In human patients rabies is almost 100% fatal. Which makes it the most deadly “killer” of all zoonotic infectious diseases. But there is hope that it could be eradicated in near future. Post-exposure prophylaxis is a successful treatment. However, it is very expensive and not always accessible in resource-poor regions. The most promising strategy is to vaccinate the majority of domestic dogs. Field evidence clearly supports this One Health approach. The global goal is to end the public health threat of rabies by 2030.
Rabies is a viral disease of humans and mammals which causes about 24,000 to 60,000 deaths worldwide per year , . More than 95% of human deaths occur in Asia and Africa . Infections occur following bite or scratch by an infected animal. Rabies causes a severe inflammation of the brain . Human rabies cases develop neurological symptoms after a typical incubation period of one to three months .
Prophylactic vaccination in humans is highly protective . However, due to high costs and possible side effects this preventive measure is only feasible and recommended for persons with a high occupational risk of rabies exposure, such as veterinarians. In unvaccinated humans, rabies is almost always fatal .
Post-exposure prophylaxis (PEP) is highly successful in preventing the disease, but only if administered fast enough (within less than 6 days after suspected infection) , . However, the high costs of the mandatory course of 4 - 5 weekly post-exposure vaccinations (50,000 UGX ≈ 14 USD per single dose, for example in Uganda by February 2017), and in severe bite cases the administration of rabies immune globulin (RIG), often makes this life-saving treatment inaccessible for poor and vulnerable populations. This burden is aggravated by the occurrence of rabies mainly in remote rural communities where children between the age of 5–14 years become the predominant victims of the fatal disease .
An uninterrupted cooling chain which ensures the transport and storage of the vaccine and RIG doses at a constant temperature of 2-8 °C is essential for an effective PEP treatment. This poses a major challenge especially in remote areas with poor infrastructure. However, simply focusing on post-exposure treatment of human patients is neither sufficient nor feasible.
Compared to achieving so-called protective “herd immunity” by vaccinating at least 70% of all domestic dogs in a region, post-exposure prophylaxis of human dog-bite patients is extremely expensive and not a sustainable solution , , . Field investigations in Africa and Asia could prove that canine mass vaccination acts as a reliable and cost-effective immunologic barrier against human exposure , .
While rabies and closely related viruses might never be completely eliminated due to their wildlife reservoirs, such as bats and wild carnivores , , , the eradication of dog-mediated human rabies is a realistic and worthwhile goal. Because more than 99% of all recorded human cases worldwide resulted from the bite of a domestic dog . The World Health Organization (WHO), World Organization for Animal Health (OIE), Food and Agriculture Organization of the United Nations (FAO), and the Global Alliance for Rabies Control jointly advocate a global One Health framework. The main pillar of this interdisciplinary strategy is the vaccination of the majority of domestic dogs, including pet, working, and stray dogs in participating countries . The goal of the campaign is to eliminate canine-mediated human rabies by 2030 .
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with special focus on advances in the development of new safe, effective and economic vaccines for domestic dogs, and oral vaccines for the control of the disease in wild animals. Therapeutic protocols used for the treatment of patients are also discussed.
El-Sayed A. Advances in rabies prophylaxis and treatment with emphasis on immunoresponse mechanisms. International Journal of Veterinary Science and Medicine. Available online 18 May 2018. ISSN 2314-4599. https://doi.org/10.1016/j.ijvsm.2018.05.001.
General information by WHO
Less-known facts about rabies and its prevention
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