UNDERSTANDING RABIES: CHALLENGES AND ADVANCES IN CONTROL AND PREVENTION

Аннотация

Rabies is a fatal zoonotic viral disease that affects the central nervous system of mammals, including humans. Despite being preventable through vaccination, rabies continues to cause significant morbidity and mortality, especially in developing countries. This article reviews the pathogenesis of rabies virus infection, the epidemiology and modes of transmission, current preventive measures including post-exposure prophylaxis (PEP), and the challenges faced in global rabies control. Emphasis is placed on the need for integrated One Health approaches to eliminatehuman rabies worldwide. Keywords: Rabies, zoonosis, rabies virus, post-exposure prophylaxis, vaccination, One Health, epidemiology. Rabies is a viral disease caused by neurotropic viruses of the genus Lyssavirus. It primarily affects mammals and is transmitted to humans mainly through the bite of infected animals, particularly dogs. The disease is characterized by acute encephalitis and is almost invariably fatal once clinical symptoms appear. Globally, an estimated 59,000 people die from rabies annually, with over 95% of these deaths occurring in Asia and Africa (WHO, 2022). Despite the availability of effective vaccines and prophylactic treatments, rabies remains a neglected publichealth issue, especially inresource-poor regions. Pathogenesis of Rabies. After an infected animal bite, the rabies virus enters peripheral nerves and migrates centripetally towards the central nervous system (CNS). The incubation period varies from weeks to months, depending onfactors such as the bite location and viral load. Once the virus reaches the brain, it causes encephalitis characterized by inflammation and neuronal dysfunction. Clinical manifestations include hydrophobia, agitation, paralysis, and ultimately comaand death. Death usually occurs within 7–10days after symptom onset. Additionally, the rabies virus has a unique ability to evade the host’s immune system during its incubation period. Unlike many viral infections, rabies virus replication in muscle cells near the site of inoculation occurs without triggering a strong local immune response. This immune evasion facilitates the virus's silent progression toward the nervous system, making early diagnosis challenging. Moreover, the virus travels along peripheral nerves rather than through the bloodstream, which limits exposure to circulating antibodies and further complicates immune detection. This neurotropic behavior underpins the urgency of immediate post-exposure prophylaxisbefore neurological symptoms develop. Epidemiology and Transmission. Dogs are the primary reservoir and source of human rabies cases globally. Other animals such as bats, raccoons, foxes, and skunks also act as reservoirs, especially in the Americas and Europe. Rabies virus transmission mainly occurs via saliva through bites or scratches. Human-to-human transmission is exceedingly rare but has been documented in cases oforgan transplantation. Geographical and socio-economic factors greatly influence the epidemiology of rabies. In low-income countries, especially in rural and peri-urban areas, lack of access to veterinary services results in insufficient dog vaccination coverage, which maintains the enzootic cycle of http://www.internationaljournal.co.in/index.php/jasass 370 Volume 15Issue 05, May 2025 Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023: 6.995, 2024 7.75 rabies transmission. Additionally, cultural practices, such as reliance on traditional healers or delayed seeking of medical care, increase the risk of fatal outcomes. In contrast, developed countries have largely eliminated dog-mediated rabies through strict animal control laws, widespread vaccination campaigns, and robust healthcare infrastructure, which underscores the importanceof sustained publichealth investment and education inrabies-endemic regions. Prevention and Control. The cornerstone of rabies prevention is vaccination, which has proven highly effective in reducing the incidence of both human and animal rabies worldwide. There are two keyvaccination strategies: Pre-exposure prophylaxis (PrEP): This is recommended for individuals at high risk of exposuretorabies virus, such as veterinarians, animal handlers, laboratory personnel, travelers to endemic regions, and certain healthcare workers. PrEP involves a series of rabies vaccinations before any exposure occurs, providing immunological priming that simplifies post-exposure treatment ifneeded. Post-exposure prophylaxis (PEP): PEP is critical and involves immediate and thorough wound cleansing, administration of rabies immunoglobulin (RIG) to neutralize virus at the wound site, followed by a series of rabies vaccinations to stimulate active immunity. Timely initiation of PEP can effectively prevent the onset of clinical rabies, which is otherwise almost invariably fatal. Mass dog vaccination campaigns represent the most cost-effective and sustainable measure for preventing human rabies. Sin