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. Key words: Control, epidemiology, history, mass vaccination, surveillance, zoonotic disease.