Introduction

Rabies, a fatal neurotropic viral infection, continues to pose a significant threat to human and animal health worldwide. Despite the availability of an effective vaccine and the advancements in research and control of this disease, rabies remains a public health concern in many regions. In a recent review article published in “Medicina Clinica,” researchers Marta Arsuaga, Rosa de Miguel Buckley, and Marta Díaz-Menéndez have provided an exhaustive epidemiological update on rabies and discussed the strategies for pre- and post-exposure management (DOI: 10.1016/j.medcli.2023.11.017).

Epidemiological Update

The global distribution of rabies is wide-reaching, with over 59,000 human deaths reported annually, primarily in Asia and Africa. The disease is transmitted through the saliva of infected animals, with domestic dogs being the main reservoir and transmitters to humans. Wildlife, such as bats, raccoons, and foxes, also contribute to the spread of the virus in some areas.

The World Health Organization (WHO) and the World Organisation for Animal Health (OIE) have set a goal to eliminate human deaths from dog-mediated rabies by 2030. This ambition is supported by the United Nations’ Sustainable Development Goals, which seek to end the epidemics of neglected tropical diseases.

Symptoms and Diagnosis

Rabies manifests in two forms: furious and paralytic. The furious type is characterized by hyperactivity and hydrophobia, whereas the paralytic form is less dramatic and often misdiagnosed, leading to a high lethality rate. Once clinical symptoms appear, the disease is almost invariably fatal.

Diagnosis relies on various techniques, including direct fluorescent antibody testing and polymerase chain reaction (PCR), which enable the identification of the virus in tissue samples.

Prevention and Control

The prevention of rabies is feasible through mass immunization of dogs, public education on avoiding animal bites, and pre-exposure prophylaxis (PrEP) for high-risk individuals. PrEP includes a series of vaccinations for people at high risk of exposure, such as veterinarians and animal handlers.

Post-exposure prophylaxis (PEP) is recommended immediately after a potential rabies exposure. PEP involves wound washing, administration of rabies immunoglobulin, and a vaccination series. Prompt PEP is critical since, once symptoms manifest, the infection cannot be managed and is lethally progressive.

Global Efforts and Challenges

International collaboration has led to the development of cost-effective oral rabies vaccines for wildlife and more affordable human vaccines. However, inadequate surveillance systems, lack of access to vaccines, and insufficient community awareness are challenges that impede the eradication of rabies.

Continuous research is focused on improving vaccine efficacy, optimizing PrEP and PEP regimens, and discovering new treatment modalities that can be effective after the onset of symptoms.

Conclusion

Rabies is a preventable disease that requires persistent global health efforts and cooperation between veterinarians, physicians, and public health workers. The comprehensive epidemiological update and review of pre- and post-exposure management strategies by Arsuaga et al. underscores the need to maintain momentum in rabies education, vaccination, and research to achieve the goal of a rabies-free world.

References

1. Arsuaga Marta M., de Miguel Buckley Rosa R., Díaz-Menéndez Marta M. (2024). Rabies: Epidemiological update and pre- and post-exposure management. Medicina Clinica (Barc). DOI: 10.1016/j.medcli.2023.11.017.
2. World Health Organization. (2023). Rabies.
3. Lembo, T. (2021). Canine rabies control and elimination: what works?
4. Hampson, K., Coudeville, L., Lembo, T., et al. (2015). Estimating the global burden of endemic canine rabies. PLoS Neglected Tropical Diseases.
5. Knobel, D. L., Cleaveland, S., Coleman, P. G., et al. (2005). Re-evaluating the burden of rabies in Africa and Asia. Bulletin of the World Health Organization.

Keywords

1. Rabies epidemiology
2. Pre-exposure rabies prophylaxis
3. Post-exposure rabies management
4. Rabies prevention
5. Global rabies eradication efforts