Rabies is a fatal viral disease caused by the rabies virus, which belongs to the Lyssavirus genus. This article provides insights and recommendations for enhancing rabies prevention efforts worldwide by analysing current practices, successes, and challenges.

---

Introduction

Rabies is a zoonotic disease transmitted primarily through the bites of infected animals, most commonly dogs. The World Health Organization (WHO) estimates that rabies causes approximately 59,000 human deaths annually, predominantly in Africa and Asia (WHO, 2021). The disease is virtually 100% fatal once clinical symptoms appear; thus, timely vaccination plays a crucial role in prevention. This paper reviews vaccination strategies, including the current immunisation protocols in both human and animal populations, highlights the significance of awareness campaigns, and evaluates the role of international cooperation in combating rabies.

---

Epidemiology 

Distribution and incidence

Rabies is present globally. Rabies transmission is significantly associated with stray dog populations and insufficient vaccination coverage. According to the WHO, over 95% of human rabies cases are attributed to dog bites (WHO, 2021).

Risk groups

High-risk groups include children, travellers to endemic areas, veterinarians, animal handlers, and persons working in laboratory settings. Understanding these risk factors is essential for developing targeted vaccination strategies.

---

Vaccination strategies

Vaccination against rabies occurs in two primary contexts: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

A. Pre-Exposure Prophylaxis (PrEP): PrEP is recommended for individuals at high risk of rabies exposure. It consists of three doses of the rabies vaccine administered on days 0, 7, and either 21 or 28. The use of PrEP in at-risk populations, such as travellers or animal handlers, has shown significant reductions in rabies incidence (Rupprecht et al., 2013).

B. Post-Exposure Prophylaxis (PEP): PEP is a critical intervention when a person has been exposed to a potentially rabid animal.

The protocol includes;

1. Wound management: Immediate and thorough washing of the wound with soap and water for at least 15 minutes.
2. Rabies Immune Globulin (RIG): Administered in cases of high-risk exposure, particularly for bites on the face, neck, or hands, where the rabies virus can spread more rapidly.
3. Rabies vaccination: A course of rabies vaccine administered on days 0, 3, 7, and 14.

---

Vaccines used various rabies

Vaccines are available, predominantly inactivated vaccines. The following are the main types:

1. Human Diploid Cell Vaccine (HDCV): Widely used and effective in both PrEP and PEP.
2. Purified Chick Embryo Cell Vaccine (PCECV): Provides a safer alternative with fewer side effects.
3. Novartis Rabies Vaccine (RabAvert): Utilised in PEP programs.

---

Animal vaccination programs

Importance

Vaccinating animals, especially dogs, is crucial for controlling rabies transmission. Since dogs are the primary reservoirs for rabies in many regions, vaccinating dog populations significantly reduces human risk.

Mass vaccination campaigns

Mass vaccination campaigns can drastically reduce rabies incidence. Examples include;

1. India: Implemented community-based dog vaccination programs that exceeded 70% vaccination coverage, leading to a significant reduction in rabies cases (Sudarshan et al., 2007).
2. Africa: A regional initiative, the "Africa Rabies Control Network," aims to coordinate vaccination efforts across countries to achieve high vaccination rates.

---

Challenges in rabies vaccination programs

1. Accessibility: In many developing countries, access to rabies vaccines is limited due to high costs and lack of infrastructure. Additionally, awareness of rabies prevention is often low, resulting in delays in seeking post-exposure treatment.
2. Resistance to vaccination: Cultural beliefs and misinformation can lead to resistance against animal vaccination efforts. Engaging communities in rabies education campaigns can help mitigate these challenges.
3. Vaccine durability and supply: A Limited supply of vaccines and variability in their durability can hinder effective vaccination schedules. Continuous efforts to improve local production capacities are necessary.

---

International cooperation and policy framework

In combating rabies, international collaboration is crucial. Organisations such as the WHO and the Pan American Health Organization (PAHO) have established frameworks for rabies elimination, emphasising the need for multisectoral approaches integrating human and animal health (WHO, 2018).

The "Zero by 30" campaign seeks to eliminate rabies deaths by 2030, promoting a One Health approach that considers the interconnectedness of animal, human, and environmental health.

---

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Partha Ghosh, BNYS, MD(YS), is a general physician and a medical writer from Siliguri, Darjeeling.