Chapter 22 - Future developments and challenges

Abstract

Rabies is one of the oldest diseases known and yet still causes untold misery in human lives lost, enduring as one of the most feared viral zoonotic diseases of the 21st century. Considerable progress has been made in tackling the worldwide rabies problem in certain geographic regions, although, unfortunately, setbacks have occurred in other regions. The disease has a case-fatality rate approaching 100% and threatens billions of people worldwide with endemic dog rabies being the largest risk factor for human disease, especially in Asia and Africa. Dogs are the most important reservoir for rabies and account for greater than 99% of the human cases of rabies. The reduction of dog-mediated rabies will therefore result in a concomitant decrease in human rabies cases. Rabies remains a neglected disease of poverty and impoverished people and children carry a disproportional share of the burden of rabies especially in resource-limited regions where individuals live on less than $1 a day. A multifaceted approach for human rabies eradication is required involving government support, advocacy, education, and preimmunization of “at risk” human populations. The high cost of rabies biologicals, including rabies vaccine and rabies immune globulin, is a barrier for effective human rabies prevention and remains an important future challenge. An improved understanding of rabies pathogenesis would be useful in the development of novel therapies for human rabies. There needs to be a more concerted effort to control both dog rabies and rabies in wildlife hosts using mass vaccination campaigns. Most importantly, dog-mediated rabies control is the highest priority in preventing human rabies cases. The “One Health” approach to global rabies control is advocated to ensure that dog-mediated human rabies cases are reduced by 2030.