Rabies Test Accuracy: Comprehensive Systematic Review and Meta-Analysis for Human and Canine Diagnostics

Abstract

Rabies is almost invariably fatal once clinical symptoms manifest. Timely and accurate diagnosis is essential for effective treatment and prevention. Dogs are the principal reservoirs of the virus, particularly in developing nations, highlighting the importance of precise diagnostic and control measures to prevent human cases. This systematic review and meta-analysis aimed to assess the accuracy of laboratory tests for diagnosing rabies in humans and dogs. The PubMed database was searched for published studies on rabies diagnosis between 1990 and 2024. Following PRISMA statement recommendations, we included 60 studies that met the selection criteria. The findings demonstrate the effectiveness of immunological tests, such as the enzyme-linked immunosorbent assay (ELISA), and molecular tests, such as reverse transcription polymerase chain reaction (RT-PCR), in diagnosing rabies in humans. Similarly, immunological tests, rapid immunochromatographic tests (RIT), ELISA, and molecular tests (RT-PCR) were effective in diagnosing rabies in dogs. Compared to the direct fluorescent antibody test (DFAT), the area under the curve restricted to false positive rates (AUCFPR= 0.887) exhibited considerable variability and lower diagnostic accuracy. Both ELISA (AUCFPR= 0.909) and RT-PCR (AUCFPR= 0.905) offered more consistent and reliable results. Notably, RIT displayed the highest performance (AUCFPR= 0.949), with excellent sensitivity and specificity, underscoring the superior diagnostic capabilities of these methods over the traditional DFAT. Given the performance of the DFAT, it is imperative to reassess and modernize rabies diagnostic protocols by integrating advanced technological methodologies. Enhancing diagnostic precision for humans and dogs is essential for facilitating timely and effective interventions, curbing viral transmission, and ultimately decreasing mortality rates.