Lyssaviruses and Rabies: Prevention, Control and Elimination

Dear Colleagues,

Rabies is one of the oldest documented zoonoses, but it remains a neglected infectious disease with a pressing need for resolution of many unanswered questions. Prior to the 1950s, rabies was believed to be caused only by rabies virus. Since that time, more than 17 different lyssaviruses have been described, due, in part, to improvements in laboratory-based surveillance and viral characterization. Yet, if our current approach to such pathogen discovery and biosecurity is to be considered adequate, how are new lyssaviruses being reported from Western Europe, and what does this finding say about the undiscovered lyssavirus diversity within Africa and Asia?

Annually, most of the tens of thousands of human rabies fatalities result from the bite of a rabid dog. During 2015, the FAO (Food and Agriculture Organization of the United Nations), the OIE (World Organisation for Animal Health), and the WHO (World Health Organization) described a plan for the global elimination of human rabies from dogs (GEHRD) by 2030 through the application of mass canine vaccination and human prophylaxis. Substantial progress on canine rabies elimination in the Americas provided a regional proof of concept for this plan. In 2016, WHO established a Strategic Advisory Group of Experts (SAGE) to consider new recommendations on human rabies vaccines and immune globulins, in support of the GEHRD. This is an ambitious but achievable goal. However, especially considering the poorly defined burden of human rabies in lesser developed countries, are we on track to declare zero human fatalities caused by dogs over the ensuing decade?

As an acute, progressive, incurable viral encephalitis, elimination of exposure to lyssaviruses is a fundamental feature of any agricultural, environmental, or public health plan. The GEHRD is no exception. Education of professionals and the public is a priority, especially children, who remain a highly vulnerable population at risk. While many education programs on bite prevention have been created, and multiple community knowledge, attitudes and practice surveys have been conducted, how do we evaluate their utility objectively to demonstrably affect positive change?

Somewhat unique for viral zoonoses, vaccination against rabies includes both postexposure prophylaxis (PEP) if a bite occurs and preexposure (Pre-P) for individuals determined to be at risk of exposure, such as veterinarians, animal handlers, laboratory workers, cavers, and certain travelers. During 2017, while on tour in India, a woman from Virginia was bitten by a puppy; she returned home and became the ninth person exposed to rabies virus abroad who has died from rabies in the USA since 2008. Given such incidents in highly developed countries with adequate health care resources, do we believe our discussions with travelers on bite avoidance, Pre-P considerations and PEP-seeking behavior as well as such obvious deliberations for residents within highly enzootic regions are still relevant?

At its root cause, rabies is a disease of nature. All warm-blooded vertebrates are believed to be susceptible. Uniquely, rabies is the only zoonosis in which routine laboratory examination of a suspect animal directly determines the need for immediate biomedical care to an exposed person with life-saving prophylaxis. Throughout the 20^th century, sensitive and specific diagnostic methods were developed for viral detection, and safe and effective vaccines were constructed for humans, domestic animals, and free-ranging wildlife. Will such methods still be applicable today or do we need newer tools in diagnosis and immunization to better support the SAGE recommendations and the GEHRD specifically and to better appreciate aspects of rabies holistically in conservation biology, public health, and veterinary medicine?

Historically, lethal control of animal populations was employed widely in an attempt to curb rabies incidents at local, national, and regional levels. Over the years, substantial evidence has mounted that seriously questions the basis for the killing of healthy animals in response to rabies concerns on firm ethical, ecological, and economic grounds. Clearly, the rationale for the GEHRD lies in the resulting herd immunity from vaccinated dogs en masse and the prophylaxis of exposed persons. Unfortunately, reports of inhumane and ineffective culling continue to surface. What needs to occur to reverse such incidents and promote more modern economical and efficacious means of rabies prevention and control?

In this Special Issue, we will focus upon applied research, clinical studies, and case reports that contribute to relevant improvements in the laboratory-based surveillance, epidemiology, pathogen discovery, prophylaxis, and related aspects of the GEHRD towards the realization of broader disease prevention, control, and elimination actions.

Much remains to be accomplished; we value your involvement to date and look forward to your additional provocative scientific contributions towards this trans-disciplinary subject.

Dr. Charles E. Rupprecht
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Tropical Medicine and Infectious Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• diagnosis
• epidemiology
• lyssavirus
• neglected diseases
• prophylaxis
• rabies
• surveillance
• vaccine
• viral infections
• zoonosis