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    Area of Science:

    • Infectious Diseases
    • Public Health
    • Vaccinology

    Background:

    • Rabies, a zoonotic disease, presents diagnostic and prophylactic challenges in Europe due to rarity and limited medical experience.
    • Uncertainty often surrounds the appropriate use of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

    Purpose of the Study:

    • To review current knowledge on rabies epidemiology, diagnosis, treatment, and prophylaxis.
    • To clarify indications and modalities for rabies prevention in Europe.

    Main Methods:

    • Selective literature search of PubMed (2000-2025) and data from global health organizations (WHO, CDC, ECDC).
    • Inclusion of recommendations from the German Standing Committee on Vaccination (STIKO).

    Main Results:

    • Globally, rabies causes ~60,000 deaths annually, primarily in Asia and Africa, with dogs as the main vector (>99%).
    • While terrestrial rabies is nearly eliminated in the EU, bat lyssaviruses pose a residual risk, alongside imported cases.
    • Modern rabies vaccines (PrEP) offer 96-100% protection with minimal side effects; PEP is highly effective when administered correctly and promptly, with few breakthrough infections reported.

    Conclusions:

    • Rabies must be considered in Europe for unclear animal exposures, especially involving bats or travel to endemic areas.
    • Expert consultation with infectious disease specialists or rabies centers is recommended for complex PEP cases.