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Review
. 2017 Dec 20;284(1869):20171880.
doi: 10.1098/rspb.2017.1880.

Rabies elimination research: juxtaposing optimism, pragmatism and realism

Sarah Cleaveland  1 , Katie Hampson  2
Affiliations
Review

Rabies elimination research: juxtaposing optimism, pragmatism and realism

Sarah Cleaveland et al. Proc Biol Sci. .

Abstract

More than 100 years of research has now been conducted into the prevention, control and elimination of rabies with safe and highly efficacious vaccines developed for use in human and animal populations. Domestic dogs are a major reservoir for rabies, and although considerable advances have been made towards the elimination and control of canine rabies in many parts of the world, the disease continues to kill tens of thousands of people every year in Africa and Asia. Policy efforts are now being directed towards a global target of zero human deaths from dog-mediated rabies by 2030 and the global elimination of canine rabies. Here we demonstrate how research provides a cause for optimism as to the feasibility of these goals through strategies based around mass dog vaccination. We summarize some of the pragmatic insights generated from rabies epidemiology and dog ecology research that can improve the design of dog vaccination strategies in low- and middle-income countries and which should encourage implementation without further delay. We also highlight the need for realism in reaching the feasible, although technically more difficult and longer-term goal of global elimination of canine rabies. Finally, we discuss how research on rabies has broader relevance to the control and elimination of a suite of diseases of current concern to human and animal health, providing an exemplar of the value of a 'One Health' approach.

Keywords: One Health; dog vaccination; elimination; neglected tropical disease; rabies.

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Conflict of interest statement

S.C. and K.H. have received support for rabies research and dog vaccination campaigns in the Serengeti ecosystem, Tanzania through donations of dog rabies vaccines from MSD Animal Health.

Figures

Figure 1.
Figure 1.
Number of journal articles published on rabies from 1960 to 2016 illustrating: (a) the shift in emphasis from oral vaccination of wildlife in the 1980s and 1990s to dog vaccination from 2000s; and (b) the increase in publications relating to canine rabies elimination since 2010. A search on Web of Knowledge was used to identify journal articles: (a) articles with rabies in the title (solid black line) and of these, articles referring to oral vaccination of wildlife (solid grey line) and canine/dog vaccination (dotted black line); and (b) articles with rabies in the title (solid black line) and, of these, articles relating to canine/dog rabies elimination (dark grey line). Further details are provided in the electronic supplementary material. Note that dog rabies and dog rabies elimination are plotted on different axes.
Figure 2.
Figure 2.
Schematic illustrating the impacts of canine rabies and role of domestic dogs in maintaining rabies transmission (shown by solid lines). Other host species (humans, livestock and wildlife) may be infected as a result of spillover transmission from dogs but cannot sustain cycles of infection independently (shown by dotted lines). With the control and elimination of rabies in dogs, the virus is likely to disappear in all other species, with the potential for benefits to human, domestic animal and wildlife health, and substantial cost savings. (Online version in colour.)
Figure 3.
Figure 3.
Hypothetical timeline of rabies control and elimination highlighting policy targets and epidemiological milestones, illustrating relative rapid progress to zero human deaths but the need for sustained effort to reach elimination of canine rabies and sustained surveillance to identify the causes of cases. In this example, drawn from a scenario typical of Latin America, human cases following declaration of zero human deaths from dog-mediated rabies might occur as a result of (i) an incursion of canine rabies (in which case the rabies-free status of the country would be reset); and (ii) vampire bat rabies and (iii) an imported human case (in which cases the status of the country as being free of dog-mediated rabies would not change). Cases of canine rabies are shown in grey and human cases in red.
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