Vetnews | September 2024 14 « BACK TO CONTENTS Global impact and challenges Rabies is a neurotropic RNA virus that claims roughly 50,000 lives each year [37]. Although it is spread most often via rabid animals biting humans, and not human-to-human transmission, it is still a major concern as infection almost always leads to death [37]. Because of the enormous toll this virus takes on humankind, governments and nations have taken many measures to ensure disease control and prevention. One of the largest principles for disease prevention is known as One Health. One Health refers to the collaboration of several disciplines of health, such as veterinarian, environmental, and human, to solve a problem. As of now, the human health discipline has the most to gain from eradicating rabies in canines specifically, since most human deaths due to rabies are caused by a rabid canine bite [37]. However, the human discipline does not use its resources to assist the veterinarian discipline in controlling this disease [37]. A study based in Indonesia researched the effectiveness of a One Health systemic approach to eradicating rabies over the course of 10 years [38]. This study used several strategies to approach disease control, the most significant being mass canine vaccination. They utilized the One Health principle by using government resources to obtain high-quality vaccinations and surveillance for the vulnerable canines on the island. According to the study, a One Health strategy demonstrates promising results when aligned with political will and national commitment [38]. Rabies control programs have achieved success but are hindered by challenges in implementation and accessibility. Another challenge in managing rabies is the large economic toll it takes on the world. One aspect of this is the cost it takes to administer life-saving PEP. The current regimen consists of up to five clinic visits, with both the vaccination and the transportation costs being high [39]. A study based in southern China tested the efficacy and safety of a 2-1 intramuscular regimen for prophylaxis with the aim of lowering the cost of administration [39]. The results demonstrated no statistically significant difference between the two regimens, meaning that there is potential money to be saved by administering the 2-1 regimen without sacrificing quality [39]. Another barrier to rabies eradication is limited education and public awareness. A study in Azerbaijan tested the effect that public awareness initiatives had on rabies containment [40]. According to the study, those exposed to rabies awareness campaigns are up to four times more likely to vaccinate their pets, a step towards rabies eradication [40]. Additionally, the study portrayed that awareness campaigns improve public knowledge of not only the disease’s symptoms but also vaccination schedules [40]. Based on these studies and the continued loss of life, the economic and societal implications of rabies necessitate cost-effective solutions and comprehensive public awareness campaigns. Conclusions Rabies is a long-standing and lethal viral infection transmitted through animal bites or contact with infected saliva. Louis Pasteur’s development of the rabies vaccine in 1885 marked a significant milestone in preventing many cases. The current preventive measures focus on human and animal vaccination, with efforts towards next-generation vaccines. The historical development of rabies vaccines has progressed from inactivated and liveattenuated forms to modern recombinant techniques, each with advantages and limitations. Post-exposure prevention involves a combination of human rabies immunoglobulin (HRIG) and rabies vaccine administration. The standard inactivated rabies virus vaccine remains widely used, with ongoing research exploring novel formulations and adjuvants to enhance efficacy. Gene therapy, virus-like particles, and monoclonal antibodies are emerging as potential advanced treatment options. The preexposure prophylaxis vaccination series, administered before potential exposure, is a crucial preventive measure. Exploring novel treatment strategies, including combined vaccine therapies and advanced molecular interventions, provides hope for more effective and accessible treatments, especially for active infections showing symptoms. As the field continues to evolve, a collaboration between researchers, clinicians, and public health authorities is crucial for primarily optimizing the rabies cocktail composition tailored to each PEP patient. Proper initiation of treatment and therapeutic doses should be considered for humans undergoing combination therapy. Global initiatives, such as the Global Strategic Plan, aim to eradicate human fatalities due to rabid canines by 2030, showcasing the importance of mass vaccination of animals, especially canines. Combining veterinary, environmental, and human health efforts, the One Health approach shows promise in controlling rabies. Challenges include economic barriers to post-exposure prophylaxis, limited education, and public awareness. Cost-effective solutions and comprehensive awareness campaigns are essential for successful rabies eradication strategies. Overall, continued research and collaborative efforts are crucial in the ongoing battle against rabies, a disease that claims almost 100% of the affected individuals’ lives if left untreated. v FIGURE 3: Comparison of the traditional therapies (HRIG + vaccines) with advanced molecular interventions in rabies treatment. Traditional methods are established and prompt, while advanced interventions focus on viral replication and immune response. Both are crucial in early rabies intervention and prevention. HRIG: human rabies immunoglobulin Article References available on request.
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