Rabies Prevention and Control

Rabies control worldwide has been inadequate and neglected for many decades, and the disease continues to predominantly affect poor communities in Africa and Asia. As a zoonosis for which the main reservoir and vector, the domestic dog (Canis familiaris), is an economically non-viable species, the absence of cross-sectoral cooperation has been a major factor in the lack of effective control efforts. A shift in global focus is required to concentrate on the fact that rabies has the highest case fatality ratio of all infectious human diseases and that it still affects human health more significantly than many other infectious diseases that are perceived to pose more significant risks. Equally necessary is an acknowledgement that rabies control is complex and that the task of creating and executing a strategic plan for the disease can be overwhelming for those governments in the developing world where dog rabies is most problematic. Nonprofit organisations operate independently of governments and intergovernmental organisations and can play a dynamic role in inter-sectoral collaboration and the creation of approaches and strategies for the control of complex diseases such as rabies. In 2008, the Global Alliance for Rabies Control (GARC) established Partners for Rabies Prevention (PRP), a widely representative group of rabies stakeholders and experts, which endeavours to support public-private rabies control activities throughout the world. After a landscape analysis, the PRP proceeded to develop and launch the Blueprint for Rabies Prevention and Control (comprising the Blueprint for Canine Rabies Prevention and Control; the Blueprint for Fox Rabies Prevention and Control and the Rabies Surveillance Blueprint). Subsequently, the Stepwise Approach towards Rabies Elimination (SARE) was embedded into the Canine Rabies Blueprint. The SARE is a planning and self-assessment tool that countries can use to develop activities and monitor progress towards a national programme and strategy for sustainable rabies control and elimination. Each of the elements needed to execute the SARE-derived strategy is cross-linked to the Canine Rabies Blueprint, which provides the specific methods and tools required, supported by references and examples. Together, the Canine Rabies Blueprint and the SARE should be regarded as a novel and dynamic operational toolkit, and a resource that provides comprehensive information for the development and implementation of rabies control strategies, built entirely on the principles of 'One Health'.

Background/ObjectivesSri Lanka has been targeted zero rabies by the end of 2025. Towards the elimination, the country needs more effective, evidence-based strategies and efforts to achieve its ultimate goal. Therefore, we conducted a systematic review of scientific literatures and data to assess current human and animal rabies control and prevention strategies in Sri Lanka. MethodsWe compiled documents regarding current and previous rabies control and prevention activities implemented in the entire country of Sri Lanka. The documents included published literatures issued between 1946 and 2020 from both online databases and university library in Sri Lanka. All the collected documents were screened based on the PRISMA statement and categorized into several types of rabies control and prevention strategies. Official reports including epidemiological data in Sri Lanka were also filed in order to analyze the current trend of rabies control and prevention in the nation. ResultsAs of end December 2020, we found 119 scientific literatures regarding rabies control and prevention in Sri Lanka. Human rabies deaths in Sri Lanka have been reduced for the last half century by successful implementation of mass dog vaccination, animal birth control and awareness raising activities. However, the country is still facing on sporadic rabies cases, limited dog vaccination coverage and insufficient dog population management in the district level. Despite the nationwide standard of dog to human ratio of 1:8, there are huge disparities or unknown of dog ecology in regions. Awareness raising including has been enhancing for both general public and school children. Surveillance system is poorly operated so that simultaneous data analysis for decision-making is impractical. ConclusionsIn order to achieve nationwide rabies elimination, it is highly recommended to implement more effective rabies control and prevention activities and build adequate scientific evidences.

An important date in rabies history

Deeply embedded in local social, cultural, and religious settings, traditional healing is part of dog bite and rabies management in many rabies endemic countries. Faith healing, which usually encompasses a more holistic approach to health including physical, mental and social dimensions, is rare in the context of rabies. In Gujarat, Western India, the Hindu goddess Hadkai Mata is worshiped by low-caste communities as the Mother of Rabies in the event of a dog bite to a person or their livestock. This belief might influence people's attitudes and behaviors toward rabies prevention but has never been investigated. Through 31 in-depth interviews with healers and staff of Hadkai Mata temples, this paper explores the system of knowledge around dog and human rabies that is built and shared in these places of worship and healing. Qualitative and quantitative data were analyzed looking for convergences and divergences with the recently launched National Action Plan for dog-mediated Rabies Elimination. Results suggest that while the etiology of human rabies as a social illness is usually explained as the goddess's wish to correct misbehaving people and restore positive interpersonal relations, there is some appreciation for the biological processes of infection that lead to rabies as a physical disease. Hadkai Mata is believed to cure rabies if her patients undergo the necessary process of moral growth. Although conventional post-exposure prophylaxis is not opposed per se, it is often delayed by patients who seek traditional treatment first. Some reluctance was expressed toward mass dog vaccination because it is seen as an interference in how the goddess controls dogs, by enraging them—hence infecting them with rabies—and sending them to bite wrongdoers. Addressing these cultural perceptions is likely to be critical in achieving effective control of dog rabies in this region. The study highlights the value of multidisciplinary approaches in the control and elimination of rabies, as well as other zoonoses. This includes the importance of understanding different culturally- and religiously- mediated ways in which humans relate to animals; and looking for points of convergence and mutual understanding, upon which context-tailored, linguistically-accurate, locally acceptable, feasible and effective strategies can be designed.

Background and Aim:Rabies remains a public health concern in Indonesia, and the coronavirus disease (COVID-19) pandemic has stymied rabies prevention and control efforts. There is a need to transform the rabies program to be adaptable to pandemic situations to improve program coverage on dog vaccination and rabies surveillance. This study aimed to create a rabies control (RaCon) mobile application for a community-based rabies surveillance system during COVID-19 in Bali, Indonesia.Materials and Methods:We employ the Design Science Research methodology. Surveillance officers, veterinarians, community leaders, outreach workers, and dog owners participated in a series of offline in-depth interviews and focus group discussions. The RaCon prototype was evaluated using the Post-Study System Usability Questionnaire (PSSUQ) framework, which included the system’s usefulness, information quality, and interface quality. In this study, we used both a qualitative (n=50) and quantitative (n=342) approach.Results:According to the findings of this study, integrating public health and animal health into the rabies surveillance system are critical to supporting the One Health approach and encouraging community engagement in rabies programs. The RaCon prototype is expected to include features such as pet ownership, case report, news and announcements, nearest vet, health information, outbreak radar, emergency call, and app feedback. The RaCon prototype passed both qualitative and quantitative evaluations, indicating that it could be used to support the rabies surveillance system, particularly in the COVID-19 situation.Conclusion:The RaCon prototype was accepted by the users and got positive feedback in terms of the system’s usefulness, information quality, and interface quality dimension. As a result, this prototype has the potential to be integrated into the rabies surveillance system in Bali, particularly to strengthen the community-based rabies surveillance system. Even though this prototype received positive feedback, this study focuses solely on the design development and evaluation of its user interface. As a result, further development is required before incorporating RaCon into the rabies prevention and control program.

Development of combined vaccines for rabies and immunocontraception

Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB s, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation.

Despite declaration as a national priority disease, dog rabies remains endemic in Liberia, with surveillance systems and disease control activities still developing. The objective of these initial efforts was to establish animal rabies diagnostics, foster collaboration between all rabies control stakeholders, and develop a short-term action plan with estimated costs for rabies control and elimination in Liberia. Four rabies diagnostic tests, the direct fluorescent antibody (DFA) test, the direct immunohistochemical test (dRIT), the reverse transcriptase polymerase chain reaction (RT-PCR) assay and the rapid immunochromatographic diagnostic test (RIDT), were implemented at the Central Veterinary Laboratory (CVL) in Monrovia between July 2017 and February 2018. Seven samples (n=7) out of eight suspected animals were confirmed positive for rabies lyssavirus, and molecular analyses revealed that all isolates belonged to the Africa 2 lineage, subgroup H. During a comprehensive in-country One Health rabies stakeholder meeting in 2018, a practical workplan, a short-term action plan and an accurately costed mass dog vaccination strategy were developed. Liberia is currently at stage 1.5/5 of the Stepwise Approach towards Rabies Elimination (SARE) tool, which corresponds with countries that are scaling up local-level interventions (e.g. dog vaccination campaigns) to the national level. Overall an estimated 5.3 – 8 million USD invested over 13 years is needed to eliminate rabies in Liberia by 2030. Liberia still has a long road to become free from dog-rabies. However, the dialogue between all relevant stakeholders took place, and disease surveillance considerably improved through implementing rabies diagnosis at the CVL. The joint efforts of diverse national and international stakeholders laid important foundations to achieve the goal of zero dog-mediated human rabies deaths by 2030.

Despite the fact that Tanzania has a legislation that appears to be adequate for the control and subsequent elimination of dog rabies, nonetheless the country has been unable to control/eliminate dog rabies. Year after year rabies outbreaks are reported, and tie-up orders and other movement restrictions are put into force, but the incidence of the disease is on the increase.

This study aimed to assess the current progress of dog-mediated rabies control and the level of political commitment among 88 rabies-endemic countries and to provide further recommendations for the elimination of dog-mediated rabies by 2030. A correlational study was conducted using data and relevant regulations from the websites of international organizations and NGOs. In general, rabies was yet to be considered a priority disease and only one out of five countries and territories has prepared a national strategic plan for rabies control and prevention. Likewise, scores of dog-mediated rabies control indicators such as dog vaccination rate and the number of post-exposure prophylaxis per 1000 people remained minimal. There were also regional differences in preparation for dog-mediated rabies control and progress towards elimination. In particular, more efforts are needed for Pan-African Rabies Control Network (PARACON) member countries. In order to meet the goal of global dog-mediated zero rabies by 2030, both dog-mediated rabies control activities such as dog vaccination and strong political commitment should be strengthened and promoted in all rabies-endemic regions of the world.

Rabies is a neglected zoonotic disease which kills many people a year, most of them in Africa and Asia. In the majority of developing countries, the number of patients receiving post exposure prophylaxis has steadily increased over time, particularly in urban areas due to dog related rabies. Studies conducted in sub-Saharan Africa show that most of the rabies cases in animals and humans are caused by canine rabies virus, mostly transmitted by domestic dogs and thus comprehensive and sustained dog vaccination is sufficient intervention in reduction and eventual elimination of human rabies in the region. In many developing countries, progress in preventing human rabies through control of the disease in the dog reservoir were slow due to technical, intersectoral, organizational and financial barriers. For developing countries like Ethiopia, strategy should be developed to prevent and control the disease. Sustainable resources for effective dog vaccination are likely to be available through the development of intersectoral financing schemes involving both medical and veterinary sectors. Prevention of animal rabies through dog vaccination, better public awareness, improved access to cost-effective and high-quality human rabies vaccines, and improved local capacity in rabies surveillance and diagnostics are essential for the elimination of human rabies. Generally, elimination of canine rabies is epidemiologically and practically feasible through mass vaccination of domestic dogs which is cost-effective approach to the prevention and elimination of human rabies deaths. The purpose of this paper is to show the burden of the disease and to give direction for effective prevention and control following developed countries experience.

Rabies is a disease that affects the nervous system. The causative agent is a virus of the rhabdovirus family. It is resistant to low temperatures, but begins to break down when heated (more than 60 degrees). The main danger of the disease is that it is transmitted from an infected animal to any mammal, including humans. Timely vaccination of a pet is the best preventive measure to protect against the virus. Throughout the world, man and animals coexist with each other in the same environment. Rabies in dogs is transmitted from them to humans after being bitten. Dogs with rabies are a huge danger to society. To prevent infection and the spread of this disease, it is timely vaccination of animals. With timely medical care, the disease will not develop. Prevention of rabies in humans includes primary immunization and post-exposure prophylaxis. Rabies vaccination is given to healthy people of certain professions - veterinarians, hunters, foresters, taxidermists, dog catchers. For this, the rabies vaccine is used. In this article, we will analyze the signs of rabies in humans and dogs and methods of protecting the population from this disease.

Epidemiology and elimination of rabies in Western Europe

Rabies is a fatal zoonotic disease that remains a major public health concern in Indonesia, including in the East Nusa Tenggara Province. Limited health literacy and insufficient understanding of rabies transmission and prevention measures contribute to the persistence of this disease in local communities. This community service activity aimed to enhance the knowledge and awareness of government employees in Mollo Selatan Subdistrict regarding rabies prevention and control, thereby strengthening their role as information agents within their workplaces and communities. The activity was conducted for one day at the Mollo Selatan Subdistrict Office and attended by 18 participants, including the subdistrict head. The materials delivered covered the dangers of rabies, modes of transmission, clinical symptoms in animals and humans, post-bite treatment, and strategies for rabies prevention and eradication. The session applied interactive methods involving lectures, group discussions, and question-and-answer sessions to facilitate active participation and understanding. The results indicated an improvement in participants’ awareness of the importance of early detection, vaccination of rabies-transmitting animals, and appropriate post-exposure management. The implication of this activity lies in the improvement of health literacy among government staff, which can foster the dissemination of rabies prevention information to the broader community and support the national goal of rabies elimination in Indonesia.

Rabies is an acute viral infection of the central nervous system, caused by a lyssavirus in the family Rhabdoviridae. It is zoonotic viral disease that can affect all mammals, including humans, cats, dogs, and wildlife and farm animals. The virus is present in the saliva of affected animals, and the most frequent method of transmission to humans is by bites, scratches or licks to broken skin or mucous membranes. The disease has a long incubation period (six months) and symptoms may take several weeks to appear after infection. The first clinical symptom is neuropathic pain at the site of infection or wound due to viral replication. Diagnosis can only be confirmed by laboratory tests preferably conducted post mortem on central nervous system tissue removed from cranium. This paper reviews the possible prevention and control of rabies. Essential components of rabies prevention and control include ongoing public education, responsible pet ownership, routine veterinary care and vaccination, and professional continuing education. Control strategies include quarantine, confirmation of diagnosis, determining the origin and spread of an outbreak. Since rabies is invariably fatal and deadly viral disease that can only be prevented the collaborative effort between Veterinarians and human health care professionals are needed in the prevention and control of rabies.