousands of human fatalities occur annually, usually in Africa and Asia, primarily after canine exposure. Human and domestic animal vaccination, before or after exposure, is the single greatest preventative strategy following a rabid animal bite.

Expert opinion: Significant progress occurred during the twenty-first century regarding vaccine development, doses, and schedules. Remaining barriers to widespread rabies vaccination include an inter-related set of economic, cultural, social, educational, ecological and technological factors. A basic understanding of local and regional root causes of cases historically allows for broader accessibility to vaccination in a trans-disciplinary fashion to meet the global elimination of human rabies caused via dogs (GEHRD) by 2030.

KEYWORDS:

• Barriers
• health disparities
• immunization
• lyssavirus
• neglected tropical disease
• one health
• prophylaxis
• rabies
• vaccines
• zoonosis

Article Highlights

• Rabies is widespread, distributed on all continents except for Antarctica.

• Multiple causative species of lyssaviruses have been detected over the past 70 years, but rabies virus is the most important member of this viral genus.

• The host spectrum is broad, and although all mammals are susceptible to infection by lyssaviruses, the major global reservoir is the domestic dog.

• Pure, potent, safe and efficacious human and veterinary biologics have been available for rabies prevention and control for decades.

• All developed countries have eliminated canine rabies.

• The combination of human rabies prophylaxis and mass canine vaccination equates to a realistic prediction for the successful elimination of human rabies caused by dogs (GEHRD) by the year 2030.

• Regional participation is critical, because if one country remains enzootic for canine rabies, such foci threaten the status of others who have achieved elimination and may be regarded as dog ‘rabies-free’.

• Human and animal rabies cases can be prevented but will continue to occur until the global inter-connectedness of multiple variables, including overt neglect, public ignorance, political indifference, regional strife, and local poverty, is alleviated.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.