Introduction
Rabies is a highly fatal zoonotic disease that causes progressive brain and spinal cord inflammation by rabies virus with horrifying symptoms. Among zoonotic diseases, rabies has huge public health significance. Rabies is one of the world’s most deadly diseases. There is no treatment once signs or symptoms of the disease begin, and the disease is fatal in humans and animals within 1–2 weeks of symptom onset [1]. All mammals can be infected by “Rabies virus” and in nearly all instances the infection ends in death [2,3]. Most of the relevant scientific focus on the rabies virus has concentrated on the classic agent. Clinically, it has two forms: 1. Furious rabies- characterized by hyperactivity and hallucinations. 2. Paralytic rabies- characterized by paralysis and coma. Warm-blooded mammals usually get rabies from the bite of rabid animals, including scratches, abrasions, or open wounds that are exposed to saliva or other potentially infectious material from a rabid animal [4]. The annual number of dog bites in Bangladesh varies from 200,000 to 300,000 and 95% of rabies occurs due to dog bites [5]. Rabies can be transmitted by other animals such are cat, fox, monkey, jackal, and mongoose [3]. In Bangladesh, different government and non-government agencies are involved in rabies control and prevention programs mostly through the implementation of mass vaccination of dogs, and post-exposure prophylaxis (PEP) of humans [6]. However, rabies cases have not been reduced as a result of these programs due to a lack of multi-sectoral management approaches. Therefore, this study explored the factors associated with rabies prevalent and control such as free-roaming dog population control with mass vaccination, wildlife conservation, pre-exposure prophylaxis (PrEP) of pet dogs/cats, and public awareness as the most effective ways to eliminate rabies in Bangladesh.
Global Situation of Rabies
The number of human deaths globally due to dog-mediated rabies is estimated to be 59,000 annually, dominated by Asia (59.6%) and Africa (36.4%) [7]. The disease occurs throughout the world, with certain exceptions there is no rabies in Japan, The United Kingdom, New Zealand, Antarctica, and many Islands such as Hawaii and the Island of the Caribbean basin; there is no rabies in Switzerland and large areas of France as result of recent wildlife vaccination programs. In many countries, wildlife rabies is becoming important as a threat to domestic animals and humans increasing day by day. Oral immunization for wildlife rabies control has been applied in the vaccination field [8].
Rabies in Bangladesh
In the last few years, Bangladesh has reduced the death of humans bitten by animals by about 50%. The recent data show that rabies cases in livestock are on a rising trend to 4,259 cases per year (Fig. 1), while up to 11 humans affected by rabies have been reported by the Directorate General of Health Services (Table 1) [6,9]. Rabies is transmitted mostly (>90%) by the bite of infected dogs to humans, livestock, and pets in Bangladesh. Wild cats, foxes, and mongooses were also important reservoirs of rabies in Bangladesh. However, there is no preventive measure in the case of wildlife animals in Bangladesh [10].
Epidemiological triad of rabies
The epidemiological triad is the perfect way to explain all infectious diseases including rabies. The triad occurs in the presence of a host, agent, and environment. In relation to the triad for rabies, the agent here is rabies virus which is the only essential cause for this disease. The high-density stray dogs/cats with wild animal exposure are the main hotspot of the spread of this virus to there lived all warm-blood mammals, especially humans, livestock, domestic pets, and community dogs that are mainly threatened. This agent-host-environment triad plays a key role in rabies transmission (Fig. 2).
Possible elimination ways of rabies
Rabies can be effectively prevented/managed by the “One Health Approach,” which includes inter-sectoral collaboration among animal, human, and environmental health professionals. This approach recognizes that the health of people is associated with the health of animals and our shared environment. Embracing a One Health approach centers on outbreak management of rabies in both humans and animals. Coordination and communication between health professionals have a key role in the overall success of the rabies elimination program (Fig. 3).
The garbage was the primary feed source for stray dogs and higher litter size was another important factor for the high density of the dog population in the community. Improper waste management in Bangladesh contributes significantly to the risk of rabies transmission. Accumulated rubbish provides food sources that sustain large populations of free-roaming dogs, the primary vectors for rabies in the country. A study focusing on Dhaka highlighted that controlling the environmental carrying capacity through effective waste management, combined with vaccination and neutering programs, is more effective in managing rabies among street dogs than vaccination alone [11]. Additionally, research has emphasized that inadequate waste collection leads to increased volumes of waste on streets and in open dumps, serving as food sources for free-roaming dogs and complicating rabies control efforts [12].
Figure 1.
Livestock rabies incidences in Bangladesh 2014–2017.
Gradually decrease the area of forest caused by deforestation day by day. Without the fence around the forest, wild animals easily enter the community interacting with stray animals and spreading the virus directly (Fig. 4).
To eliminate rabies most effective possible way to break the interaction between wildlife and community animals is the de-population of street dogs and public awareness. Rabid wildlife serves as reservoirs of infection for livestock and companion animals. There is a link between infected wildlife humans, and domestic animals (primarily dogs and cats). Therefore, wildlife rabies control is more necessary. If deemed appropriate, commercial inactivated rabies vaccines recommended for domestic species should be used. If wild animal handling is not possible or practical, a commercial oral rabies vaccine and bait currently sanctioned by international authorities may be considered for remote delivery. In Bangladesh, a significant reservoir and principal cause of human fatalities are the dogs, mostly acquired from rabid foxes [13].
Table 1.
Human rabies incidence in Bangladesh 2012–2021.
| Year | Number of dog bite patients (N) | Number of human rabies cases (N) |
|---|---|---|
| 2012 | 129,444 | 82 |
| 2013 | 252,275 | 82 |
| 2014 | 254,621 | 106 |
| 2015 | 252,301 | 83 |
| 2016 | 298,772 | 66 |
| 2017 | 258,445 | 80 |
| 2018 | 253,409 | 57 |
| 2019 | 253,861 | 57 |
| 2020 | 152,014 | 26 |
| 2021 | 142,312 | 11 |
Hence, birth control and mass vaccination programs for stray dogs would be appropriate measures for controlling rabies. Since 2012, Dhaka City has implemented CNVR programs as part of the national rabies control initiative. These programs involve capturing free-roaming dogs, neutering and vaccinating them against rabies, and then releasing them back into their territories. This approach aims to reduce the stray dog population over time and establish herd immunity against rabies. A study estimated that Dhaka City had approximately 37,009 free-roaming dogs, with varying sterilization rates across different city corporations [14]. Surgical and chemical neutering are the appropriate ways to birth control street dogs and cats. Previous research supports chemical neutering of the male, which is easier than surgical [15,16]. The success of eliminating rabies depends mainly on public participation.
Figure 2.
Illustrate the risk factor of rabies by applying the epidemiologic triangle.
Figure 3.
Conceptual framework on how to eliminate rabies.
Figure 4.
Conceptual framework for controlling rabies using the one health approach.
Figure 5.
Conceptual framework on how to spread human and livestock rabies.
Participation can be bolstered through a series of awareness campaigns. The people learn the importance of proper garbage management, fast aid with PEP rabies vaccine of humans and animals after a dog bite, regular PrEP rabies vaccine for pets, and so on, from the public awareness programs. PEP is the only means available for human and animal rabies prevention after a rabid animal bite (Fig. 5).
Conclusion
The successful elimination of rabies from society requires strengthening our surveillance, outbreak response, and epidemiological investigation to explore the risk factors, proper rubbish management, stray dogs/cats birth control, strategic mass dog vaccination, wildlife conservation, PEPs for humans and animals, regular PrEP for pets, specimen referral, laboratory testing capacity, euthanasia of rabid animals, advocacy and public awareness, professional education, and inter-sectoral collaboration or one health approach.
Acknowledgments
The authors would like to thank Professor Subrata Kumar Shil for their feedback and input on the initial version of the manuscript. In addition, the authors are thankful to all helping hands for their direct and indirect help.
Funding
No funding was used in the preparation of this paper.
