Treatment and Risk Assessment of Rabies

Dear Colleagues,

Rabies is a neglected tropical disease that causes an estimated 59 000 human deaths every year, mainly in Africa and Asia, predominantly from exposure to rabid dogs. The COVID-19 pandemic had a major effect on rabies vaccination programmes in dogs and accessing post-exposure prophylaxis for bite victims, and many countries reported significant increases in both human and animal cases of rabies. The target set by the World Health Organization (WHO) and the World Organization for Animal Health (WOAH) to eliminate dog-acquired human rabies by 2030 is achievable but will require a scale-up of dog vaccination campaigns and greater efforts for pre- and especially post-exposure prophylaxis in humans.  Limited veterinary services in many areas, especially rural areas, and the focus on veterinary diseases with an economic impact significantly hamper rabies vaccination programmes in dogs. Post-exposure prophylaxis (PEP) is dependent on the availability of expensive vaccines and rabies immune globulin (RIG) and demands complex regimens and correct administration and public and health worker knowledge. Efforts to simplify regimens and recommend cost- and dose-sparing intradermal vaccine administration prompted the 2018 WHO revision of the guidelines for the prevention of rabies in humans. The development of monoclonals to replace expensive and scarce RIG is progressing, but efficacy studies in Africa are lacking and are not easy to perform. Research and development for new vaccines that are thermo-tolerant and obviate the need for multiple dose regimens would significantly reduce costs and improve compliance with PEP.

The availability of diagnostic testing in animals has improved significantly with networks of veterinary laboratories (RabLab network). This has resulted in the introduction of newer approaches for sample collection and testing for lyssavirus antigen. The burden of rabies and confirmation of the disease in humans remains a challenge. The disease is significantly underrecognized, underdiagnosed and misdiagnosed, especially in countries with a high prevalence of HIV, tuberculosis and malaria and other viral causes of encephalitis with overlapping signs and symptoms. We highlight with concern the limited training on rabies and other zoonosis in medical curricula. Post-mortem sampling of brain tissues for confirmatory diagnosis is not simple, and specialized testing human health laboratories are very limited, particularly in Africa. A One Health approach to prevention is absolutely key, and this needs to be strengthened.

In this Special Issue on rabies, we welcome articles from all over the world and particularly from rabies-endemic areas of Africa and Asia. We welcome articles focusing on novel ways to empower communities in prevention, improve dog-vaccination coverage, diagnostics and any other related areas. The editorial team is composed of Dr Claude Sabeta from the University of Pretoria (Faculty of Veterinary Sciences, Onderstepoort) and Professor Lucille Blumberg (of the National Institute of Communicable Diseases).

Prof. Dr. Claude Sabeta
Guest Editor

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• prevention
• exposure
• dog-vaccination control
• elimination
• diagnostics
• new biologicals
• rabies burden
• One Health