An overview of rabies - History, epidemiology, control and possible elimination

Abstract

Rabies remains the most important zoonotic disease in many countries. Public concern and fears are most
focused on dogs as the source of rabies infection to humans and other domestic animals. Several bat species
are reservoir hosts of rabies and therefore can be a public health hazard. The possibility of a carrier state or
asymptomatic form of rabies deserves serious evaluation. Rabies in most countries was successfully
controlled through mass vaccination of dogs, long before the recognition of bat and other wildlife rabies and
the availability of modern vaccines. Though, the epidemiology, virology, transmission, pathology, clinical
manifestations, diagnosis, treatment and control of rabies infection have been described extensively, the
incidence is increasingly on the high side. However, experts have recognized for decades that rabies is wholly
eradicable from all species except bats through targeted mass immunization, and the chief obstacle to
eradicating rabies especially in bats is that no one has developed an aerosolized vaccine that could be sprayed
into otherwise inaccessible caves and tree trunks. Inventing such a vaccine is considered difficult but possible.
Forestalling this problem will require active epidemiological surveillance of wild and domestic animals with a
wide range of modern molecular and ancillary epidemiological tools. This also demands government and
private sector intervention, funding and collaboration of professionals in human and veterinary medicine with
those in the environmental sciences. Recently, the heroic recovery of an unvaccinated teenager from clinical
rabies offers hope of future specific therapy. While post-exposure vaccination is essential and should be
continued with improvement to achieve consistently positive results, progress toward eliminating rabies has
been markedly faster in nations that have emphasized preventive vaccination of animals.