Current status of rabies and prospects for elimination

The application of One Health concept in China and its practice and innovation in cross-sector cooperation

Background

This study explores the opportunities and challenges associated with the One Health concept in China. Taking the practice of multi-sector health collaboration in China as an example, this study analyses the possible obstacles and opportunities.

Methods

From June to August 2023, 30 semi-structured interviews were conducted with experts from the Health Commission, Centre for Disease Control and Prevention, Department of Ecology and Environment, Ministry of Agriculture and Rural Affairs, Department of Transportation, Administration for Market Regulation, and other departments. Qualitative analysis of the interview data was performed using NVivo12.

Results

The One Health concept has universal appeal and application potential, but there are many challenges in practice. First of all, cross-departmental cooperation requires clear departmental responsibilities and coordination strategies, but in reality, it is often due to the overlapping of functions between departments or the lack of effective communication mechanism, resulting in insufficient cooperation. Secondly, the low two-way interaction and the lack of effective information exchange and data sharing mechanisms also limit the full implementation of the One Health concept. In addition, the shortage of professional human resources further exacerbates the problem, and finally, the degree of awareness and emphasis of society on public Health is also a key factor affecting the implementation of the One Health concept.

Conclusion

The concept of One Health has shown great potential and necessity in the collaborative work of multiple departments in China, but there are still significant obstacles in the implementation process of One Health concept in multiple departments. However, to fully realize this concept, more efforts are still needed in the areas of cooperation mechanisms, professional talent training, information exchange and social awareness. Future work should focus on strengthening intersectoral communication and coordination, raising public health awareness, and optimizing relevant policies and strategies to better address global public health challenges.

Development and validation of an all-in-one rabies virus Bat-Clade genomic sequencing and host identification protocol

Rabies virus (RABV), remains a significant public health concern, with bat-maintained lineages accounting for all currently documented cases in Brazil. Despite the availability of pharmacological prophylaxis for humans and animals, the high genetic diversity of RABV in diverse natural bat hosts and continued circulation in multiple animals pose challenges for effective surveillance. Here, we developed and validated a novel, rapidly deployable amplicon-based sequencing approach for RABV genomic surveillance. This "all-in-one" protocol integrates whole RABV genome sequencing with host species identification through COI gene amplification and sequencing, addressing the challenges posed by RABV's high genetic diversity and complex transmission dynamics. We assessed the protocol's effectiveness by sequencing 25 near-complete RABV genomes from host species across four distinct families (Bovidae, Equidae, Felidae, and Microchiroptera) obtained from the Rabies Control and Surveillance Program from the Rio Grande do Sul State, Southern Brazil. The method achieved an average genome coverage of 91.4 % at a minimum 5x read depth, with a mean depth coverage of 816x across sequenced genomes. The results demonstrated significant Bat-Clade sublineage diversity, which was classified using the MADDOG RABV lineage system. The protocol successfully identified three bat species (Tadarida brasiliensis, Desmodus rotundus, and Myotis nigricans) among the samples, highlighting its capability for precise host identification. This study presents a powerful tool for high-resolution evaluation of RABV genomic features and host identification, enabling more targeted animal and human health interventions. This new approach has the potential to enhance RABV surveillance capabilities, contributing to more effective rabies control strategies within a One Health framework.

Structures of two lyssavirus glycoproteins trapped in pre- and post-fusion states and the implications on the spatial-temporal conformational transition along with pH-decrease

Lyssavirus glycoprotein plays a crucial role in mediating virus entry and serves as the major target for neutralizing antibodies. During membrane fusion, the lyssavirus glycoprotein undergoes a series of low-pH-induced conformational transitions. Here, we report the structures of Ikoma lyssavirus and Mokola lyssavirus glycoproteins, with which we believe that we have trapped the proteins in pre-fusion and post-fusion states respectively. By analyzing the available lyssaviral glycoprotein structures, we present a sequential conformation-transition model, in which two structural elements in the glycoprotein undergo fine-modulated secondary structural transitions, changing the glycoprotein from a bended hairpin conformation to an extended linear conformation. In addition, such conformational change is further facilitated, as observed in our surface plasmon resonance assay, by the pH-regulated interactions between the membrane-proximal region and the pleckstrin homology and the fusion domains. The structural features elucidated in this study will facilitate the design of vaccines and anti-viral drugs against lyssaviruses.

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

INTRODUCTION

Dog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given?

METHODS

A structured review was performed using a keyword search querying "pediatric" "dog bite" "management". Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed.

RESULTS

A total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6-25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days.

CONCLUSION

High-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed.

LEVEL OF EVIDENCE

Level II - systematic review.

Immunological findings of West Caucasian bat virus in an accidental host

The Lyssavirus genus includes seventeen viral species able to cause rabies, an acute and almost invariably fatal encephalomyelitis of mammals. Rabies virus (RABV), which represents the type species of the genus, is a multi-host pathogen that over the years has undergone multiple events of host-switching, thus occupying several geographical and ecological niches. In contrast, non-RABV lyssaviruses are mainly confined within a single natural host with rare spillover events. In this scenario, unveiling the mechanisms underlying the host immune response against a virus is crucial to understand the dynamics of infection and to predict the probability of colonization/adaptation to a new target species. Presently, the host response to lyssaviruses has only been partially explored, with the majority of data extrapolated from RABV infection. West Caucasian bat virus (WCBV), a divergent lyssavirus, has recently been associated with a spillover event to a domestic cat, raising concern about the risks to public health due to the circulation of the virus in its natural host. Through this study we have investigated the immune response determined by the WCBV versus two widely known lyssaviruses. We selected the Syrian hamster as representative of an accidental host, and chose the intramuscular route in order to mimic the natural infection. In hamsters, WCBV was highly pathogenic, determining 100% lethality and mild encephalitis. In comparison with Duvenhage virus (DUVV) and RABV, we found that WCBV displayed an intermediate ability to promote cellular antiviral response, produce pro-inflammatory cytokines, and recruit and activate lymphocytes in the hamsters' central nervous system.

IMPORTANCE

Although all lyssaviruses cause fatal encephalomyelitis in mammals, they display a different host tropism and pathogenicity, with the ecology of Rabies virus (RABV) continually evolving and adapting to new host species. In 2020, West Caucasian bat virus (WCBV) was identified as the causative agent of rabies in a domestic cat in Italy. This event raised concerns about its public health consequences, due to the absence of biologicals against the infection. Our study investigates the host immune response triggered by WCBV in comparison with a pathogenic strain of RABV and the low pathogenic Duvenhage lyssavirus (DUVV), as a proxy to understand the mechanisms leading to lyssavirus spillover and pathogenicity. We overall confirm that previous evidence indicating an inverse relationship between lyssavirus pathogenicity and immune response is applicable for WCBV as well. Importantly, this work represents the first transcriptomic analysis of the WCBV interaction in the central nervous system with an accidental host.

Rabies vaccinations at the rural-urban divide: successes and barriers to dog rabies vaccination programs from a rural and urban campaign in Zambia

Introduction

Dog vaccination against rabies is considered one of the most effective strategies at preventing human deaths from rabies and is a key strategy for eliminating dog-mediated human rabies deaths. Traditional vaccination approaches in Zambia rarely collect operational data to assess coverage and inform subsequent campaigns.

Methods

Following mass vaccination campaigns in rural (Itezhi tezhi) and urban (Lusaka) communities, we evaluated vaccination coverage achieved during the campaigns and characterized and estimated the dog population in these communities.

Results

Herd immunity (i.e., 70% vaccination coverage) was not achieved in the Lusaka campaign, likely due to challenges in pre-campaign community sensitization and distance to vaccination sites in the central point campaign approach. Dog population density showed a strong exponential association with human density (R2 = 0.89). Extrapolating this relationship nationally, there are an estimated 3.2 million dogs in Zambia (human-to-dog ratio 5.8:1) with 86% residing in rural communities at a very low density of less than 6 dogs per square kilometer.

Discussion

As most dogs were found to reside at very low densities, unique challenges to large-scale dog vaccination approaches may impact Zambia, due to high logistical costs associated with these settings. Prioritizing vaccinations in higher-density free-roaming dog populations could maximize effectiveness in resource-limited settings. Private veterinary services were commonly utilized among surveyed dog owners in urbanized communities in Lusaka, suggesting that they are an important collaborator for achieving rabies herd immunity. With improved knowledge of dog population and ownership characteristics, Zambia is well-prepared to design more effective vaccination campaigns as the rabies elimination program expands.

The Deadly Details: How Clear and Complete Are Publicly Available Sources of Human Rabies Information?

Human rabies is preventable but almost always fatal once symptoms appear, causing 59,000 global deaths each year. Limited awareness and inconsistent access to post-exposure prophylaxis hinder prevention efforts. To identify gaps and opportunities for improvement in online rabies information, we assessed the readability, understandability, actionability, and completeness of online public rabies resources from government and health agencies in Australia and similar countries, with the aim of identifying gaps and opportunities for improvement. We identified materials via Google and public health agency websites, assessing readability using the Simple Measure of Gobbledygook (SMOG) index and understandability and actionability with the Patient Education Materials Tool for Print materials (PEMAT-P). Completeness was assessed using a framework focused on general and vaccine-specific rabies information. An analysis of 22 resources found a median readability of grade 13 (range: 10-15), with a mean understandability of 66% and mean actionability of 60%; both below recommended thresholds. Mean completeness was 79% for general rabies information and 36% for vaccine-specific information. Visual aids were under-utilised, and critical vaccine-specific information was often lacking. These findings highlight significant barriers in rabies information for the public, with most resources requiring a high literacy level and lacking adequate understandability and actionability. Improving readability, adding visual aids, and enhancing vaccine-related content could improve accessibility and support wider prevention efforts.

The global H5N1 influenza panzootic in mammals

Influenza A viruses have caused more documented global pandemics in human history than any other pathogen1,2. High pathogenicity avian influenza viruses belonging to the H5N1 subtype are a leading pandemic risk. Two decades after H5N1 'bird flu' became established in poultry in Southeast Asia, its descendants have resurged3, setting off a H5N1 panzootic in wild birds that is fuelled by: (1) rapid intercontinental spread, reaching South America and Antarctica for the first time4,5; (2) fast evolution via genomic reassortment6; and (3) frequent spillover into terrestrial7,8 and marine mammals9. The virus has sustained mammal-to-mammal transmission in multiple settings, including European fur farms10,11, South American marine mammals12-15 and US dairy cattle16-19, raising questions about whether humans are next. Historically, swine are considered optimal intermediary hosts that help avian influenza viruses adapt to mammals before jumping to humans20. However, the altered ecology of H5N1 has opened the door to new evolutionary pathways. Dairy cattle, farmed mink or South American sea lions may have the potential to serve as new mammalian gateways for transmission of avian influenza viruses to humans. In this Perspective, we explore the molecular and ecological factors driving the sudden expansion in H5N1 host range and assess the likelihood of different zoonotic pathways leading to an H5N1 pandemic.

A prospective study on safety and clinical efficacy of rabies biologicals in paediatric patients with category III animal exposure

Purpose

Rabies remains a significant public health concern worldwide, particularly among paediatric populations who are vulnerable to animal exposures. This prospective study aimed to assess the safety and clinical efficacy of rabies biologicals in pediatric patients following category III animal exposures.

Materials and Methods

A prospective study was undertaken enrolling 289 pediatric patients fulfilling eligibility criteria who presented with category III animal exposures at the anti-rabies clinic of Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bangalore. All the subjects received rabies biologicals as per National Centre for Disease Control guidelines. The details pertaining to socio-demographic profile, biting animal, characteristics of wound, and details of post-exposure prophylaxis (PEP) provided were recorded. All the study subjects were followed up for immediate and delayed adverse events (AEs). Subsequently, all were followed up for 6 months to demonstrate the clinical efficacy of PEP.

Results

The mean age of study subjects was 9.4 years, and most of them (43%) were going to school. Dog was the predominant biting animal (96.6%) with most bites being abrasions (45%), mainly on the lower limbs (42%). Single rabies monoclonal antibody was the most commonly administered passive immunization (67%), and purified Vero cell rabies vaccine was the predominant vaccine (65%). AEs following PEP were primarily local, predominantly pain (13.2%), and there were no systemic events. All the subjects were alive and healthy at the end of 6 months following PEP.

Conclusion

This study contributes valuable insights into the safety and clinical efficacy of rabies biologicals in a pediatric cohort following category III animal exposures, supporting the continued use of these biologicals in pediatric patients.

Analysis of the antigenic and immunogenic properties of the native rabies virus glycoprotein purified by Lens culinaris lectin affinity chromatography

Rabies virus glycoprotein (RABV-G) is responsible for the recognition of specific cell surface receptors and induces the production of neutralizing antibodies (VNA). Since RABV-G is a glycoprotein, this work aimed to evaluate Lens culinaris (LCA) chromatography as a simple and effective purification method. The purity and identification of the protein obtained were analyzed by SDS-PAGE, ELISA and lectin-binding assay. The antigenic properties of the purified RABV-G were evaluated by direct ELISA using human serum samples from individuals who had received rabies pre-exposure vaccination. For the immunogenicity study, Swiss Webster mice were immunized with purified RABV-G and the specific antibodies were measured by direct ELISA and RFFIT. As results, it was observed that the purified protein reveled a molecular mass of 55 kDa and the presence of carbohydrate; additionally, it was recognized by anti-rabies virus glycoprotein monoclonal antibody. Purified RABV-G induced high VNA titers (>50.0 IU/ml) in vivo, as detected by RFFIT, as well as RABV-G specific IgG1 (0.8 mean OD±SD) and IgG2a (0.3 mean OD±SD) antibodies, with a predominance of IgG1 (p< 0.001). In addition, it was observed that RABV-G was efficient in selectively detecting anti- RABV-G IgG in the sera of vaccinated individuals compared to the negative control. Therefore, LCA chromatography was efficient in preserving the native properties of RABV-G that are essential in inducing an adequate humoral immune response. In addition, the purified RABV-G presented analytical potential as an ELISA reagent.

Deep mutational scanning of rabies glycoprotein defines mutational constraint and antibody-escape mutations

Rabies virus causes nearly 60,000 human deaths annually. Antibodies that target the rabies glycoprotein (G) are being developed as post-exposure prophylactics, but mutations in G can render such antibodies ineffective. Here, we use pseudovirus deep mutational scanning to measure how all single amino-acid mutations to G affect cell entry and neutralization by a panel of antibodies. These measurements identify sites critical for rabies G's function, and define constrained regions that are attractive epitopes for clinical antibodies, including at the apex and base of the protein. We provide complete maps of escape mutations for eight monoclonal antibodies, including some in clinical use or development. Escape mutations for most antibodies are present in some natural rabies strains. Overall, this work provides comprehensive information on the functional and antigenic effects of G mutations that can help inform development of stabilized vaccine antigens and antibodies that are resilient to rabies genetic variation.

Spatiotemporal dynamics of rabies virus detected in rabid dogs in Cameroon, 2010-2021

Rabies is a viral zoonosis that causes an estimated 60,000 human deaths each year, mainly in Africa and Asia. The etiological agent of rabies, the Rabies Lyssavirus or Rabies Virus (RABV) has been characterized in dog populations in Cameroon, in previous studies. However, the dynamics of RABV maintenance and propagation in dogs are still to be documented in Cameroon. This study thus, aimed at investigating the spatial and temporal dynamics of RABV variants in Cameroon. Long genomic sequences of about 4893 nucleotides, encompassing the N, P, M and G genes as well as part of the G-L intergenic region (Ψ), were determined from 56 RABV strains recovered from dog populations in Cameroon from 2010 to 2021. Temporal and spatial dynamics of RABV circulation in Cameroon were investigated by Bayesian analyses with the BEAST 1.10.4 package from extended RABV genomic sequences data combined with their collection dates and the geographical coordinates of their sampling areas. This revealed a genetic evolution rate of 3.14 × 10-4 substitutions/site/year among Africa-1a and Africa-2 clades of RABV from Cameroon. The most recent common ancestor (MRCA) of the studied strains of the Africa-1a lineage was estimated to have emerged between 1880 and 1906 (95 % HPD; mean 1894), while that of the strains of the Africa-2 clade had a slightly later estimated origin between 1907 and 1928 (95 % HPD, mean 1918). Overall, phylogeographic analyses suggested RABV spread in Cameroon between sub-national regions. Our data provides substantial support to previous findings from similar epidemiological settings, indicating human mediated movements of infected dogs between distant cities may be a key factor in the maintenance of the enzootic cycle of rabies among dogs in Cameroon.

A single dose of an ALVAC vector-based RABV virus-like particle candidate vaccine induces a potent immune response in mice, cats and dogs

Rabies, caused by the Rabies virus (RABV), is a highly fatal zoonotic disease. Existing rabies vaccines have demonstrated good immune efficacy, but the complexity of immunization procedures and high cost has impeded the elimination of RABV, particularly in the post-COVID-19 era. There is a pressing need for safer and more effective rabies vaccines that streamline vaccination protocols and reduce expense. To meet this need, we have developed a potential rabies vaccine candidate called ALVAC-RABV-VLP, utilizing CRISPR/Cas9 gene editing technology. This vaccine employs a canarypox virus vector (ALVAC) to generate RABV virus-like particles (VLPs). In mice, a single dose of ALVAC-RABV-VLP effectively activated dendritic cells (DCs), follicular helper T cells (Tfh), and the germinal centre (GC)/plasma cell axis, resulting in durable and effective humoral immune responses. The survival rate of mice challenged with lethal RABV was 100%. Similarly, in dogs and cats, a single immunization with ALVAC-RABV-VLP elicited a stronger and longer-lasting antibody response. ALVAC-RABV-VLP induced superior cellular and humoral immunity in both mice and beagles compared to the commercial inactivated rabies vaccine. In conclusion, ALVAC-RABV-VLP induced robust protective immune responses in mice, dogs and cats, offering a novel, cost-effective, efficient, and promising approach for herd prevention of rabies.

Analytical Methods for Evaluating the Immunogenicity of Recombinant Rabies Virus Glycoprotein Expressed in the Yeast Komagataella phaffii

BACKGROUND

Rabies is a fatal viral disease preventable by vaccination. The multiple-dose regimens, along with the high production costs of current rabies vaccines, limit their use in rabies-endemic countries with developing economies and consequently there is a need for new efficacious, low-cost rabies vaccines. This study investigates the immunogenicity of recombinant rabies virus glycoprotein (rRABVG), expressed in the yeast Komagataella phaffii (K. phaffii), as a candidate subunit rabies vaccine.

METHODS

Monoclonal antibodies were used to confirm neutralizing epitopes presence on the rRABVG. The rRABVG potency was estimated by antigen quantification methods using ELISA and SRID. Serological methods, specifically ELISA and RFFIT, were applied to investigate the immune response of mice groups immunized with rRABVG varying doses, with or without adjuvant.

RESULTS

The potency estimated by antigen quantification was dependent on the method employed. Active immunization assessment using ELISA was effective when the solid-phase antigen is the rRABVG. The RFFIT data indicated that a single adjuvanted dose of 20 µg rRABVG is sufficient for virus-neutralizing antibodies induction at a protective level of 0.5 IU/mL within 10 days post immunization.

CONCLUSION

These data demonstrate that K. phaffii produced rRABVG is immunoactive and could be an attractive candidate to develop a low-cost subunit rabies vaccine.

Molecular characterisation of human rabies in Tanzania and Kenya: a case series report and phylogenetic investigation

BACKGROUND

Rabies remains a major public health problem in low- and middle-income countries. However, human rabies deaths are rarely laboratory-confirmed or sequenced, especially in Africa. Five human rabies deaths from Tanzania and Kenya were investigated and the causative rabies viruses sequenced, with the aim of identifying implications for rabies control at individual, healthcare and societal levels.

CASE PRESENTATION

The epidemiological context and care of these cases was contrasting. Four had a clear history of being bitten by dogs, while one had an unclear biting history. Two individuals sought medical attention within a day of being bitten, whereas three sought care only after developing rabies symptoms. Despite seeking medical care, none of the cases received complete post-exposure prophylaxis: one patient received only tetanus vaccination, one did not complete the post-exposure vaccination regimen, one followed an off-label vaccination schedule, and two did not receive any post-exposure vaccinations before the onset of symptoms. These cases highlight serious gaps in health-seeking behaviour, and in health systems providing appropriate care following risky exposures, including in the accessibility and effectiveness of post-exposure prophylaxis as it is administered in the region.

CONCLUSIONS

The viral genomic and epidemiological data confirms dog-mediated rabies as the cause of each of these deaths. The phylogenetic investigation highlights the transboundary circulation of rabies within domestic dog populations, revealing distinct rabies virus clades with evidence of regional spread. These findings underscore the importance of coordinated cross-border control efforts between the two countries. Urgent action is needed to improve awareness around the need for emergency post-exposure vaccines that should be accessible in local communities and administered appropriately, as well as investment in coordinated dog vaccination to control dog-mediated rabies, the underlying cause of these deaths.

Rabies control in Ghana: Stakeholders interventions, challenges and opportunities

Background

Rabies remains a significant public health issue in Ghana, predominantly affecting rural communities with limited access to health care and veterinary services. The disease is primarily transmitted through bites from infected domestic dogs and leads to many deaths worldwide each year. Despite various interventions, Ghana continues to struggle with rabies control and prevention. This narrative paper focuses on rabies control in Ghana, examining stakeholders' interventions, challenges faced, and opportunities available.

Methods

The paper reviews existing rabies control measures in Ghana, including dog vaccination efforts and One Health strategies. It also discusses the limitations of these interventions, such as minimal vaccination coverage, weak surveillance, and inadequate intersectoral coordination.

Results

Ghana has implemented dog vaccination campaigns, but coverage remains minimal. Additionally, weak disease surveillance, cultural perceptions, and inadequate coordination across sectors have hampered the country's ability to control rabies effectively.

Conclusion

Adopting One Health principles, which integrate human, animal, and environmental health efforts, is emphasized as a critical strategy to eliminate rabies in Ghana by 2030. By addressing these challenges and leveraging available opportunities, Ghana can strengthen its rabies control programs and work toward a rabies-free future.

Orchestration of antiviral responses within the infected central nervous system

Many newly emerging and re-emerging viruses have neuroinvasive potential, underscoring viral encephalitis as a global research priority. Upon entry of the virus into the CNS, severe neurological life-threatening conditions may manifest that are associated with high morbidity and mortality. The currently available therapeutic arsenal against viral encephalitis is rather limited, emphasizing the need to better understand the conditions of local antiviral immunity within the infected CNS. In this review, we discuss new insights into the pathophysiology of viral encephalitis, with a focus on myeloid cells and CD8+ T cells, which critically contribute to protection against viral CNS infection. By illuminating the prerequisites of myeloid and T cell activation, discussing new discoveries regarding their transcriptional signatures, and dissecting the mechanisms of their recruitment to sites of viral replication within the CNS, we aim to further delineate the complexity of antiviral responses within the infected CNS. Moreover, we summarize the current knowledge in the field of virus infection and neurodegeneration and discuss the potential links of some neurotropic viruses with certain pathological hallmarks observed in neurodegeneration.

RTP4 restricts lyssavirus rabies infection by binding to viral genomic RNA

Rabies, caused by lyssavirus rabies (Rabies lyssavirus, RABV), is a fatal disease among humans and almost all warm-blooded animals. In this study, we found that RABV infection induces the up-regulation of receptor transporter protein 4 (RTP4) in mouse brains and different cells of nervous tissue. Over-expression of RTP4 reduces the viral titer of RABV in different neuronal cells. Furthermore, a recombinant RABV expressing RTP4, named rRABV-RTP4, was constructed and displayed a lower viral titer in different neuronal cells due to the expression of RTP4. Moreover, the survival rates of mice infected with rRABV-RTP4 were significantly higher than those of mice infected with parent virus rRABV or control virus rRABV-RTP4(-). In terms of mechanism, RTP4 could bind viral genomic RNA (vRNA) of RABV, and suppress the whole viral genome amplification. In addition, we found that the zinc finger domain (ZFD) of RTP4 exerts the antiviral function by truncation analysis, and an important amino acids site (C95) in the RTP4 3CxxC motif which is essential for its antiviral function was identified by mutation analysis. This study contributes to our understanding of how RTP4 or other RTP proteins play a role in defense against the invasion of RABV or other viruses.

Detection and Serological Evidence of European Bat Lyssavirus 1 in Belgian Bats between 2016 and 2018

Lyssaviruses are neurotropic viruses capable of inducing fatal encephalitis. While rabies virus has been successfully eradicated in Belgium, the prevalence of other lyssaviruses remains uncertain. In this study, we conducted a survey on live animals and passive surveillance to investigate the presence of lyssaviruses in Belgium. In 2018, a total of 113 saliva samples and 87 blood samples were collected from bats. Saliva was subjected to RT-qPCR to identify lyssavirus infections. Additionally, an adapted lyssavirus neutralisation assay was set up for the detection of antibodies neutralising EBLV-1 in blood samples. Furthermore, we examined 124 brain tissue samples obtained from deceased bats during passive surveillance between 2016 and 2018. All saliva samples tested negative for lyssaviruses. Analysis of the blood samples uncovered the presence of lyssavirus-neutralising antibodies in five bat species and 32% of samples with a wide range depending on bat species, suggesting past exposure to a lyssavirus. Notably, EBLV-1 was detected in brain tissue samples from two Eptesicus serotinus specimens collected in 2016 near Bertrix and 2017 near Étalle, confirming for the first time the presence of EBLV-1 in Belgium and raising awareness of the potential risks associated with this species of bats as reservoirs of the virus.

Magnetic resonance imaging in rabies encephalitis, a case report, and review of the literature

Rabies is an acute fatal disease of the central nervous system. Neuroimaging plays an important role, especially in establishing an early diagnosis and distinguishing it from other types of encephalitis. This case report aims to give a brief review of this condition and report the less common MRI findings of the disease. We herein report a case of a 61-year-old male bitten by a stray dog who presented with fever, vomiting, headache, sialorrhea, dysarthria, dysphagia, and upper limb weakness which progressed to lower limbs on the next day. T2W and FLAIR images demonstrated subtle bilateral hyperintense signal in the deep gray matter with more apparent increased signal intensity in the white matter of the frontal and parietal lobes which shows mild diffusion restriction but no postcontrast enhancement. The diagnosis of rabies encephalitis was made based on a typical history of exposure, a compatible clinical presentation, and MRI findings. Rabies diagnosis is essentially clinical. It is definitively confirmed by the isolation of the virus from biological samples such as saliva, CSF, hair, or detection of rabies antigens or antibodies. Magnetic resonance imaging (MRI) brain used as one of the modalities of investigation for distinguishing it from other encephalitis. Rabies per se does not have any characteristic features on the MRI brain.

Spatial accessibility and inequality analysis of rabies-exposed patients to rabies post-exposure prophylaxis clinics in Guangzhou City, China

BACKGROUND

The incidence of rabies exposure is high and increasing in China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and inequality of rabies-exposed patients to rabies PEP clinics is less known in China.

METHODS

Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City, China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran's I statistics were utilized to evaluate the inequality and clustering of accessibility scores.

RESULTS

From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d0] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran's I statistics showed that there were certain inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou.

CONCLUSIONS

This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.

Knowledge, attitudes, and practices of healthcare professionals regarding rabies in tertiary care hospitals: A cross-sectional study in Peshawar, Pakistan

BACKGROUND

Rabies, caused by the rhabdovirus, is a fatal zoonotic disease with over 59,000 annual deaths globally. Asia and Africa account for 95%, with India leading, followed by China. In Pakistan, where it's endemic, over 50,000 cases are reported yearly. Controlling rabid dog populations through vaccination is crucial in curbing mortality. This research aimed to evaluate healthcare professionals' knowledge, attitudes, and practices concerning rabies in Peshawar, Pakistan.

METHODS

The study was conducted at different tertiary care hospitals in Peshawar, Pakistan from 16 August 2021 to 15 February 2022. Cross-sectional research was conducted to gather data from a total of 100 healthcare workers representing different sections within the healthcare field, including Medical Officers, House Officers, Faculty Staff, Nurses, and Paramedics. Data on knowledge, attitudes, and practices about rabies were collected using a standardized questionnaire. The data analysis included using descriptive statistics and chi-square testing to ascertain potential correlations.

RESULTS

Among the healthcare professionals, 68 (68%) were males, and 32 (32%) were females. Profession-wise, the included professionals were Nurses 31 (31%), Medical Officers 27 (27%), House officers 26 (26%), paramedical staff 13 (13%), and faculty staff 3 (3%). 91 (91%) and 9 (9%) healthcare professionals responded that dogs and cats are responsible for rabies transmission, respectively. Moreover, 82 (82%) individuals responded that animal bite plays a vital role in the transmission of rabies, whilst 76 (76%) individuals responded that rabies transferred from human to human. 82 (82%) individuals replied that the anti-rabies vaccine (ARV) is the treatment of choice for rabies. Furthermore, 78 (78%) individuals responded that ARV is safe in pregnancy and lactation. Moreover, after being asked about the perception of the health care professionals about the failure in controlling rabies, their responses were unavailability of ARV/RIG 41 (41%), lack of control of stray dogs 34 (34%), lack of awareness 20 (20%). The study revealed statistically significant correlations between healthcare occupations and variables: knowledge of animals responsible for transmitting rabies (p = 0.024) and awareness of human-to-human transmission (p = 0.007). Significant disparities were noted in understanding rabies transmission through contaminated water (p = 0.002). There were variations in attitudes and practices seen across different positions, particularly about views about home treatments (p = 0.033) and the perceived effectiveness of cleansing bite wounds (p = 0.010). Disparities in perceptions of rabies treatment and the accessibility of anti-rabies vaccines and immunoglobulin were observed, with variations based on individual roles.

CONCLUSION

The present research elucidates variations in rabies knowledge, attitudes, and practices among healthcare workers, specifically concerning their respective roles. Tailored training programs and standardized practices play a crucial role in mitigating these discrepancies, fostering a greater understanding of rabies, and enhancing the quality of patient treatment. It is recommended that future studies undertake an assessment of the efficacy of therapies and advocate for the adoption of collaborative One Health strategies in the realm of rabies management.

Construction of Vero cell-adapted rabies vaccine strain by five amino acid substitutions in HEP-Flury strain

Rabies virus (RABV) causes fatal neurological disease. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) using inactivated-virus vaccines are the most effective measures to prevent rabies. In Japan, HEP-Flury, the viral strain, used as a human rabies vaccine, has historically been propagated in primary fibroblast cells derived from chicken embryos. In the present study, to reduce the cost and labor of vaccine production, we sought to adapt the original HEP-Flury (HEP) to Vero cells. HEP was repeatedly passaged in Vero cells to generate ten- (HEP-10V) and thirty-passaged (HEP-30V) strains. Both HEP-10V and HEP-30V grew significantly better than HEP in Vero cells, with virulence and antigenicity similar to HEP. Comparison of the complete genomes with HEP revealed three non-synonymous mutations in HEP-10V and four additional non-synonymous mutations in HEP-30V. Comparison among 18 recombinant HEP strains constructed by reverse genetics and vesicular stomatitis viruses pseudotyped with RABV glycoproteins indicated that the substitution P(L115H) in the phosphoprotein and G(S15R) in the glycoprotein improved viral propagation in HEP-10V, while in HEP-30V, G(V164E), G(L183P), and G(A286V) in the glycoprotein enhanced entry into Vero cells. The obtained recombinant RABV strain, rHEP-PG4 strain, with these five substitutions, is a strong candidate for production of human rabies vaccine.

Rabies Virus Infection Causes Pyroptosis of Neuronal Cells

Rabies virus (RABV) is a neurotropic virus that causes fatal neurological disease, raising serious public health issues and attracting extensive attention in society. To elucidate the molecular mechanism of RABV-induced neuronal damage, we used hematoxylin-eosin staining, transmission electron microscopy, transcriptomics analysis, and immune response factor testing to investigate RABV-infected neurons. We successfully isolated the neurons from murine brains. The specificity of the isolated neurons was identified by a monoclonal antibody, and the viability of the neurons was 83.53-95.0%. We confirmed that RABV infection induced serious damage to the neurons according to histochemistry and transmission electron microscope (TEM) scanning. In addition, the transcriptomics analysis suggested that multiple genes related to the pyroptosis pathway were significantly upregulated, including gasdermin D (Gsdmd), Nlrp3, caspase-1, and IL-1β, as well as the chemokine genes Ccl2, Ccl3, Ccl4, Ccl5, Ccl7, Ccl12, and Cxcl10. We next verified this finding in the brains of mice infected with the rRC-HL, GX074, and challenge virus standard strain-24 (CVS-24) strains of RABV. Importantly, we found that the expression level of the Gsdmd protein was significantly upregulated in the neurons infected with different RABV strains and ranged from 691.1 to 5764.96 pg/mL, while the basal level of mock-infected neurons was less than 100 pg/mL. Taken together, our findings suggest that Gsdmd-induced pyroptosis is involved in the neuron damage caused by RABV infection.

Assessment of respondents' knowledge, attitudes, and practices toward rabies and associated risk factors in Shone Town, Southern Ethiopia

IMPORTANCE

Rabies is a neglected tropical viral disease most often transmitted through the bite of an infected animal.

OBJECTIVE

This study assessed the level of knowledge, attitudes, and practices of the Shone Town community toward rabies.

METHODS

A survey-based cross-sectional study was conducted in Shone town, Ethiopia, from November 2022 to April 2023. Woreda was selected purposefully, while Kebeles and the study populations were selected by simple random sampling. Four hundred and sixteen respondents were interviewed using a semi-structured questionnaire.

RESULTS

All respondents had heard about rabies from different sources, with the majority hearing from informal sources (62%). Approximately 51.9%, 0.7%, and 47.4% of individuals were aware of saliva contact, rabid animal bites, and both as means of transmission, respectively. The survey showed that 64.4% of participants knew the 100% fatal nature of rabies once the clinical signs developed, and 35.6% did not. Approximately 51.4% of respondents agreed that killing stray dogs was an effective method for rabies prevention. In this study, 72.6% of the respondents had contact with pets, and 36.8% of the interviewees had vaccinated their dogs. Only the educational level (p = 0.03) was associated with knowledge of the transmission route. Age (p = 0.04) and educational level (p = 0.01) had a statistically significant association with knowledge of the risk of not vaccinating dogs.

CONCLUSIONS AND RELEVANCE

A lack of formal education in the communities, low levels of education, and the majority of respondents acquiring their knowledge from unofficial sources are important contributors to the low levels of awareness.

Transcriptome analysis of salivary glands of rabies-virus-infected mice

Rabies is a fatal zoonotic disease that poses a threat to public health. Rabies virus (RABV) is excreted in the saliva of infected animals, and is primarily transmitted by bite. The role of the salivary glands in virus propagation is significant, but has been less studied in the pathogenic mechanisms of RABV. To identify functionally important genes in the salivary glands, we used RNA sequencing (RNA-seq) to establish and analyze mRNA expression profiles in parotid tissue infected with two RABV strains, CVS-11 and PB4. The biological functions of differentially expressed genes (DEGs) were determined by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, which revealed 3,764 DEGs (678 up-regulated and 3,086 down-regulated) in the CVS-11 infected group and 4,557 DEGs (874 up-regulated and 3,683 down-regulated) in the PB4 infected group. Various biological processes are involved, including the salivary secretion pathway and the phosphatidylinositol 3-kinase-Akt (PI3K-Akt) signaling pathway. This study provides the first mapping of the transcriptome changes in response to RABV infection in parotid tissue, offering new insights into the study of RABV-affected salivary gland function and RABV pathogenic mechanisms in parotid tissue. The salivary gland-enriched transcripts may be potential targets of interest for rabies disease control.

Establishment of serological neutralizing tests using pseudotyped viruses for comprehensive detection of antibodies against all 18 lyssaviruses

Rabies is a fatal zoonotic, neurological disease caused by rabies lyssavirus (RABV) and other lyssaviruses. In this study, we established novel serological neutralizing tests (NT) based on vesicular stomatitis virus pseudotypes possessing all 18 known lyssavirus glycoproteins. Applying this system to comparative NT against rabbit sera immunized with current RABV vaccines, we showed that the current RABV vaccines fail to elicit sufficient neutralizing antibodies against lyssaviruses other than to those in phylogroup I. Furthermore, comparative NT against rabbit antisera for 18 lyssavirus glycoproteins showed glycoproteins of some lyssaviruses elicited neutralizing antibodies against a broad range of lyssaviruses. This novel testing system will be useful to comprehensively detect antibodies against lyssaviruses and evaluate their cross-reactivities for developing a future broad-protective vaccine.

Evaluation of the effect of sample suspension concentration and viral load on the outcome of the rabies tissue culture infection test

In this study, we examined various brain suspension concentrations and viral loads in Neuro-2a cell cultures using 20 rabies-positive bovine samples. The reproducibility of results varied: 65% showed consistent outcomes across all concentrations, while 35% disagreed in at least one. Viral titers ranged from less than 25 × 101 to 25 × 103.50 TCID50/mL, with 20% below 25 × 101 TCID50/mL. Concentrations between 5% and 20% yielded over 90% agreement in positive results, but at 30%, agreement dropped from 85% to 50%. Cell confluence was successfully maintained at 5%, 10%, and 20%, while concentrations of 30% and above led to confluence loss. Low viral loads also negatively impacted reproducibility. These results suggest that sample concentration has a direct influence on preservation of cell confluence and that low viral loads may influence the reproducibility of the rabies tissue culture infection test (RTCIT).

Genetic analyses of rabies virus glycoprotein and nucleoprotein gene sequences reveal the emergence of multiple lineages in animals in Arkhangai province, a central region of Mongolia

Genetic characterizations of rabies viruses circulating in carnivore and non-carnivore animals were investigated for the first time in Arkhangai province, a central region of Mongolia. Also, glycoprotein gene of the rabies virus was sequenced for the first time in Mongolia. The nucleotide sequences of the glycoprotein and nucleoprotein genes were analysed, revealing the presence of multiple lineages in this area. Of particular concern are the lineages identified in carnivores, which might emerge to spread throughout Mongolia, further facilitating transboundary transmission to neighbouring countries, including China and Russia.

Exploring the spatial pattern of animal bites in Iran (2021-2022)

OBJECTIVE

Knowledge of the spatial pattern of animal bites can be helpful for targeted resource allocation and to develop and deliver effective intervention programs. The aim of this study was to explore the spatial pattern of the animal bites in Iran during 2021-2022.

METHODS

Animal bite cases from all provinces and counties in Iran were obtained from a nationally based registry. Global Moran's I was applied to check spatial autocorrelation. The spatially adjusted standardized incidence ratios (SIRs) were estimated using the Besag, York, and Mollie (BYM) model. Spatial clusters were identified by local indicators of spatial association (LISA) and purely spatial scan statistic.

RESULTS

A total of 260,470 animal bites were registered during the study period. There was a positive spatial autocorrelation (global Moran's I=0.27, p-value=0.001). The majority of SIRs greater than 1.00 was found in counties in the northern belt of Iran (e.g., observed greater than expected animal bites). LISA found that approximately 7% of counties in the north and northeast, 18% in the west and south, and 3% in the central part of Iran were significant hot spots, cold spots, and spatial outliers (p-value≤0.05). Spatial scan statistic detected primary hot spot cluster in the counties in the Mazandaran and Alborz provinces (Relative Risk=2.56, p-value<0.001), while primary cold spot cluster involved counties in Kurdistan and Kermanshah province (0.37, <0.001).

CONCLUSION

Animal bites were unevenly distributed in Iran. Further prevention and control programs as well as appropriately resource allocation are needed in order to reduce the observed animal bites spatial disparity.

Evaluating the benefit of serology during potential Australian bat lyssavirus and rabies post-exposure prophylaxis

Post-exposure prophylaxis (PEP) for potential lyssavirus exposures consists of wound management, rabies vaccination and may include rabies immunoglobulin (RIG). Rabies serology is sometimes indicated if there is risk of PEP failure.

OBJECTIVES

Evaluate the benefit of serology by indication.

METHODS

Chart review of potential lyssavirus exposures managed at a Public Health Unit (June 2015 - December 2022) where serology was requested was conducted. The proportion of non-therapeutic titres was compared by sex, age, Indigenous status, serology indication, and whether RIG was given.

RESULTS

46 notifications with serology were included. Males (5/19) and people over 40 (3/16) were more likely to demonstrate a non-therapeutic response. 2/3 of cases where vaccine doses were not given in the deltoid were non-therapeutic. The rate of non-therapeutic titres was similar for RIG given into the ipsilateral arm (2/11) and given excess RIG for weight (1/4). Although this small sample was inconclusive in isolation, it was also noted that all cases who did not receive RIG had therapeutic serology, whereas 6/35 of those receiving RIG had non-therapeutic serology.

CONCLUSIONS

This study supports broader literature questioning the utility of systemic RIG administration as likely limited and potentially detrimental considering the increased risk of immune interference.

IMPLICATIONS FOR PUBLIC HEALTH

Highlights a need to review Australian national guidelines to align with World Health Organization advice recommending local RIG administration only.

A single immunization with core-shell structured lipopolyplex mRNA vaccine against rabies induces potent humoral immunity in mice and dogs

The persistence and clinical consequences of rabies virus (RABV) infection have prompted global efforts to develop a safe and effective vaccines against rabies. mRNA vaccines represent a promising option against emerging and re-emerging infectious diseases, gaining particular interest since the outbreak of COVID-19. Herein, we report the development of a highly efficacious rabies mRNA vaccine composed of sequence-modified mRNA encoding RABV glycoprotein (RABV-G) packaged in core-shell structured lipopolyplex (LPP) nanoparticles, named LPP-mRNA-G. The bilayer structure of LPP improves protection and delivery of RABV-G mRNA and allows gradual release of mRNA molecules as the polymer degrades. The unique core-shell structured nanoparticle of LPP-mRNA-G facilitates vaccine uptake and demonstrates a desirable biodistribution pattern with low liver targeting upon intramuscular immunization. Single administration of low-dose LPP-mRNA-G in mice elicited potent humoral immune response and provided complete protection against intracerebral challenge with lethal RABV. Similarly, single immunization of low-dose LPP-mRNA-G induced high levels of virus-neutralizing antibody titers in dogs. Collectively, our data demonstrate the potential of LPP-mRNA-G as a promising next-generation rabies vaccine used in human and companion animals.

Tracking lethal threat: in-depth review of rabies

An infectious disease known as rabies (family Rhabdoviridae, genus Lyssavirus) causes severe damage to mammals' central nervous systems (CNS). This illness has been around for a very long time. The majority of human cases of rabies take place in underdeveloped regions of Africa and Asia. Following viral transmission, the Rhabdovirus enters the peripheral nervous system and proceeds to the CNS, where it targets the encephalon and produces encephalomyelitis. Postbite prophylaxis requires laboratory confirmation of rabies in both people and animals. All warm-blooded animals can transmit the Lyssavirus infection, while the virus can also develop in the cells of cold-blooded animals. In the 21st century, more than 3 billion people are in danger of contracting the rabies virus in more than 100 different nations, resulting in an annual death toll of 50,000-59,000. There are three important elements in handling rabies disease in post exposure prophylaxis (PEP), namely wound care, administration of anti-rabies serum, and anti-rabies vaccine. Social costs include death, lost productivity as a result of early death, illness as a result of vaccination side effects, and the psychological toll that exposure to these deadly diseases has on people. Humans are most frequently exposed to canine rabies, especially youngsters and the poor, and there are few resources available to treat or prevent exposure, making prevention of human rabies challenging.

An mRNA vaccine against rabies provides strong and durable protection in mice

Introduction

Rabies is a serious public health problem worldwide for which an effective treatment method is lacking but can be prevented by vaccines. Current vaccines are produced in cell or egg cultures, which are both costly and time consuming.

Methods

Here, a non-replicating mRNA vaccine (RV021) encoding the rabies virus glycoprotein was developed in vitro, and its immunogenicity and protective efficacy against live virus was evaluated in mice.

Results

A two-dose vaccination with 1 μg of RV021 at 7-day intervals induced a protective level of neutralizing antibody that was maintained for at least 260 days. RV021 induced a robust cellular immune response that was significantly superior to that of an inactivated vaccine. Two doses of 1 μg RV021 provided full protection against challenge with CVS of 30~60-fold lethal dose, 50%. Vaccine potency testing (according to the National Institutes of Health) in vivo revealed that the potency of RV021 at 15 μg/dose was 7.5 IU/dose, which is substantially higher than the standard for lot release of rabies vaccines for current human use.

Conclusion

The mRNA vaccine RV021 induces a strong protective immune response in mice, providing a new and promising strategy for human rabies prevention and control.

Evolution and distribution of rabies viruses from a panorama view

Rabies kills more than 59,000 people annually, mainly in developing countries. Previous studies on the evolution and distribution of rabies viruses (RABVs) were scattered. Here, we explore the evolution and distribution of this deadly virus from a novel panorama view. Multiple bioinformatic software tools were employed to analyze the phylogenetic diversity, evolution, spatiotemporal, and distribution of RABVs. The analyses were based on 1,202 qualified full-length genomes of RABVs and numerous literatures. Of the 10 distinct phylogenetic clades of RABV that we identified, more frequent intra- and inter-clade recombination occurs in the sequences of Asian-SEA, Arctic, and Cosmopolitan clades isolated from China, while according to existing sequence information, RABV might originate from bats (posterior probability, PP = 0.75, PP = 0.60 inferred from N and L genes, separately) in North America (PP = 0.57, PP = 0.62 inferred from N and L genes, separately). Due to the difference in evolutionary rate of N (2.22 × 10-4 subs/site/year, 95% HPD 1.99-2.47 × 10-4 subs/site/year) and L genes (1.67 × 10-4 subs/site/year, 95% HPD 1.59-1.74 × 10-4 subs/site/year), the root age was 1,406.6 (95% HPD 1,291.2-1,518.2) and 1,122.7 (95% HPD 1,052.4-1,193.9) inferred from N and L genes, separately. Among other findings, Mephitidae plays an important role in the interspecific transmission and communication of RABV, which we found tends to spread to populations genetically proximate to the host. We also identified amino acids under positive selection in different genes of different clades as well as single nucleotide variation sites important for different lineages. IMPORTANCE Rabies virus is widely distributed all over the world, and wild animals are its largest potential reservoir. Our study offers a panorama view about evolution and distribution of rabies viruses and emphasizes the need to monitor the transmission dynamics of animal rabies.

How knowledgeable are people in Nepal about rabies?

Eliminating dog-mediated human rabies cases by 2030 is a collective global pledge. Rabies is a vaccine-preventable, zoonotic, and fatal viral disease tormenting human beings and animals for at least four thousand years. An average annual fatality of 59,000 people has been reported from rabies in more than 150 countries, including Nepal. Understanding people's knowledge towards rabies is paramount to preventing this disease. A cross-sectional study was conducted in three districts, namely, Siraha, Parsa, and Parasi in Nepal, from October to December 2021 to assess the level of public awareness of rabies. Information was obtained using a structured questionnaire among 308 household heads. Study findings show that some of the respondents were unfamiliar with the term 'rabies'. They knew major carriers or sources of rabies, but the majority of them (87.3%) did not know its causative agent. They had some idea of how rabies is transmitted from animals to humans, but they lacked a clear understanding of the fate of the animals and humans once affected cases are symptomatic. Only 35.1% of respondents knew that rabies pathogens attack and multiply in the brain tissues. Rabies vaccination in pets is critical for rabies eradication, yet only 26.3% of respondents were aware of the vaccination schedule. Nearly 90% of respondents thought post-exposure prophylaxis (PEP) to be effective immediately after a suspected animal bite. The findings show that there was a significant relationship between independent variables viz. pet ownership (X2 = 20.273, p < 0.001), level of education (X2 = 39.215, p < 0.001), household income (X2 = 13.574, p < 0.001), family size (X2 = 15.053, p < 0.001), main occupation (X2 = 11.618, p = 0.020), age (X2 = 6.982, p = 0.008) with dependent variable i. e., knowledge category (good and poor knowledge). Education to invoke awareness among rural people about rabies, its transmission and prevention, including making anti-rabies vaccines freely available, should be the priority for municipalities, public health and veterinary health authorities in the study districts and throughout the country.

Immunogenicity and Antigenicity of the Ectodomain of Rabies Virus Glycoprotein Stably Expressed in HEK293T Cells

Rabies continues to be a huge threat to public health. The rabies virus envelope glycoprotein (RABV G) is a major rabies virus antigen and contains neutralizing epitopes, which are primary candidates for subunit vaccines and diagnostic antigens. However, the production and purification of rRABV G while retaining its antigenic and immunogenic remains to be a challenge. Here, we aimed to establish a platform for rRABV G production and purification, and determine the immunogenicity and antigenicity of rRABV G. The cDNA fragment encoding the soluble form of RABV G was synthesized and cloned into a lentiviral expressing vector. Recombinant lentiviral vector LV-CMV-RABV G-eGFP was packaged, titered, and then transduced into HEK 293T cells. The cell culture supernatant was purified using nickel affinity chromatography and subsequently confirmed through Western Blot analysis and indirect enzyme-linked immunosorbent assay (ELISA). The ELISA utilized human sera obtained from individuals who had been vaccinated with the human commercial Purified Vero Cells Rabies Vaccine (PVRV). Notably, we observed a neutralizing antibody response in immunized pigs rather than in mice. This discrepancy could potentially be attributed to factors such as the instability of the rRABV G protein, variations in host responses, and variances in the adjuvant used. Taking all these findings into account, the rRABV G protein generated in this study exhibits promise as a potential vaccine candidate for the prevention of rabies.

The occurrence and extent of anxiety and distress among Dutch travellers after encountering an animal associated injury

BACKGROUND

Prompt administration of post-exposure prophylaxis (PEP) is crucial to prevent a fatal rabies infection after an animal associated injury (AAI), preferably within 24 h. PEP, especially in case of a type III injury for which rabies immune globulin (RIG) is needed, is difficult to obtain abroad. This, along with the fear of potentially having contracted a lethal disease, might be an important source for anxiety and distress. We investigated the occurrence and extent of self-reported anxiety and distress at different timepoints among Dutch travellers after encountering an AAI, and the involved factors.

METHODS

A retrospective quantitative observational study was conducted including insured Dutch travellers who actively contacted Eurocross Assistance after encountering an AAI abroad. An online questionnaire was designed to measure anxiety and distress levels, using the HADS (Hospital Anxiety and Depression Scale) and distress thermometer at three time points: departure from home (T1), post-AAI (T2), and treatment administration (T3). Statistical analyses included T-tests, Chi-square tests, and ANCOVA analyses.

RESULTS

We showed a significant increase in mean anxiety and distress scores at T2, and a significant decrease at T3. Women were more often anxious and distressed. Between T1 and T2, PrEP, and being aware of the risks were positively associated with anxiety levels, and PrEP and WHO region Africa with distress levels. Between T2 and T3, anxiety levels remained higher for monkey-induced injury, thoracic injuries, and WHO region Southeast Asia. PEP-delay between 24-48 h resulted in decreased distress levels at this time period, while type II injury elevated distress levels.

CONCLUSIONS

This study showed significant anxiety and distress levels after an AAI among the vast majority of travellers, which is detrimental to their health-related quality of life (HR-QOL). This highlights the importance of proper pre-travel information. In the context of rabies prevention, these results suggest that pre-travel advice and policy makers should also take aspects of HR-QOL into consideration.

Improved Transdermal Delivery of Rabies Vaccine using Iontophoresis Coupled Microneedle Approach

AIM

This study was aimed to develop rabies vaccine incorporated microneedle (MN) patches and evaluate the immunogenicity of prepared formulations in combination with iontophoresis.

METHODS

Patches comprising of polyvinyl pyrrolidone, hyaluronic acid and polyethylene glycol 400 were engineered by vacuum micromolding technique. Physical evaluation of patches included determination of folding endurance, % swelling and morphological features. In vitro release study was performed in skin simulant agarose gel using model drug (methylene blue) loaded patches. In vitro insertion ability was assessed using stratum corneum simulant parafilm. In vivo insertion study was performed in rats. Immunogenicity was evaluated in dogs by determining immunoglobulin G (IgG) and rabies virus neutralizing antibodies (RVNA) titer.

RESULTS

Patches displayed uniformly distributed microprojections with pointed tips and smooth surface,  ~ 70% swelling, remained intact for  ~ 200 foldings and successfully penetrated the parafilm. The area covered by model drug across agarose gel was almost double following treatment with MN-iontophoresis combination (MNdi) compared to MN alone (MNdo). Histological examination of rat skin treated with vaccine laden MN (MNvo) and MN-iontophoresis combination (MNvi) confirmed the formation of grooves in epidermis without any damage to the deep vasculature. A ~ 73% and  ~ 206% increase (compared to untreated counterpart) was observed in the IgG titer of MNvo and MNvi treated dogs, respectively. The RVNA titer was increased by  ~ 1.2 and  ~ 2.2 times (compared to threshold value) after MNvo and MNvi treatment, respectively.

CONCLUSION

MN-iontophoresis combination provided relatively potent immunogenic response over the conventional intramuscular injection, hence, can be used for administering vaccines transcutaneously.

Short-Chain Fatty Acids Alleviate Vancomycin-Caused Humoral Immunity Attenuation in Rabies-Vaccinated Mice by Promoting the Generation of Plasma Cells via Akt-mTOR Pathway

Mounting evidence suggests that gut microbial composition and its metabolites, including short-chain fatty acids (SCFAs), have beneficial effects in regulating host immunogenicity to vaccines. However, it remains unknown whether and how SCFAs improve the immunogenicity of the rabies vaccine. In this study, we investigated the effect of SCFAs on the immune response to rabies vaccine in vancomycin (Vanco)-treated mice and found that oral gavage with butyrate-producing bacteria (C. butyricum) and butyrate supplementation elevated RABV-specific IgM, IgG, and virus-neutralizing antibodies (VNAs) in Vanco-treated mice. Supplementation with butyrate expanded antigen-specific CD4+ T cells and IFN-γ-secreting cells, augmented germinal center (GC) B cell recruitment, promoted plasma cells (PCs) and RABV-specific antibody-secreting cells (ASCs) generation in Vanco-treated mice. Mechanistically, butyrate enhanced mitochondrial function and activated the Akt-mTOR pathway in primary B cells isolated from Vanco-treated mice, ultimately promoting B lymphocyte-induced maturation protein-1 (Blimp-1) expression and CD138+ PCs generation. These results highlight the important role of butyrate in alleviating Vanco-caused humoral immunity attenuation in rabies-vaccinated mice and maintaining host immune homeostasis. IMPORTANCE The gut microbiome plays many crucial roles in the maintenance of immune homeostasis. Alteration of the gut microbiome and metabolites has been shown to impact vaccine efficacy. SCFAs can act as an energy source for B-cells, thereby promoting both mucosal and systemic immunity in the host by inhibiting HDACs and activation of GPR receptors. This study investigates the impact of orally administered butyrate, an SCFA, on the immunogenicity of rabies vaccines in Vanco-treated mice. The results showed that butyrate ameliorated humoral immunity by facilitating the generation of plasma cells via the Akt-mTOR in Vanco-treated mice. These findings unveil the impact of SCFAs on the immune response of the rabies vaccine and confirm the crucial role of butyrate in regulating immunogenicity to rabies vaccines in antibiotic-treated mice. This study provides a fresh insight into the relationship of microbial metabolites and rabies vaccination.

Open source board based acoustofluidic transwells for reversible disruption of the blood-brain barrier for therapeutic delivery

BACKGROUND

Blood-brain barrier (BBB) is a crucial but dynamic structure that functions as a gatekeeper for the central nervous system (CNS). Managing sufficient substances across the BBB is a major challenge, especially in the development of therapeutics for CNS disorders.

METHODS

To achieve an efficient, fast and safe strategy for BBB opening, an acoustofluidic transwell (AFT) was developed for reversible disruption of the BBB. The proposed AFT was consisted of a transwell insert where the BBB model was established, and a surface acoustic wave (SAW) transducer realized using open-source electronics based on printed circuit board techniques.

RESULTS

In the AFT device, the SAW produced acousto-mechanical stimulations to the BBB model resulting in decreased transendothelial electrical resistance in a dose dependent manner, indicating the disruption of the BBB. Moreover, SAW stimulation enhanced transendothelial permeability to sodium fluorescein and FITC-dextran with various molecular weight in the AFT device. Further study indicated BBB opening was mainly attributed to the apparent stretching of intercellular spaces. An in vivo study using a zebrafish model demonstrated SAW exposure promoted penetration of sodium fluorescein to the CNS.

CONCLUSIONS

In summary, AFT effectively disrupts the BBB under the SAW stimulation, which is promising as a new drug delivery methodology for neurodegenerative diseases.

Single visit rabies pre-exposure prophylaxis: A literature review

BACKGROUND

The current WHO-recommended rabies pre-exposure prophylaxis (PrEP) are two-visit vaccination schedules, but there are studies suggesting that single visit schedules might be sufficient to prime the immunity.

METHODS

A literature review was conducted to retrieve and summarize published data on single visit rabies PrEP. PubMed database was screened for articles published between January 1st, 2003 and December 31st, 2022. The bibliographies of the articles chosen to undergo full text review and of the current major WHO publications on rabies were searched to find additional references, regardless of publication date. The primary outcome was the percentage of subjects having received rabies PrEP on single visit schedules who achieved antibody levels ≥0.5 IU/mL one week after post-exposure prophylaxis (PEP), regardless of the PEP regimen.

RESULTS

11 studies were selected for inclusion, totalling 935 subjects, of which 696 received a simulated PEP schedule. Of these 696, a serological test result on day 7 was available for 408 of them, and 406 subjects (99.51%) seroconverted after PEP without any difference regarding time delay between PrEP and PEP or the vaccination schedule used for PEP.

CONCLUSION

Single visit PrEP schedules seem to confer sufficient protection in most healthy individuals without immunocompromised status if a booster PEP is administered after a suspected rabies exposure. Further studies in real-life settings and in different age categories are needed to confirm this finding, which may increase the availability of vaccines and thus the accessibility of PrEP for vulnerable populations.

Incidence and mortality trends of neglected tropical diseases and malaria in China and ASEAN countries from 1990 to 2019 and its association with the socio-demographic index

BACKGROUND

People in China and the countries in the Association of Southeast Asian Nations (ASEAN) are affected by neglected tropical diseases and malaria (NTDM). In this study, we aimed to assess the current status and trends of NTDM burden from 1990 to 2019 in China and ASEAN countries, and also explore the association of NTDM burden with socio-demographic index (SDI).

METHODS

The data from the Global Burden of Diseases Study 2019 (GBD 2019) results were used. Absolute incidence and death number, and age-standardized incidence and mortality rate (ASIR and ASMR) of NTDM in China and ASEAN were extracted. The estimated annual percentage change (EAPC) and join-point regression in the rates quantified the trends. Nonlinear regression (second order polynomial) was used to explore the association between SDI and ASRs.

RESULTS

The ASIR of NTDM increased in China, Philippines, Singapore and Brunei, at a speed of an average 4.15% (95% CI 3.83-4.47%), 2.15% (1.68-2.63%), 1.03% (0.63-1.43%), and 0.88% (0.60-1.17%) per year. Uptrends of ASIR of NTDM in recent years were found in China (2014-2017, APC = 10.4%), Laos (2005-2013, APC = 3.9%), Malaysia (2010-2015, APC = 4.3%), Philippines (2015-2019, APC = 4.2%), Thailand (2015-2019, APC = 2.4%), and Vietnam (2014-2017, APC = 3.2%, all P < 0.05). Children < 5 had relatively low incidences but unexpectedly high mortality rates of NTDM in most ASEAN countries. Both incidence and mortality rates of NTDM were higher in older people. ASIR and ASMR of NTDM had a U-shaped association with SDI.

CONCLUSIONS

The burden of NTDM in China and ASEAN countries was still huge and affects vulnerable and impoverished populations' livelihoods, including children under the age of 5 and people aged 60 and older. Facing with the large burden and complex situation of NTDM in China and ASEAN countries, regional cooperating strategies are needed to reduce the burden of NTDM, so as to achieve the goal of elimination in the world.

Emergency response using oral rabies vaccination of dogs -field data from Namibia demonstrate high efficiency

Dog-mediated rabies is responsible for tens of thousands of human deaths annually, and in resource-constrained settings, vaccinating dogs to control the disease at source remains challenging for various reasons. Currently, rabies elimination efforts rely on mass dog vaccination by the parenteral route. While oral rabies vaccination (ORV) of dogs is primarily considered a tool to increase herd immunity, particularly by targeting free-roaming and stray dogs, here, we are showcasing an ORV-only approach as an emergency response model. Using a third-generation vaccine and a standardized egg-flavored bait, we assessed the effectiveness and vaccination under field conditions in the Zambezi region of Namibia. During this trial, with four teams and within four working days, 3097 dogs were offered a bait, of which 88,0% were considered vaccinated. Teams managed to vaccinate, on average, over 20 dogs/h, despite using a door-to-door vaccination approach. The favorable results both in terms of bait acceptance and successful vaccination as well as field applicability and effectiveness further support the great potential of ORV in dog rabies control programmes.

Transcriptomic Analysis of mRNA Expression Profiles in the Microglia of Mouse Brains Infected with Rabies Viruses of Varying Virulence

Rabies is a lethal encephalitis caused by the rabies virus (RABV) with a fatality rate near 100% after the onset of clinical symptoms in humans and animals. Microglia are resident immune cells in the central nervous system. Few studies have been conducted on the functional role of microglia in RABV infection. Here, we performed a transcriptomic analysis of mRNA expression profiles in the microglia of mouse brains intracerebrally infected with RABV. We successfully isolated single microglial cells from the mouse brains. The survival rate of dissociated microglial cells was 81.91%-96.7%, and the purity was 88.3%. Transcriptomic analysis revealed 22,079 differentially expressed mRNAs identified in the microglia of mouse brains infected with RABV strains (rRC-HL, GX074, and CVS-24) of varying virulence at 4 and 7 days post-infection (dpi) compared to the control group. The numbers of DEGs versus the control at 4 and 7 dpi in mice infected with rRC-HL, GX074, and CVS-24 were 3622 and 4590, 265 and 4901, and 4079 and 6337. The GO enrichment analysis showed that response to stress, response to external stimulus, regulation of response to stimulus, and immune system process were abundant during RABV infection. The KEGG analysis indicated that the Tlr, Tnf, RIG-I, NOD, NF-κB, MAPK, and Jak-STAT signaling pathways were involved in RABV infection at both 4 and 7 dpi. However, some phagocytosis and cell signal transduction processes, such as endocytosis, p53, phospholipase D, and oxidative phosphorylation signaling pathways, were only expressed at 7 dpi. The involvement of the Tnf and Tlr signaling pathways prompted us to construct a protein-protein interaction (PPI) network of these pathways. The PPI revealed 8 DEGs, including Mmp9, Jun, Pik3r1, and Mapk12. Notably, Il-1b interacted with Tnf and Il-6 with combined scores of 0.973 and 0.981, respectively. RABV causes significant changes in mRNA expression profiles in the microglia in mice. 22,079 differentially expressed mRNAs were identified in the microglia of mice infected with RABV strains of varying virulence at 4 and 7 dpi. The DEGs were evaluated using GO, KEGG, and PPI network analysis. Many immune pathways were up-regulated in RABV-infected groups. The findings will help elucidate the microglial molecular mechanisms of cellular metabolism dysregulated by RABV and may provide important information for investigating RABV pathogenesis and therapeutic methods.

Evaluation of country infrastructure as an indirect measure of dog-mediated human rabies deaths

Background

Rabies is a neglected disease, primarily due to poor detection stemming from limited surveillance and diagnostic capabilities in most countries. As a result, there is limited ability to monitor and evaluate country, regional, and global progress towards the WHO goal of eliminating human rabies deaths by 2030. There is a need for a low-cost, readily reproducible method of estimating rabies burden and elimination capacity in endemic countries.

Methods

Publicly available economic, environmental, political, social, public health, and One Health indicators were evaluated to identify variables with strong correlation to country-level rabies burden estimates. A novel index was developed to estimate infrastructural rabies elimination capacity and annual case-burden for dog-mediated rabies virus variant (DMRVV) endemic countries.

Findings

Five country-level indicators with superior explanatory value represent the novel "STOP-R index:" (1) literacy rate, (2) infant mortality rate, (3) electricity access, (4) political stability, and (5) presence/severity of natural hazards. Based on the STOP-R index, 40,111 (95% CI 25,854-74,344) global human rabies deaths are estimated to occur in 2022 among DMRVV-endemic countries and are projected to decrease to 32,349 (95% CI 21,110-57,019) in 2030.

Interpretation

The STOP-R index offers a unique means of addressing the data gap and monitoring progress towards eliminating dog-mediated human rabies deaths. Results presented here suggest that factors external to rabies programs influence the successes of rabies elimination, and it is now possible to identify countries exceeding or lagging in expected rabies control and elimination progress based on country infrastructure.

Diagnostic sensitivity and specificity of immunohistochemistry for the detection of rabies virus in domestic and wild animals in South Africa

We estimated the diagnostic sensitivity (DSe) and specificity (DSp) of an immunohistochemistry (IHC) protocol compared to the direct fluorescent antibody test (DFAT), which is the gold standard test for rabies diagnosis. We obtained brain samples from 199 domestic and wild animal cases (100 DFAT-negative, 99 DFAT-positive), by convenience sampling from 2 government-accredited rabies virus (RABV) testing laboratories in South Africa, between February 2015 and August 2017. Tissues that had been stored at 4-8°C for several days to weeks at the 2 accredited laboratories were formalin-fixed and paraffin-embedded. Nighty-eight cases tested IHC-positive using a polyclonal anti-RABV nucleoprotein antibody and a polymer detection system. The overall DSe and DSp for the RABV IHC test were 98% (95% CI: 93-100%) and 99% (95% CI: 95-100%), respectively. Domestic dogs accounted for 41 of 98 RABV IHC-positive cases, with the remainder in 4 domestic cats, 25 livestock, and 28 wildlife. Herpestidae species, including 7 meerkats and 9 other mongoose species, were the most frequently infected wild carnivores, followed by 11 jackals. Three cases in domestic dogs had discordant test results; 2 cases were IHC-/DFAT+ and 1 case was IHC+/DFAT-. Considering the implications of a false-negative rabies diagnosis, participating in regular inter-laboratory comparisons is vital, and a secondary or confirmatory method, such as IHC, should be performed on all submitted specimens, particularly negative cases with human contact history.

Interleukin-1β suppresses rabies virus infection by activating cGAS-STING pathway and compromising the blood-brain barrier integrity in mice

Rabies, caused by rabies virus (RABV), is an ancient zoonotic disease that severely threatens the public health throughout the world. Previous study indicated that interleukin-1β (IL-1β) plays an important role in RABV infection. However, the mechanism how IL-1β affects RABV pathogenicity is still unknown yet. In this study, we confirmed that IL-1β was able to reduce viral titers of RABV in different cells, and the recombinant RABV expressing IL-1β, designated as rCVS-IL1β, could be suppressed in different cells due to the expression of IL-1β. Furthermore, the survival rates of mice infected with rCVS-IL1β by intramuscular route was significantly higher than those of mice infected with parent virus rCVS, which is associated with the less viral loads for entry into the central nervous system (CNS). We further characterized that the cGAS-STING pathway was activated in rCVS-IL1β infected bone marrow derived dendritic cells (BMDC), which could contribute to the decreased viral loads of RABV after intramuscular infection. Moreover, we also observed that the expression of IL-1β by rCVS-IL1β could compromise the blood-brain barrier (BBB) integrity by degrading the tight junction proteins, which allowing peripheral inflammatory cytokines, chemokines, and CD4+T cells to enter into the brain for the clearance of RABV in the CNS. Together, our study suggests that IL-1β could attenuate RABV pathogenicity through activating cGAS-STING pathway in to decrease the viral entry into the CNS and enhance the BBB permeability to promote RABV clearance in the CNS as well, which provides new insight into developing effective therapeutics for rabies.

Update on laboratory data of animal rabies at the Centre Pasteur of Cameroon from 2014 to 2021

Rabies is a worldwide zoonotic disease mainly transmitted to humans by an infected dog bite. Despite the endemicity of rabies in dogs and few documented cases in Cameroon, there is still not enough data on frequency of rabies cases in animals. The present study aims to update data on the circulation of rabies in animals screened at the Centre Pasteur of Cameroon (CPC) between 2014 and 2021. The detection of rabies in animals was based on passive surveillance. Animal rabies cases were confirmed on brain biopsies using fluorescent antibody test and SYBR green based real-time RT-PCR for negative results confirmation. The total nucleoprotein (N) gene of animal-derived RABV isolated were amplified by hemi nested RT-PCR and subjected to phylogenetic analyses. From 2014 to 2021, a total of 92 animals including 86 dogs (93.5%), 3 cats, 2 pigs and 1 chiropteran were screened for rabies at the CPC. From the 86 dog sampled, 62.3% (54/86) were tested positive for rabies and 1 out of 3 cat samples was also tested positive. The PEP demand was very high (59,371) during the study period. Phylogenetic analyses assigned all 15 studied isolates successfully sequenced to the Africa-1a lineage belonging to the Cosmopolitan clade. The study highlights the frequent circulation of rabies in Cameroon and the role of dogs and cat as main reservoir and vector of rabies.

Evaluation of Dynamics, Demography and Estimation of Free-Roaming Dog Population in Herat City, Afghanistan

FRDs pose a serious challenge in countries where dog-bite-related rabies is endemic. Understanding the size and core demographic characteristics of FRD populations is essential for the planning and implementation of effective dog-population and canine-rabies-control programmes. The photographic sight-resight method was used to estimate the FRD population and evaluate its demographic characteristics in Herat city. A total of 928 free-roaming dogs (FRD) were identified through 3172 sightings, and the total free-roaming population was estimated to amount to 1821 (95% CI: 1565-2077), which led to the estimation of 10 dogs/km² and the human-to-FRD ratio of 315:1. The male-to-female ratio was 2.85:1. The majority of them were healthy, with an ideal body score. Although the FRD density is considered low, it is still a concern and significant, since the majority of the people are unaware of the importance of canine populations in the transmission of zoonotic diseases such as rabies, and there were no specific measures for managing and controlling FRD populations. The information gained can be useful in animal health planning to design effective dog-population-control programmes, and for the planning of national rabies-prevention programmes.