Rabies: Recent advances in pathogenesis and control

Abstract

Current knowledge of rabies is reviewed, with emphasis on recent developments in virology, immunology, pathogenesis, treatment, and prophylaxis. Although only a few cases of human rabies occur annually in the United States, the infection is enzootic in wildlife, and an estimated 30,000 possible exposures requiring treatment occur each year. Rabies belongs to the family rhabdovirus, and its molecular anatomy and biochemistry of replication have been described in some detail. There have been advances in measurement of antirabies antibodies, and techniques for measuring cellular immune response have recently been developed. Early stages of infection are more fully understood, with a hypothesis to explain peripheral sequestration of virus during prolonged incubation periods. Rabies was once thought to be uniformly f fatal, but a few patients have survived with aggressive supportive measures. A newly developed vaccine (soon to be licensed in the United States) has been shown highly potent for preexposure immunization and promises to be very effective for postexposure prophylaxis. Current Public Health Service recommendations for postexposure treatment are summarized. Recent research has suggested a novel approach to control of wildlife rabies through oral immunization.

Presence of Virus Neutralizing Antibodies in Cerebral Spinal Fluid Correlates with Non-Lethal Rabies in Dogs

“…Consisting of vaccination with RABV vaccines and administration of anti-rabies immunoglobulin at the site of exposure and systemically [34], it is believed that PEP prevents the rabies virus from invading the CNS due to the long incubation period of the infection [35]. It has long been thought that it is difficult to clear the virus once it enters into the CNS [4], [36]. This dogma was initially cast into doubt by the finding that RABV can be cleared form the CNS by VNA administered intravenously [37].…”

Evaluation of a human diploid cell strain rabies vaccine: final report of a three year study of pre-exposure immunization

“…For many years the World Health Organization has recommended immunization of persons at risk of exposure to rabies (WHO, 1957). Vaccines produced either in neural or avian tissue are unsatisfactory for this purpose either because they are poorly antigenic and require multiple injections or because they are associated with unacceptable clinical reactions (Miller & Nathanson, 1977;Turner, 1977). However, significant advances in rabies prophylaxis have occurred since the development of a vaccine derived from rabies virus grown in human diploid cells (Wiktor & Koprowski, 1965).…”