Review of rabies situation and control in the North African region with a focus on Tunisia.

Rabies is a major zoonosis that affects the central nervous system of warm-blooded mammals. The disease is present worldwide, except for some islands. Africa and Asia record over 95% of the fatal cases of rabies worldwide, and therefore the greatest risk to human life from rabies occurs in these regions. Mass vaccination of dogs is the most appropriate way to control and eliminate the disease at the animal source, in order to interrupt the infectious cycle of the disease from animals to humans. Rabies is endemic in the North African region, and countries should be encouraged to develop programmes for eliminating human rabies through the implementation of sustained campaigns to immunise dogs and by providing post-exposure prophylaxis (PEP) to people who have been exposed to suspected rabid dogs. In Tunisia, the national strategy against rabies was started in 1981 and it has been upgraded since. Following the launch of the annual vaccination programme in 1993, there was a significant improvement in the health status for rabies in Tunisia, with a decrease in the number of cases in animals and humans. Since 2011, an increase in cases of rabies in dogs and humans has been observed, due to lower vaccination coverage, mismanagement of waste and an increase in the stray dog population. The political will at international, regional and national levels is the cornerstone of the strategy to eliminate the disease. In the framework of the regional approach in the Maghreb, additional efforts and political willingness are necessary at the national level to better control and eventually eliminate rabies.