Rabies Virus: A Review of Pathogenesis, Diagnosis, and Prevention

Abstract

Rabies virus is considered as one of the deadliest known infectious agents in medical science with a case-fatality rate of nearly 100% once clinical symptoms take place. Although there are good vaccines and post-exposure prophylaxis, the disease claims between 59,000 human lives each year and the majority of these are in low- and middle-income countries in Africa and Asia. Recent developments in molecular virology have clarified the key factors of viral neuroinvasion, immune evasion, as well as host-pathogen interaction. At the same time, there have been new technologies in diagnostic technologies such as point-of-care molecular assays and rapid field-deployable systems that have increased surveillance in resource-constrained environments. Global prevention efforts have developed by incorporating One-Health approaches which focus on cross-sectoral integration between human health, veterinary services and the environmental sector. This overall discussion summarizes the existing knowledge of the pathogenesis of rabies virus, with a particular focus on molecular pathways of neurotropism and immune subversion, current diagnostic methods with respect to sensitivity and field use, and prevention and control measures such as mass immunization of dogs, simplified pre-exposure and post-exposure prophylaxis, and new vaccine systems. The continuous obstacles to international extermination are addressed, such as infrastructural obstacles, economic limitations, sluggish care-seeking habits, and surveillance systems deficits. To realize the goal of the World Health Organization to reduce death by 2030 due to dogs as the primary causative agent of human rabies, continued investment on animal vaccination, increased access to biologics, the implementation of rapid diagnostics, and the enhancement of intersectoral coordination in One-Health models is mandatory.