David N. Fisman, MD, MPH
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2821.
Requests for Single Reprints: David N. Fisman, MD, MPH, University of Toronto, 155 College Street, Room 678, Toronto ON M5T 3M7 Canada; e-mail, email@example.com.
Fisman D.; Taking the Bite Out of Rabies, Putting Teeth Into “One Health”. Ann Intern Med. 2014;160:132-133. doi: 10.7326/M13-2821
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Published: Ann Intern Med. 2014;160(2):132-133.
Rabies is a scourge to humans and animals that was first mentioned in medical texts as early as the sixth century BCE. The development of rabies vaccines by Pasteur in the late 19th century provided a potent tool for protection of both animals and humans (1). Canine rabies has been eliminated from many high-income countries, and human rabies cases are vanishingly rare in Canada and the United States, largely because of requirements for vaccination and the availability of postexposure immunization protection when exposure (to rabid feral animals) does occur.
The situation is different in many low- and middle-income countries, where rabies remains an important cause of illness and death in humans and animals. In low- and middle-income countries, risk for human rabies derives largely from interaction with domestic or stray dogs, which may be infected by feral animals (jackals, foxes, and coyotes, for example) that serve as reservoirs for the disease. Human rabies claims tens of thousands of lives annually in less affluent countries, particularly those in Africa and Asia (2). Global economic costs attributable to rabies run into the billions of dollars (2), and countries with rabies endemics may be perceived to lack resources to support effective programs for humane control of animal populations and vaccination of domestic animals. Timely postexposure immunization may not be available in rural areas, causing the bite of a rabid animal to become a de facto death sentence.
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Infectious Disease, Vaccines/Immunization, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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