Rohde Rodney E, Rupprecht Charles E
Clinical Laboratory Science, Texas State University, San Marcos, TX, 78666, USA.
LYSSA LLC, Cumming, Georgia, 30004, USA.
Fac Rev. 2020 Nov 16;9:9. doi: 10.12703/b/9-9. eCollection 2020.
Rabies is an ancient, much-feared, and neglected infectious disease. Caused by pathogens in the family Rhabdoviridae, genus , and distributed globally, this viral zoonosis results in tens of thousands of human fatalities and millions of exposures annually. All mammals are believed susceptible, but only certain taxa act as reservoirs. Dependence upon direct routing to, replication within, and passage from the central nervous system serves as a basic viral strategy for perpetuation. By a combination of stealth and subversion, lyssaviruses are quintessential neurotropic agents and cause an acute, progressive encephalitis. No treatment exists, so prevention is the key. Although not a disease considered for eradication, something of a modern rebirth has been occurring within the field as of late with regard to detection, prevention, and management as well as applied research. For example, within the past decade, new lyssaviruses have been characterized; sensitive and specific diagnostics have been optimized; pure, potent, safe, and efficacious human biologics have improved human prophylaxis; regional efforts have controlled canine rabies by mass immunization; wildlife rabies has been controlled by oral rabies vaccination over large geographic areas in Europe and North America; and debate has resumed over the controversial topic of therapy. Based upon such progress to date, there are certain expectations for the next 10 years. These include pathogen discovery, to uncover additional lyssaviruses in the Old World; laboratory-based surveillance enhancement by simplified, rapid testing; anti-viral drug appearance, based upon an improved appreciation of viral pathobiology and host response; and improvements to canine rabies elimination regionally throughout Africa, Asia, and the Americas by application of the best technical, organizational, economic, and socio-political practices. Significantly, anticipated Gavi support will enable improved access of human rabies vaccines in lesser developed countries at a national level, with integrated bite management, dose-sparing regimens, and a 1 week vaccination schedule.
狂犬病是一种古老、令人恐惧且被忽视的传染病。由弹状病毒科病毒属的病原体引起，全球范围内均有分布，这种病毒性人畜共患病每年导致数万人死亡，数百万人暴露感染。所有哺乳动物都被认为易感，但只有某些类群充当储存宿主。依赖直接进入中枢神经系统、在其中复制并从中传出，是病毒延续的基本策略。通过隐蔽和颠覆相结合的方式，狂犬病病毒是典型的嗜神经病原体，可引起急性进行性脑炎。目前尚无治疗方法，因此预防是关键。尽管狂犬病并非被考虑根除的疾病，但近来该领域在检测、预防、管理以及应用研究方面出现了某种现代复兴。例如，在过去十年中，已鉴定出新型狂犬病病毒；优化了灵敏且特异的诊断方法；纯净、高效、安全且有效的人用生物制品改善了人类预防措施；区域努力通过大规模免疫控制了犬类狂犬病；在欧洲和北美大片地理区域，通过口服狂犬病疫苗控制了野生动物狂犬病；并且围绕有争议的治疗话题的辩论也已重启。基于迄今为止的这些进展，对未来十年有某些期望。这些期望包括病原体发现，即在旧世界发现更多狂犬病病毒；通过简化、快速检测加强基于实验室的监测；基于对病毒病理生物学和宿主反应的更好理解出现抗病毒药物；以及通过应用最佳技术、组织、经济和社会政治实践，在非洲、亚洲和美洲区域改善犬类狂犬病的消除情况。重要的是，预计全球疫苗免疫联盟（Gavi）的支持将使欠发达国家在国家层面能够更好地获得人用狂犬病疫苗，并实施综合咬伤管理、节省剂量方案以及一周的疫苗接种计划。
