Rabies in East and Southeast Asia: a mirror of the global situation

Despite the availability of efficacious and safe vaccines for human and animal use, rabies takes tens of thousands of human lives annually worldwide. The vast majority of human rabies cases are due to exposure through a rabid dog and subsequent lack of access to post-exposure prophylaxis (PEP) in remote and poor communities around the globe. Therefore, low- and middle-income countries and rural settings are highly affected by this deadly zoonotic disease, while rabies is eliminated from the domestic reservoir in most of the economically strong countries and areas. Although rabies reservoirs in wildlife remain a danger almost all around the world, human cases due to exposure to sylvatic and bat rabies is marginal. Recently momentum, fuelled by the World Health Organization and partners, has been gaining to achieve global elimination of dog-mediated human rabies. Main objectives are increasing efficiency of surveillance, wide scale vaccination of dog population together with dog population management and worldwide coverage for affordable PEP. Advances on the agenda to this global goal vary from country to country. Whereas surveillance and intervention in animals and humans remain patchy and inefficient in some countries, others are focussing on interventions in humans. Those most advanced in the control of rabies have implemented surveillance and prevention measures in the animal reservoir, which is the most cost-effective approach. The South and Southeast Asian region mirrors the described global situation comprising the whole spectrum from rabies-free countries, to countries with only sylvatic rabies and finally the largest group of those with endemic dog rabies. Within the latter, distinctions are made between those that focus on prevention in humans and those with a One Health approach including intervention in animals. Some areas have even adopted an integrative community participation approach including educational programmes. The different sections of this chapter describe the detailed rabies situation in South and Southeast Asian countries grouped by epidemiological context and implemented prevention measures. It highlights the need for holistic control programmes coordinated across the whole region to achieve sustainable elimination of rabies.