Current Status of Rabies and Its Eradication in Eastern and Southeastern Europe

Risk of rabies reintroduction into the European Union as a result of the Russo-Ukrainian war: A quantitative disease risk analysis

AIMS

The importation of rabid animals poses a continual threat to rabies freedom in the European Union (EU). Following the Russian invasion of Ukraine in 2022, the European Commission eased the rules on companion animal importations for Ukrainian refugees through derogations to the EU Pet Travel Scheme (EU PETS). As Ukraine remains endemic for canine rabies, this paper aimed to quantitatively assess whether the change in regulations affected the risk of rabies introduction to the EU.

METHOD AND RESULTS

Transmission pathways for both EU PETS and derogations to this scheme were considered, as well as the scenarios of 100% compliance and reduced compliance within both schemes. Stochastic modelling was performed via a Monte Carlo simulation to calculate the median and 95% confidence intervals of the annual risk of rabies entry and the years between rabies entries into the EU. Following 100% compliance, the derogation scheme posed a significantly lower risk at a value of 3.63 × 10-3 (CI 95% 1.18 × 10-3-9.34 × 10-3) rabies entries per year in comparison to EU PETS where the risk was 4.25 × 10-2 (CI 95% 1.44 × 10-2-9.81 × 10-2). Despite a significantly lower risk as compared to EU PETS under 100% compliance, the derogation scheme was more sensitive to a reduction in compliance which resulted in a 74-fold increase in risk. Given this, even under reduced compliance, the annual risk remained lower under the derogation scheme, although this was not statistically significant.

CONCLUSION

The findings of this study suggest that a 4-month period of quarantine, as modelled for the derogation scenario, could reduce the annual risk of rabies entry. This scheme may present a viable solution for the management of companion animal influxes in future crises.

A Global Perspective on Oral Vaccination of Wildlife against Rabies

The long-term mitigation of human-domestic animal-wildlife conflicts is complex and difficult. Over the last 50 yr, the primary biomedical concepts and actualized collaborative global field applications of oral rabies vaccination to wildlife serve as one dramatic example that revolutionized the field of infectious disease management of free-ranging animals. Oral vaccination of wildlife occurred in diverse locales within Africa, Eurasia, the Middle East, and North America. Although rabies is not a candidate for eradication, over a billion doses of vaccine-laden baits distributed strategically by hand, at baiting stations, or via aircraft, resulted in widespread disease prevention, control, or local disease elimination among mesocarnivores. Pure, potent, safe, and efficacious vaccines consisted of either modified-live, highly attenuated, or recombinant viruses contained within attractive, edible baits. Since the late 1970s, major free-ranging target species have included coyotes (Canis latrans), foxes (Urocyon cinereoargenteus; Vulpes vulpes), jackals (Canis aureus; Lupulella mesomelas), raccoons (Procyon lotor), raccoon dogs (Nyctereutes procyonoides), and skunks (Mephitis mephitis). Operational progress has occurred in all but the latter species. Programmatic evaluations of oral rabies vaccination success have included: demonstration of biomarkers incorporated within vaccine-laden baits in target species as representative of bait contact; serological measurement of the induction of specific rabies virus neutralizing antibodies, indicative of an immune response to vaccine; and most importantly, the decreasing detection of rabies virus antigens in the brains of collected animals via enhanced laboratory-based surveillance, as evidence of management impact. Although often conceived mistakenly as a panacea, such cost-effective technology applied to free-ranging wildlife represents a real-world, One Health application benefiting agriculture, conservation biology, and public health. Based upon lessons learned with oral rabies vaccination of mesocarnivores, opportunities for future extension to other taxa and additional diseases will have far-reaching, transdisciplinary benefits.

Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017-2019)

BACKGROUND

Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure.

METHOD

The study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose.

RESULTS

Age emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45-60 and 75-92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG.

CONCLUSIONS

This study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.

Prospects for dog rabies elimination in Nigeria by 2030

The attainment of the global target of zero dog-mediated human rabies by 2030 depends on functional rabies programmes. Nigeria, a rabies-endemic country, and the most populous country in Africa has a very poor rabies control strategy with a score of 1.5 out of 5 based on the Stepwise Approach towards Rabies Elimination (SARE). In this article, we report a scoping review that we conducted to highlight the strengths, weaknesses, opportunities and threats as well as situational analysis of rabies control in Nigeria and suggest a timeline for key activities that are needed to ensure zero by 30. Our findings reveal that rabies is grossly under-reported as only 998 human and 273 dog-suspected rabies cases were reported across Nigeria between 2017 and 2022. Our literature review also demonstrates a paucity of information on rabies in both human and animal health sectors. A total of 49 studies on dog rabies in Nigeria, with a predominance of reports from the North Central geopolitical region (48%, n = 23) were therefore included in this study. Currently, only 16.2% (n = 6/37) of Nigerian states have available data related to the estimated dog populations, the dog ownership rates, the vaccination status of dogs or the incidence of dog bites. Based on a dog-to-human ratio of 1:16.3, we estimated that the dog population in Nigeria was 12,969,368 (95% CI: 12,320,900-13,617,836). Thus, to attain herd immunity and dog rabies control in Nigeria, at least 9.1 million dogs must be vaccinated annually. Our review reveals that, despite the strengths and available opportunities to achieve rabies control in Nigeria by 2030, the weaknesses and challenges will make the attainment of zero by 30 very difficult or impossible. Nigeria's best-case scenario by the year 2030 is SARE stage 3-4 (control-elimination) out of 5. Otherwise, the rabies control programme might not surpass SARE stages 2-3. To attain zero by 30, Nigeria must re-strategize its current rabies control programme by funding and implementing the national strategic plan for rabies control, creating a rabies desk office in the 37 states (FCT inclusive), rigorously conducting mass vaccination campaigns, providing post-exposure prophylaxis, prioritizing mass enlightenment with a focus on responsible pet ownership and conduct baseline national rabies surveillance in the animal and human health sectors.

Spatiotemporal patterns of rabid dogs and cats and the opinions of personnel responsible for disease control in Thailand

The aim of this study was to evaluate the patterns of rabies cases in dogs and cats in Thailand from 2013 to 2016 via spatiotemporal analysis. We also assessed the opinions of responsible district-level personnel regarding risk factors and control measures for rabies. Evaluation of rabies case patterns was based on secondary data from a national online database, and a structured questionnaire was used to obtain the opinions of district-level personnel. A total of 1202 cases (1202/13058, 9.21 %) of rabid dogs and cats were documented between 2013 and 2016, with the majority of cases involving dogs (1165/13058; 8.92 %). The spatiotemporal analysis indicated that most of the cases were recorded in central Thailand and that there was a general trend of an increase in rabies cases from the beginning of 2013 to the end of 2016. Month-by-month analysis for each year suggested that the number of rabies cases tended to increase over the course of the year in 2013 and 2016. Results from the autocorrelation indicated that the correlation coefficient tended to be similar in adjacent time lags. In terms of the opinion analysis, only one factor (i.e., the presence of a forest that served as a habitat for carrier animals in the district) was statistically significant (P < 0.05) in the final binary logistic regression model. The results of this study may facilitate planning for effective rabies control in Thailand.

Phylogeographic Aspects of Bat Lyssaviruses in Europe: A Review

During the last few decades, bat lyssaviruses have become the topic of intensive molecular and epidemiological investigations. Since ancient times, rhabdoviruses have caused fatal encephalitis in humans which has led to research into effective strategies for their eradication. Modelling of potential future cross-species virus transmissions forms a substantial component of the recent infection biology of rabies. In this article, we summarise the available data on the phylogeography of both bats and lyssaviruses in Europe and the adjacent reg ions, especially in the contact zone between the Palearctic and Ethiopian realms. Within these zones, three bat families are present with high potential for cross-species transmission and the spread of lyssaviruses in Phylogroup II to Europe (part of the western Palearctic). The lack of effective therapies for rabies viruses in Phylogroup II and the most divergent lyssaviruses generates impetus for additional phylogenetic and virological research within this geographical region.

Genomic Surveillance of Rabies Virus in Georgian Canines

Rabies is a fatal zoonosis that is considered a re-emerging infectious disease. Although rabies remains endemic in canines throughout much of the world, vaccination programs have essentially eliminated dog rabies in the Americas and much of Europe. However, despite the goal of eliminating dog rabies in the European Union by 2020, sporadic cases of dog rabies still occur in Eastern Europe, including Georgia. To assess the genetic diversity of the strains recently circulating in Georgia, we sequenced seventy-eight RABV-positive samples from the brain tissues of rabid dogs and jackals using Illumina short-read sequencing of total RNA shotgun libraries. Seventy-seven RABV genomes were successfully assembled and annotated, with seventy-four of them reaching the coding-complete status. Phylogenetic analyses of the nucleoprotein (N) and attachment glycoprotein (G) genes placed all the assembled genomes into the Cosmopolitan clade, consistent with the Georgian origin of the samples. An amino acid alignment of the G glycoprotein ectodomain identified twelve different sequences for this domain among the samples. Only one of the ectodomain groups contained a residue change in an antigenic site, an R264H change in the G5 antigenic site. Three isolates were cultured, and these were found to be efficiently neutralized by the human monoclonal antibody A6. Overall, our data show that recently circulating RABV isolates from Georgian canines are predominantly closely related phylogroup I viruses of the Cosmopolitan clade. Current human rabies vaccines should offer protection against infection by Georgian canine RABVs. The genomes have been deposited in GenBank (accessions: OQ603609-OQ603685).

Animal bites management in Northern Iran: Challenges and solutions

OBJECTIVES

Animal bite is considered a serious social, economic, and health risk for societies with poor animal bites and population management. The objective of this study was to propose a model for animal bites management in Golestan Province.

METHODS

The present study is a multi-method study conducted quantitatively and qualitatively. First, as a cross-sectional study, the animal bites in Golestan Province and the country were calculated and their trend was predicted. Secondly, in the qualitative study (content analysis), the challenges, barriers, and methods of animal bite control were extracted through conducting semi-structured interviews and focused group discussion meetings. Finally, the model of animal bite management was developed and it was confirmed by Round Delphi. The data were analyzed via content analysis using MAXQDA18. The participants in this study consisted of university professors, managers, and executive officers involved in animal bite and rabies control plans.

RESULTS

This study revealed that the animal bite in Golestan Province had an upward trend, as in the country, and dogs were the main cause of bites (90%). The obstacles and challenges of current animal bites control program in eight areas were expressed by the participants. Also, the animal bite management model, which was obtained from the data of different stages of this study, included nine fields and 41 sub-fields. The fields of the animal bite management model included: providing a cultural package, resolving barriers to animal population control plans, wide coverage of dog vaccination, passing and enacting preventive laws, attracting financial support, constructing standard equipment, providing proper medical services, enhancing inter-departmental coordination, and controlling rabies in the wild. This model was confirmed in a Delphi round.

CONCLUSION

Our study indicated that Golestan Province with an average bite higher than twice the country's average is one of the leading provinces in this regard. Thus, revising the animal bite and animal population control plans in this province is necessary. The model designed in this study can be used as a practical guide by policy makers and officials to manage animal bite and related consequences in this province.

Rabies in a postpandemic world: resilient reservoirs, redoubtable riposte, recurrent roadblocks, and resolute recidivism

Rabies is an ancient disease. Two centuries since Pasteur, fundamental progress occurred in virology, vaccinology, and diagnostics-and an understanding of pathobiology and epizootiology of rabies in testament to One Health-before common terminological coinage. Prevention, control, selective elimination, and even the unthinkable-occasional treatment-of this zoonosis dawned by the twenty-first century. However, in contrast to smallpox and rinderpest, eradication is a wishful misnomer applied to rabies, particularly post-COVID-19 pandemic. Reasons are minion. Polyhostality encompasses bats and mesocarnivores, but other mammals represent a diverse spectrum of potential hosts. While rabies virus is the classical member of the genus, other species of lyssaviruses also cause the disease. Some reservoirs remain cryptic. Although global, this viral encephalitis is untreatable and often ignored. As with other neglected diseases, laboratory-based surveillance falls short of the notifiable ideal, especially in lower- and middle-income countries. Calculation of actual burden defaults to a flux within broad health economic models. Competing priorities, lack of defined, long-term international donors, and shrinking local champions challenge human prophylaxis and mass dog vaccination toward targets of 2030 for even canine rabies impacts. For prevention, all licensed vaccines are delivered to the individual, whether parenteral or oral-essentially 'one and done'. Exploiting mammalian social behaviors, future 'spreadable vaccines' might increase the proportion of immunized hosts per unit effort. However, the release of replication-competent, genetically modified organisms selectively engineered to spread intentionally throughout a population raises significant biological, ethical, and regulatory issues in need of broader, transdisciplinary discourse. How this rather curious idea will evolve toward actual unconventional prevention, control, or elimination in the near term remains debatable. In the interim, more precise terminology and realistic expectations serve as the norm for diverse, collective constituents to maintain progress in the field.

Structure, function, and evolution of the Orthobunyavirus membrane fusion glycoprotein

La Crosse virus, responsible for pediatric encephalitis in the United States, and Schmallenberg virus, a highly teratogenic veterinary virus in Europe, belong to the large Orthobunyavirus genus of zoonotic arthropod-borne pathogens distributed worldwide. Viruses in this under-studied genus cause CNS infections or fever with debilitating arthralgia/myalgia syndromes, with no effective treatment. The main surface antigen, glycoprotein Gc (∼1,000 residues), has a variable N-terminal half (Gc^S) targeted by the patients' antibody response and a conserved C-terminal moiety (Gc^F) responsible for membrane fusion during cell entry. Here, we report the X-ray structure of post-fusion La Crosse and Schmallenberg virus Gc^F, revealing the molecular determinants for hairpin formation and trimerization required to drive membrane fusion. We further experimentally confirm the role of residues in the fusion loops and in a vestigial endoplasmic reticulum (ER) translocation sequence at the Gc^S-Gc^F junction. The resulting knowledge provides essential molecular underpinnings for future development of potential therapeutic treatments and vaccines.

Preparation and the assessed efficacy of oral baits for the vaccination of free-roaming dogs against rabies

Background and Aim:

Rabies is considered a highly fatal zoonotic disease and many deaths in humans have been associated with dog bites. This study was designed to prepare an oral anti-rabies vaccine in the form of baits to eliminate the disease in free-roaming dogs and subsequently protect humans from dog bites.

Materials and Methods:

The Evelyn Rokintniki Abelseth (ERA) rabies virus strain was propagated in baby hamster kidney cell cultures and adjusted to the recommended dose for application. Four forms of oral baits were employed with the rabies vaccine, which was evaluated for safety, acceptability, and potency in different dog groups. Enzyme-Linked Immunosorbent Assay (ELISA) and the serum neutralization test (SNT) were used to determine the protective rabies antibody titer in the sera of vaccinated dogs.

Results:

According to the results, a dose of 3 mL of the ERA strain, containing a viral titer of 10^7.6 TCID₅₀/mL, induced a mean antibody titer of 25.6 by SNT, and the PI% was 75.7 by Block ELISA, providing a protective level of the rabies antibody in 100% of vaccinated dogs. All used baits were found to be safe, inducing no abnormal general post-vaccination signs (the signs are limited to mild fever, mild loss of appetite, and mild-to-moderate loss of energy for 24-36 h after vaccination).

Conclusion:

It was found that most of the accepted and highly potent bait types consisted of a mixture of wheat flour, vegetable oil, sodium alginate, corn starch, meat meal, cellulose gum, and water. This dog meal was covered with bran and edible wax to seal the bait cavity after inserting the vaccine sachet. This bait was able to induce a protective level of rabies antibodies in 100% of vaccinated dogs after receiving one bait/dog. Hence, such a bait could be recommended for use in the protection of free-roaming dogs and the elimination of the disease.

Wolf Dispersal Patterns in the Italian Alps and Implications for Wildlife Diseases Spreading

Simple Summary

Wildlife dispersal directly influences population expansion patterns, and may have indirect effects on the spread of wildlife diseases. For many species, little is known about dispersal, despite its importance to conservation. We documented the natural dispersal processes of an expanding wolf (Canis lupus) population in the Italian Alps to understand the dynamics of the recolonization pattern and identify diseases that might be connected with the process through the use of non-invasive genetic sampling over a 20-year period. By documenting 55 dispersal events, with an average minimum straight dispersal distance of 65.8 km (±67.7 km), from 7.7 km to 517.2 km, we discussed the potential implications for maintaining genetic diversity of the population and for wildlife diseases spreading.

Abstract

Wildlife dispersal directly influences population expansion patterns, and may have indirect effects on the spread of wildlife diseases. Despite its importance to conservation, little is known about dispersal for several species. Dispersal processes in expanding wolf (Canis lupus) populations in Europe is not well documented. Documenting the natural dispersal pattern of the expanding wolf population in the Alps might help understanding the overall population dynamics and identifying diseases that might be connected with the process. We documented 55 natural dispersal events of the expanding Italian wolf alpine population over a 20-year period through the use of non-invasive genetic sampling. We examined a 16-locus microsatellite DNA dataset of 2857 wolf samples mainly collected in the Western Alps. From this, we identified 915 individuals, recaptured 387 (42.3%) of individuals, documenting 55 dispersal events. On average, the minimum straight dispersal distance was 65.8 km (±67.7 km), from 7.7 km to 517.2 km. We discussed the potential implications for maintaining genetic diversity of the population and for wildlife diseases spreading.

Knowledge, Attitudes and Practices on Rabies among Human and Animal Health Professionals in Senegal

Rabies is still a public health problem in Senegal. This study aimed to assess the knowledge, attitudes and practices on rabies among human and animal health professionals. It was a cross-sectional, descriptive and analytical study conducted in the Kaffrine district. Data were collected from 28 June to 01 July 2021. An exhaustive recruitment was done, and the final sample size was 95 health professionals. R software was used for descriptive, bivariate and multivariate analyses. Health professionals with sufficient knowledge, positive attitudes and good practices in relation to rabies represented 35.8%, 26.3% and 45.3% of the study respectively. The results of the multivariate analysis showed that professionals who worked in urban areas (AOR = 11.10; 95% CI = [3.50-41.69]) and who worked in animal health (AOR = 7.45; 95% CI = [1.16-70.40]) were more likely to have sufficient knowledge about rabies. Professionals with tertiary education (AOR = 12.40; CI95% = [1.80-268.00]) and with sufficient knowledge (AOR = 3.41; CI95% = [1.01-12.70]) were more likely to have a positive attitude about rabies. Professionals with a positive attitude about rabies (AOR = 3.23; 95% CI = [1.08-10.70]) were more likely to have a good practice when presented with an animal bite case. These results suggest that improving health professionals' knowledge about rabies is essential in order to influence their attitudes and practices against rabies.