Rabies as a Neglected Zoonotic Disease: Overcoming Challenges to Protect the Most Vulnerable

Pashu Sandesh, 24 May 2023

Dr Ragini Mishra

(Ph.D. Scholar- Division of Veterinary Microbiology, ICAR-IVRI, Izatnagar-243122, Bareilly)

Rabies is a viral disease that affects the central nervous system, including the brain, in mammals. It is caused by the rabies virus, which is usually transmitted through the bite or scratch of an infected animal. Rabies can also be contracted if infected saliva comes into contact with open wounds or mucous membranes. The most common carriers of the rabies virus are dogs, bats, raccoons, skunks, and foxes. However, any mammal can potentially carry and transmit the virus. In some parts of the world, such as North America and Western Europe, domestic dogs are the primary source of rabies transmission to humans. Once the rabies virus enters the body, it travels along nerve fibres towards the brain. The incubation period, the time between infection and the onset of symptoms, can vary from a few days to several years, but it usually ranges from one to three months. During this time, the virus multiplies within the body without causing noticeable symptoms. As the disease progresses, symptoms typically include fever, headache, fatigue, and discomfort at the site of the initial bite. As the virus affects the central nervous system, symptoms can also include confusion, anxiety, agitation, hallucinations, paralysis, difficulty swallowing, and hydrophobia (fear of water). Once symptoms appear, the disease is almost always fatal. If a person is bitten or scratched by an animal suspected to have rabies, immediate medical attention is crucial. Post-exposure prophylaxis (PEP) is a treatment given after potential exposure to rabies to prevent the virus from causing the disease. PEP involves a series of injections of rabies vaccine and sometimes immunoglobulin to boost the body's immune response. Prevention of rabies primarily involves vaccinating domestic animals, such as dogs and cats, and avoiding contact with stray or wild animals. It is also important to seek medical attention for any animal bites or scratches, even if they seem minor, to assess the risk of rabies transmission. Rabies is a significant public health concern worldwide, causing tens of thousands of deaths each year, particularly in regions with limited access to healthcare and animal control resources. However, vaccination programs and effective post-exposure treatments have helped reduce the impact of rabies in many developed countries.

Rabies is widely recognized as a neglected zoonotic disease. Rabies negligence refers to situations where inpiduals or organizations fail to take proper precautions to prevent or address the risk of rabies. This negligence can have serious consequences, as rabies is a deadly disease that can be prevented with appropriate measures.

Here are some key points highlighting the neglected status of rabies:

  1. Disease Burden: Rabies causes an estimated 59,000 human deaths worldwide each year, with over 95% of these deaths occurring in Africa and Asia. Despite its high fatality rate, rabies often receives inadequate attention compared to other infectious diseases with a lower mortality rate. The disease burden is primarily borne by marginalized communities in rural areas where access to healthcare and preventive measures is limited.
  2. Impact on the Most Vulnerable: Rabies has a disproportionate impact on vulnerable populations, including children and inpiduals living in poverty. Children are often at higher risk due to their proximity and interactions with animals. Moreover, the economic burden of rabies falls heavily on low-income families who may struggle to afford post-exposure prophylaxis (PEP) or veterinary services for their animals.
  3. Lack of Awareness and Education: In many regions affected by rabies, there is a lack of awareness and education about the disease among the general population, healthcare providers, and policymakers. Insufficient knowledge about rabies transmission, prevention, and appropriate response measures hinders effective control efforts and contributes to the continued neglect of the disease.
  4. Inadequate Surveillance and Reporting: Surveillance systems for rabies are often weak or non-existent in many endemic countries. This leads to underreporting of cases, making it difficult to assess the true burden of the disease and allocate appropriate resources for prevention and control. Limited data on rabies cases also hampers the prioritization of rabies as a public health issue.
  5. Limited Access to Vaccination and PEP: Access to both pre-exposure vaccination and timely post-exposure prophylaxis (PEP) is essential in preventing human rabies deaths. However, in many low-income countries, these life-saving interventions are often inaccessible or unaffordable for those at risk. This lack of access exacerbates the neglect of rabies as a preventable disease.
  6. Neglected Animal Vaccination: Vaccination of domestic dogs, which are the primary source of rabies transmission to humans, is a crucial strategy for controlling rabies. However, the vaccination coverage of dogs in endemic regions remains low, primarily due to resource constraints, limited veterinary infrastructure, and logistical challenges. The neglect of animal vaccination perpetuates the cycle of rabies transmission and prevents effective disease control.
  7. Limited Research and Funding: Rabies research and development have historically received less attention and funding compared to other infectious diseases of similar global significance. Limited investment in research hampers the development of improved diagnostics, treatments, and control strategies. The lack of innovative solutions further perpetuates the neglect of rabies as a zoonotic disease.

Addressing the neglected status of rabies requires a multi-faceted approach involving increased awareness, improved surveillance systems, enhanced access to vaccination and PEP, investment in research and development, and strengthened collaboration between human and animal health sectors. Efforts to prioritize rabies control and prevention at the global, regional, and national levels are essential to combat this neglected zoonotic disease and reduce its burden on vulnerable populations.