The Lancet broadens rabies awareness with in-depth report

A comprehensive review article detailing new advances in rabies research was recently published online in the prestigious medical journal, The Lancet, significantly boosting the profile of rabies research and on-going efforts to eliminate this deadly zoonotic disease. 

The review article titled “Current status of rabies and prospects for elimination” by Anthony Fooks et al. summarizes and updates much of the available information on rabies – from treatment options to advances in new diagnostic devices – and draws attention to two primary directions for focusing disease elimination efforts.

Firstly, the authors call for a re-invigorated campaign to increase dog vaccinations and humane dog population management in rabies-endemic areas as the first priority to prevent further outbreaks, especially in countries with under-resourced public health infrastructures. 

And, secondly, citing the high prevalence of pediatric cases in countries where rabies is highly endemic, the authors call for the development of a rabies vaccine that could be included as part of the routine vaccination schedule for young children.

Additionally, the authors highlight misunderstandings caused by social and cultural taboos and the consequent under-reporting of rabies cases as probable reasons for a decline in funding and policy attention on this incurable disease over recent years. 

The review article, summarises 131 articles into an informative, timely review, providing a refresher course on the most-recent findings and bases a majority of the text on citations from the past decade. The article, which will likely serve as a resource for the rabies research community over the next few years because of its comprehensive summary of recent developments in rabies research and recommendations for further elimination efforts, is currently only available through paid subscription.

However, it would be ideal if the journal expanded publication to the open-access format of The Lancet’s Global Health Series, allowing research centers in developing countries easier access to the material.

The authors do call for further research, especially in immunology, distilling the next essential research and policy steps for the rabies community and pointing out underdeveloped topics that need further attention.

For example, Fooks, et al. continue to call for a deeper exploration of the molecular mechanisms involved in disease pathogenesis, noting that it is not well-understood how the rabies virus avoids immune detection in the periphery.

In addition, the authors seek the development of a single-dose vaccine to ease the adoption of rabies vaccination in high risk areas into current pediatric schedules more cost-effectively, and note that further immunological research evaluating memory and recall responses must be completed to extend long-term antibody reactivity for more effective vaccine lifetimes.

The authors also mention new approaches in rabies biologics development, such as the development of recombinant DNA vaccines and of new, more cost-effective biologicals to potentially replace human rabies immunoglobulin during post-exposure prophylaxis.

Because confirmation of infection is based primarily on post-mortem tests, further work on straightforward diagnostics that can confirm the presence of the rabies virus during early stages of the disease progression would provide more flexibility for treatment options and disease surveillance. 

Whilst many of these research areas could simplify and expand rabies control options, it is important to remember that the tools for preventing human rabies deaths and eliminating canine rabies already exist. However, publication of this information in a prominent journal will draw new attention to rabies research efforts, and policy-makers may be able to capitalize on the high profile of this review article to attract more support for the One Health vision to rabies management.

The article finishes by pointing out that the canine rabies elimination is a strategy supported by the WHO, OIE and FAO, and appropriate tools are being developed to help guide and support governments through the necessary processes to achieve this for all those at risk of rabies.

Contributed by Laura Baker, a technical writer who volunteers for GARC.