Rabies in the Middle East: Causes of Spread, Methods of Control and Prophylaxis: A Review of the English Language Sources

Introduction. According to statistics, rabies causes death of almost 59,000 people per year worldwide, but information about the cases of rabies in animals and people in the Middle East is scarce and not always reliable, whereas the region is deemed to be one of the most troublesome in terms of rabies, that makes the present research relevant. The aim of the review is to summarize the data from the literature sources published in the English language referring to the causes of rabies spread in the Middle East, methods of control of this highly dangerous infectious disease and the issues of prophylaxis measures efficiency.

Materials and Methods. The search for the material for reviewing was conducted in the electronic libraries PubMed, Web of Science, MDPI.com, etc. The search covered the sources published during the last 15 years in the English language only. The search was conducted by the keywords: rabies, Middle East, spread, prophylaxis, vaccination. The material that passed screening was analysed, systematised, and presented in a form of a figure, table, and PRISMA flow chart.

Results. The review has led to the conclusion that the situation with rabies spread in the Middle East is not uniform. Thus, Cyprus, Bahrain, Kuwait, Qatar and the United Arab Emirates are recognised as rabies free, which is mainly due to the (semi)isolated geographical location of some of these countries. In the majority of the Middle East countries, the situation is far from being favourable: people undergo a high risk of getting infected by both dogs and wild animals. The main methods of control of this zoonosis that could be emphasized are those targeted at raising awareness of the population about the deadly danger of this infectious disease, the modes of its transmission, symptoms and the importance of timely preventive vaccination of people and domestic animals.

Discussion and Conclusions. On the whole, the aim of the conducted review on summarising the existing information on the causes of rabies spread in the Middle East and the main methods of control of this disease including the prophylaxis methods has been achieved. However, even though the review sample was quite big, in our opinion, the selected sources do not always truly reflect the situation concerning rabies in the studied territory. This can be explained by the objective and subjective reasons. The former include, for example, the instability of the epizootic and geopolitical situation, which hinders collection and analysis of statistical veterinary and medical reports. Among the subjective reasons, the considerable rabies incidence in the wild animals could be named, which ends in their death and is hardly ever recorded anywhere. The key aspect of prophylaxis is vaccination of animals and people against rabies. Despite all difficulties, it is necessary to ensure the availability of Human Rabies Immune Globulin and vaccines for animals in sufficient quantities in the Middle East countries.

1. Alaifan T, Altamimi A. A Systematic Review of Epidemiology of Rabies in Arab Countries. Journal of Health Informatics in Developing Countries. 2019;13(2) URL: https://www.jhidc.org/index.php/jhidc/article/view/242/271 (accessed: 10.11.2024)

2. Bannazadeh Baghi H, Alinezhad F, Kuzmin I, Rupprecht CE. A Perspective on Rabies in the Middle East − Beyond Neglect. Veterinary sciences. 2018;5(3):67. https://doi.org/10.3390/vetsci5030067

3. Barecha CB, Girzaw F, Kandi V, Pal M. Epidemiology and Public Health Significance of Rabies. Perspectives in Medical Research. 2017;5(1):55–67. URL: https://pimr.org.in/Barecha-new.PDF (accessed: 10.11.2024)

4. Pazira S, Golahdouz M, Taherizadeh M, Pourhossein B, Hosseini S, Jalilian F, et al. Investigation of the Frequency of Rabies in EMRO Countries: A Review Study. Journal of Clinical Images Medical Case Reports. 2021;2(5):1296. https://doi.org/10.52768/2766-7820/1296

5. Kassir MF, El Zarif T, Kassir G, Berry A, Musharrafieh U, Bizri AR. Human Rabies Control in Lebanon: A Call for Action. Epidemiology and Infection. 2019;147:e46. https://doi.org/10.1017/S095026881800300X

6. Abela-Ridder B, Balogh de K, Kessels JA, Dieuzy-Labaye I, Torres G. Global Rabies Control: The Role of International Organisations and the Global Strategic Plan to Eliminate Dog-Mediated Human Rabies. Scientific & Technical Review. 2018;37(2):741–749. https://doi.org/10.20506/rst.37.2.2837

7. Horton D.L., McElhinney L.M., Freuling C.M., Marston D.A., Banyard A.C., Goharrriz H., et al. Complex Epidemiology of a Zoonotic Disease in a Culturally Diverse Region: Phylogeography of Rabies Virus in the Middle East. PLoS Neglected Tropical Diseases. 2015;9(3):e0003569. https://doi.org/10.1371/journal.pntd.0003569

8. Pernicová E, Krsek M. Rabies in the World and the Zero by 30 Strategy. Journal Epidemiology, Microbiology, Immunology. 2023;72(4):239–242.

9. Abela-Ridder B (Ed.). Zero by 30 The Global Strategic Plan To End Human Deaths From Dog-Mediated Rabies by 2030. Guideline. Geneva: Food and Agriculture Organization of the United Nations (FAO), World Organisation for Animal Health (OIE), World Health Organization (WHO), Global Alliance for Rabies Control; 2018. URL: https://iris.who.int/bitstream/handle/10665/272756/9789241513838-eng.pdf?sequence=1 (accessed: 10.11.2024)

10. Kasem S, Hussein R, Al-Doweriej A, Qasim I, Abu-Obeida A, Almulhim I, et al. Rabies Among Animals in Saudi Arabia. Journal of Infection and Public Health. 2019;12(3):445–447. https://doi.org/10.1016/j.jiph.2018.10.005

11. Dhayhi NS, Arishi HM, Al Ibrahim AAY, Khalaf Allah MB, Hawas AM, Alqasmi H, et al. First Confirmed Case of Local Human Rabies in Saudi Arabia. International Journal of Infectious Diseases. 2019;87:117–118. https://doi.org/10.1016/j.ijid.2019.08.011

12. Memish ZA, Abdullah MA, Gautret P. Rabies in Saudi Arabia: A Need for Epidemiological Data. International Journal of Infectious Diseases. 2015;34:99–101. https://doi.org/10.1016/j.ijid.2015.03.016

13. Freuling C, Müller T. Rapid Assessment of Rabies in Northwest Syria. 25 January 2024. URL: https://fscluster.org/sites/default/files/2024-01/Rapid%20assessment%20of%20Rabies%20in%20Northwest%20Syria%20-%20December%202023.pdf (accessed: 10.11.2024).

14. Picot V, Rasuli A, Abella-Rider A, Saadatian-Elahi M, Aikimbayev A, Barkia A, et al. The Middle East and Eastern Europe Rabies Expert Bureau (MEEREB) Third Meeting: Lyon-France (7–8 April, 2015). Journal of Infection and Public Health. 2017;10(6):695–701. http://doi.org/10.1016/j.jiph.2017.03.005