Strengthening one health approaches for rabies elimination in Pakistan

Rabies, due to infection with the Lyssavirus of the Rhabdoviridae, is a virtually 100% lethal viral illness acquired mostly by bites from an infected animal, particularly by dogs, but also cattle, goats, cats, and feral animals like bats and foxes. The virus has a 1-3-month incubation period and infects the central nervous system, manifesting as either encephalitic rabies (hydrophobia, excitability, hypersalivation) or paralytic rabies (increasing muscle weakness, paralysis, coma). One documented case in Pakistan was a 18-year-old farmer who was bitten by his rabid cow, probably from a stray dog, and illustrates the zoonotic risk from domestic animals. Worldwide, rabies kills about 74,000 people a year 44% in Africa, 56% in Asia further placing an estimated USD 8.6 billion economic cost on society for 15 million human exposures every year. Prevention is carried out through immediate wound cleansing and early post-exposure prophylaxis (PEP): four doses for non-vaccinated people or two booster shots for previously vaccinated persons with protective antibody levels. For the reduction of human and animal rabies, the World Health Organization and partners are working towards "Zero human rabies deaths by 2030" through dog vaccination, population management, and livestock immunization in high-risk regions. Public education, responsible ownership, and protective handling practices continue to be essential for shattering the transmission chain.