ISSN: 2320-5407 Int. J. Adv. Res.

12(08), 279-287

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/19253
DOI URL: http://dx.doi.org/10.21474/IJAR01/19253

RESEARCH ARTICLE
RABIES EPIDEMIOLOGY AND HEALTH AUTHORITIES’ EFFORTS IN CONTROL AND
PREVENTION OF THE DISEASE IN THE KINGDOM OF SAUDI ARABIA: A NARRATIVE REVIEW

Wejdan H. Alqatifi1 and Ibrahim H. Alshubaith2

1. Preventive Medicine Department, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia.
2. International Organizations and Healthy Cities Department, Healthy Cities Program, Al-Ahsa
Municipality, Ministry of Municipal and Rural Affairs and Housing, Al-Ahsa, Saudi Arabia.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Rabies, a fatal zoonotic disease, has significant public health and
Received: 09 June 2024 economic impacts globally. In the Kingdom of Saudi Arabia, rabies
Final Accepted: 11 July 2024 presents a significant challenge due to its prevalence among both
Published: August 2024 domestic and wild animals. This review provides a comprehensive
overview of rabies epidemiology in Saudi Arabia, detailing the clinical
Key words:-
Epidemiology, Prevention, Control, forms, pathogenesis, transmission modes, and clinical manifestations in
Rabies, Saudi Arabia humans and animals. The control and prevention strategies employed
by Saudi health authorities, including public health policies and
vaccination campaigns, are critically analyzed. Despite the
implementation of advanced healthcare and preventive measures, rabies
persists as a significant threat, particularly in regions with a high
incidence of animal bites. This review emphasizes the necessity for
continuous monitoring, enhanced public awareness, and improved
diagnostic capabilities to mitigate rabies transmission and ensure public
health safety in Saudi Arabia and the broader Gulf region.

Copy Right, IJAR, 2024,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Since 1980, there has been a remarkable increase in the incidence of infectious disease outbreaks globally. In fact,
new viruses are being identified at a rate of approximately three to four per year(Otte and Pica-Ciamarra, 2021). A
significant proportion of emerging human pathogens, exceeding 60%, exhibit zoonotic characteristics, indicating the
potential for animal-to-human transmission. These conditions result in 2.5 billion infections and 2.7 million deaths
annually, with the most recent emergence being the coronavirus disease 2019 (COVID-19)(Otte and Pica-Ciamarra,
2021; Rahman et al., 2020; Sharan et al., 2023).The economic impact of these diseases is considerable, resulting in
significant costs for medical interventions, lost productivity, and disease control efforts (Elsohaby and Villa, 2023).
As explained by Rahman et al. (Rahman et al., 2020), rabies, a fatal zoonotic condition, causes 30,000 to 70,000
yearly human casualties. While dogs are the primary reservoir, wild animals such as cats and jackals can also act as
vectors for the transmission of the disease.The first documented case of rabies was in Babylon in 2300
B.C.(Gholami et al., 2014). In developing countries, the majority of cases are attributed to stray dog bites, while in
developed nations, bat, fox, and other wild animal transmissions are the primary sources of infection(Rahman et al.,
2020).

Corresponding Author:-Wejdan H. Alqatifi

Address:-Preventive Medicine Department, Al-Ahsa Health Cluster, Ministry of Health,
Al-Ahsa, Saudi Arabia. 279
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Types of rabies
According to Fooks et al. (Fooks et al., 2017), rabies can be classified into two traditional forms: furious
(encephalitic) and paralytic. Encephalitic cases usually occur unexpectedly, while paralytic cases occur in about
20% of cases. The condition is fatal once noticed and affects only a small percentage of those bitten(Dutta, 2014).

The prodromal symptoms of furious rabies include parasthesia, itching, fever, headache, tachycardia, anxiety,
insomnia, restlessness, and myalgias. After two to three days, excitement develops, causing mental excitement,
restlessness, hyperesthesia, and hydrophobia. Hydrophobia is expressed by an abrupt spasm of the mouth, pharynx,
larynx, and respiratory muscles. It can be induced by offering water(Fooks et al., 2014; Jackson, 2011; Warrell and
Warrell, 2015; Plotkin, 2000; Setiawan et al., 2018).

Rabies can be characterized by flaccid paralysis, fever, and profuse sweating(Ghosh et al., 2009; Dutta, 2014). This
type of rabies is correlated with rare distal paraesthesiaand percussion myoedema and has a longer survival period
(Hemachudha et al., 2005). The disorder has been identified in various species, including dogs, cats, foxes, sheep,
goats, dromedaries, and horses. The initial outbreak was first reported in 1992/1993, affecting 44 animals and four
species. The first documented case of human infection with this strain of rabies was declared in 1990, affecting a
young schoolboy who had been bitten by a fox(Wernery, 2014). Cases of rabies have been recorded in different
countries within the wider Gulf region over the years(Wernery, 2014; Bannazadeh Baghi et al., 2018). As reported
by Wernery(Wernery, 2014), the disorder spread across Oman, where foxes serve as the primary reservoir for rabies,
yet they are behind in terms of animal bites to humans.

In 2013, a recurrence of rabies was observed in the Arabian Peninsula, with infected animals including six feral cats,
two red foxes, and one horse(Wernery, 2014). Epidemiological data from Kuwait indicates that dogs, bats, and other
mammals may be the hosts of the disorder. It is uncertain whether Bahrain, Qatar, and the UAE are truly free of
dog-mediated rabies, given that the classification is based on incomplete data and the lack of designated reference
laboratories (Bannazadeh Baghi et al., 2018). In Saudi Arabia, rabies is a well-documented disease, with the
majority of human bites occurring from canines, felines, rodents, and foxes(Memish et al., 2015). Despite
advancements in healthcare, there has been a dearth of inquiries into rabies, with only one confirmed case reported.
It is of interest to public health to continue to investigate animal-associated injuries. It is also noteworthy that
Dhayhi et al. (Dhayhi et al., 2019) and Alknawy et al. (Alknawy et al., 2018) have provided evidence of the first
verified cases of local human rabies in the country.

The clinical incidence of rabies in Saudi Arabia is attributed to a number of different animal species, including dogs,
cats, rodents, camels, foxes, monkeys, and wolves (Algahtani et al., 2020; Kasem et al., 2019; Al-Tayib, 2019;
Memish et al., 2015). In 2007, a study conducted in Al-Qassim examined 4,124 camels and found that the incidence
of clinical rabies was 0.2 percent among camels that were most likely infected by bites from wild dogs (70%) or
foxes (17%) (Kasem et al., 2019). From 1997 to 2006, a total of 26 dogs, 10 foxes, 8 camels, and 7 cats were
reported to have rabies in Al-Qassim region(Memish et al., 2015; Kasem et al., 2019).

A revised report from 2007 to 2009 revealed that 11,069 animal bites had occurred in the country, with dogs
(49.5%) and cats (26.6%) being the most prevalent(Memish et al., 2015; Kasem et al., 2019). The most common
wild animals infected with the virus in the country are foxes and wolves, with the illness also being diagnosed in
monkeys at a prevalence rate of 1.3%(Kasem et al., 2019).

The greatest burden of rabies-positive animals is observed in Al-Qassim, Eastern province, Riyadh, and Al-Madina
territories. There is a prominent seasonal variation in the monthly incidence of bite injuries, with dog and cat bites
demonstrating a year-long pattern of occurrence, while fox bites tend to increase in August and September (Memish
et al., 2015; Al-Tayib, 2019). Despite the advances in healthcare in Saudi Arabia, there has been a paucity of
inquiries into rabies in society, with only one confirmed case report in the previous decade. Animal-associated
injuries remain a significant public health concern, and Dhayhi et al. (Dhayhi et al., 2019) and Alknawy et al.
(Alknawy et al., 2018) provide compelling evidence of the first verified cases of local human rabies in the country.

Pathogenesis
The most significant risk factor pertains to bites on the hands, neck, face, and head, predominantly involving
puncture(Singh et al., 2017; Chhabra et al., 2015; Consales and Bolzan, 2007). Such cases are correlated with
shorter incubation periods due to the reduced length and greater number of neurons(Singh et al., 2017).

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In most cases, the virus can persist in the muscle for an extended duration, which may provide an opportunity for
post-exposure intervention and clearance by the host’s immune system (Singh et al., 2017; Consales and Bolzan,
2007). The virus attaches to G-protein receptors on target cells (myocytes, local sensory, and motor neurons) and
amplifies in muscle cells and macrophages(Singh et al., 2017).

The virus has been observed to persist for up to 18 days before migrating upwards and reaching the CNS, where it
infects nerve cells(Singh et al., 2017). The virus travels retrogradely along peripheral nerves, affecting both motor
and sensory nerves (Singh et al., 2017; Warrell and Warrell, 2004; Mazarakis et al., 2001). Additionally, RABV
may enter the bloodstream due to a large inoculum at the bite site or in cases with short incubation periods(Singh et
al., 2017; Burrell et al., 2017).

In accordance with the findings of Hemachudha et al. (Hemachudha et al., 2013), the dissemination of RABV
infection is contingent upon the quantity of virus inoculum and the tissue tropism of the virus. It is most probable
that dog-specific variants will infect deep bites that penetrate muscle tissue. Furthermore, Hemachudha et al.
(Hemachudha et al., 2013) indicated that the virus's entry via the motor route is based upon the presence of the
nicotinic acetylcholine receptor at the neuromuscular junction.

Mode of transmission from animals to humans

In their respective studies, Singh et al. (Singh et al., 2017),Noman et al.(Noman et al., 2021), Li et al.(Li et al.,
2021), and Ngugi et al. (Ngugi et al., 2018) have identified the most common mode of transmission of the disorder
as bites from animals, such as dogs and cats, which carry the infection due to their close association with humans. In
Asia and Africa, canid bites account for 85-95% of cases, often resulting in physical and emotional trauma(Singh et
al., 2017).

The risk of infection by bite is 5-80% higher than the chance of tissue invasion from licks or scratches, with a 0.1-
1% chance(Singh et al., 2017). The mortality rate is dependent on the severity of the infection, the location of the
wound, and the potency of the virus in the saliva. Bat-specific RABV isolates exhibit greater virulence in superficial
epidermal injections and at lower temperatures, as evidenced by studies by Singh et al. (Singh et al.,
2017)andConsales and Bolzan(Consales and Bolzan, 2007). In accordance with the findings of Consales and Bolzan
(Consales and Bolzan, 2007), Singh et al. (Singh et al., 2017) propose that percutaneous infection may occur as a
result of undetected skin contact and bites.

Over the past 50 years, a few non-bite rabies cases have been reported, but the incidence is lower than previously
thought (Singh et al., 2017; Samad et al., 2024). The most efficient transmission route is saliva from bites, but other
routes include inhalation of aerosolized RABV, tissue and organ transplants, handling of carcasses, and
contamination of wounds. Inhalation exposure represents a potential transmission route(Singh et al., 2017;
Hemachudha et al., 2013).

In 2005, corneal transplantation resulted in the acquisition of the infection in patients in the United States and in
Germany, all of whom ultimately died. This incident highlighted the necessity for diagnostic testing, particularly in
individuals presenting with nervous symptoms (Singh et al., 2017; Lu et al., 2018).

Rabies-infected individuals may transmit the disease through bites, although this is less well-documented(Singh et
al., 2017; Feder et al., 2012). Unprotected contact with affected individuals and secretions with high virions can
pose risks to relatives and healthcare professionals. Standard barrier precautions are crucial for minimizing
transmission risk. Airborne exposure during vaccine production and animal vaccinations also pose risks. It is
imperative to implement pre- and post-exposure prophylaxis to effectively manage these conditions(Singh et al.,
2017; Weese, 2004; Bertozzi et al., 2016; Lodha et al., 2023; Costescu Strachinaru et al., 2024).

The skinning and handling of carcasses infected with rabies represent a significant transmission pathway, with dog
slaughtering being a major pathogenic avenue(Nguyen et al., 2021; Tasiame et al., 2022; Ekanem et al., 2013). The
consumption of dog meat is a delicacy in some societies. The presence of rabies virus in healthy dogs used for
slaughtering predisposes butchers to rabies. The dog trade, slaughter processes, and consumption of dog meat
represent fundamental elements of the rabies-specific epidemiological triangle. Congested trucks have been
identified as a significant risk factor for the propagation of disorder among canines(Singh et al., 2017; Tasiame et
al., 2022; Ekanem et al., 2013; Mshelbwala et al., 2013).

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Singh et al. (Singh et al., 2017) and Mshelbwala et al.(Mshelbwala et al., 2013) emphasize the potential risk of
rabies in the dog trade, where butchers handle animals without the necessary precautions and are not subject to
government regulation. Furthermore, the unhygienic conditions prevalent in slaughterhouses and the dissemination
organs of slaughtered animals serve to exacerbate the risk (Singh et al., 2017). The consumption of dog meat does
not directly cause rabies transmission; however, the risk of transmission arises during the catching, handling,
transporting, and slaughtering of the animals. The majority of butchers lack an understanding of the zoonotic
significance of rabies, thereby exacerbating the risk element inherent to their trade(Singh et al., 2017; Mshelbwala et
al., 2013; Garba et al., 2013).

Clinical signs and symptoms in humans

The disorder manifests in various ways, as evidenced by the findings of Plotkin (Plotkin, 2000), Warrell and Warrell
(Warrell and Warrell, 2015), Consales and Bolzan (Consales and Bolzan, 2007), and Fooks et al. (Fooks et al.,
2017), with an average incubation period of 20-60 days. The symptoms may manifest within five to six days, or in
some cases, over a period of six months(Plotkin, 2000). However, the average phase lasts one to three months in
approximately 60% of cases(Takayama, 2008).

Salomão et al. (Salomão et al., 2017) emphasize the considerable variability in the incubation periods for pathogens,
which can range from two to three months. The time required for the pathogen to manifest in a host is influenced by
various factors, including location, wound depth, and virus strain. The duration of infection can extend up to seven
years following exposure. The initial symptoms of the disease include fever, anxiety, malaise, paraesthesia, and
pruritus(Fooks et al., 2017; Warrell and Warrell, 2015; Plotkin, 2000).

A neuropsychiatric disorder of a particularly intense and distressing nature is typified by a constellation of

symptoms including agitation, confusion, hydrophobia, hyperventilation, hypersalivation, priapism, and convulsions
(Jackson, 2011; Plotkin, 2000). Hydrophobia, or fear of water, is a common symptom indicative of cerebral and
autonomic dysfunction (Jackson, 2011). The disorder is episodic, with patients exhibiting cooperative and oriented
behavior. In some cases, peripheral nerve paralysis is present, often accompanied by fever. Eventually, individuals
exhibit symptoms and become paralyzed(Jackson, 2011; Plotkin, 2000; Hemachudha et al., 2005).

While paralytic rabies and Guillain-Barré Syndrome (GBS) share clinical points of similarity, GBS is distinguished
by its sensory involvement and the absence of fever and encephalitic signs in oxygenated patients(Jackson, 2011;
Plotkin, 2000; Hemachudha et al., 2005). It is of the utmost importance to conduct diagnostic investigations to
distinguish between the two conditions. Recovery from rabies is limited, and patients who have received only partial
vaccinations may experience severe neurological complications. No known treatment is currently available(Plotkin,
2000; Hemachudha et al., 2005; Manoj et al., 2016).

Manifestations in animals
Rabies in animals presents with a range of symptoms, including hyperexcitability, autonomic dysfunction, and
aerophobia a(Burgos-Cáceres, 2011; Rohde, 2016; Lackay et al., 2008). However, the most common presentation is
that of unexplained paralysis and behavioral changes, including loss of appetite, interest in unusual objects, pawing,
breathing difficulties, swallowing difficulties, seizures, and hypersensitivities to touch or sound (Abdulkhazhieva
and Abdulkhazhieva, 2023; Rohde, 2016).

Dogs, cats, and domestic ferrets are subjects of intense study in the rabies ecosystem due to their close contact with
humans (Lackay et al., 2008). The incubation period for rabies virus in canines can range from seven days to several
months, during which time the animal may exhibit symptoms including drooling, aggression, anxiety, and whining.
The initial signs of rabies infection in canines include fever, nervousness, irritability, atypical behavior, and itching
at the bite site (Burgos-Cáceres, 2011; Abdulkhazhieva and Abdulkhazhieva, 2023).

Dogs exhibit excitement for up to a week, followed by an encephalic and paralytic stage (Lackay et al., 2008). The
excitement phase is characterised by aggressiveness, attacks, wandering movements, voicechanges, and seizures.
The paralytic phase is characterised by the loss of voice, depression, and paralysis, which may ultimately result in a
coma(Abdulkhazhieva and Abdulkhazhieva, 2023). The disease typically results in respiratory failure and death,
with an average duration of three to eight days. Cats exhibit similar symptoms, yet they tend to conceal themselves
and display greater viciousness(Lackay et al., 2008). Behavior that is inexplicable or that exhibits an abrupt
adjustment should be regarded as suspicious (Frymus et al., 2009). Cats may present with nonspecific symptoms,

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such as fever, anorexia, vomiting, and diarrhea, and later, uncharacteristic behaviors. The typical interval between
the onset of symptoms and death is 1-10 days(Frymus et al., 2009).

Small domestic animals like ferrets and rabbits are becoming popular companions, with an elevated risk of
infection(Quesenberry and de Matos, 2020; Sujatha et al., 2023). The symptoms of this condition include lethargy,
ataxia, paresis, paraparesis, paralysis, constipation, hypothermia, inappetence, anorexia, abnormal vocalization,
sneezing, paraesthesia, and ptyalism. These symptoms are described in detail by Lackay et al. (Lackay et al., 2008).
In rabbits, the symptoms include weakness in the forelimbs, palpable crepitus, head tremors, ear infection, nasal
discharge, and anorexia(Lackay et al., 2008). In the case of foxes, increased aggressiveness may be observed
(Rohde, 2016). It is of paramount importance to observe and understand the diversity of presentations exhibited by
species in order to develop effective responses.

Laboratory investigations
Laboratory investigations for rabies can take various forms, including direct microscopy for interpreting histological
sections and the World Health Organization-recommended direct fluorescent antibody test (DFAT) (Singh et al.,
2017; Hemachudha et al., 2013; Mani and Madhusudana, 2013; Duong et al., 2016). Histopathological image
analysis can reveal the Negri body, but these techniques have poor sensitivity and are not recommended for primary
diagnosis (Singh et al., 2017; Mani and Madhusudana, 2013). Fluorescent testing has been demonstrated to have
nearly 99% specificity and sensitivity(Mani and Madhusudana, 2013).

Another viral antigen investigative tool is rapid rabies enzyme immunodiagnosis (RREID), which identifies the
presence of RABV antigens in specimens using monoclonal or polyclonal antibodies(Mani and Madhusudana, 2013;
Duong et al., 2016).The utilization of rabies virus antigen in animal diagnostics has been investigated, with the rapid
immunodiagnostic test (RIDT) being a cost-effective and efficacious method for animal rabies diagnosis.
Nevertheless, the findings indicate that the low specificity of RIDT for human brain specimens renders it unsuitable
for the diagnosis of zoonotic diseases in humans(Mani and Madhusudana, 2013).

Reverse-transcriptase PCR (RT-PCR) is a crucial diagnostic tool for rabies due to its high sensitivity and
specificity(Duong et al., 2016). Nevertheless, Duong et al. (Duong et al., 2016) advised that it is a time- and
resource-intensive process, while Mani and Madhusudana(Mani and Madhusudana, 2013) acknowledge that the risk
of cross-contamination represents a significant flaw in its application. Additionally, practitioners may employ real-
time reverse transcriptase PCR (RT-qPCR) in diagnostic procedures. Duong et al. (Duong et al., 2016) have
expressed confidence in the potential of this approach, particularly with regard to the lower cross-contamination risk
associated with the assays.

The direct rapid immunohistochemical test (dRIT), developed by the US Centers for Disease Control and Prevention
(CDC), is a rapid, sensitive, and specific method for detecting rabies virus antigen in suspected brain smears, as
compared to the fluorescent antibody technique(Mani and Madhusudana, 2013; Duong et al., 2016; Lembo et al.,
2006).

Control and prevention of rabies in Saudi Arabia and Gulf Area

In Saudi Arabia, rabies is a reportable disease, and the Ministry of Health requires that all healthcare facilities in the
country report suspected or confirmed cases to the Public Health Directorate(Memish et al., 2015; Algahtani et al.,
2020).

Nevertheless, underreporting persists as a significant challenge across the Middle East, even in countries where the
issue is perceived as endemic(Bannazadeh Baghi et al., 2018). Three National Reference Laboratories have been
designated for testing the disease in animals in Saudi Arabia: one in Qassim, one in Al-Ahsa, and one in Jeddah
(Memish et al., 2015; Algahtani et al., 2020). Additionally, the government provides healthcare facilities with a
policy delineating the practices for handling rabid animal brain specimens and the protocols for submission(Memish
et al., 2015; Kasem et al., 2019).

Furthermore, the Ministry of Health has disseminated a synopsis of pre- and post-exposure prophylaxis and
treatment for rabid animal human bite victims to all healthcare professionals in the country(Memish et al., 2015).
Additionally, the Ministry of Environment, Water, and Agriculture program is focused on the eradication of canine-
transmitted human rabies by 2030(Kasem et al., 2019) and is worthy of note in the context of rabies control in Saudi

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Arabia. The program's core strategies include "advocacy by the authorities for the prevention and control of rabies,
community mobilization, dog immunization, resource allocation, public awareness, provision of post-exposure
prevention, and facilitation of coordination between human and animal health sectors(Kasem et al., 2019).

The measures currently in place in Saudi Arabia are consistent with the findings of scholarly research indicating that
the most effective approach to preventing and controlling the zoonosis is through the management of animals. As
Singh et al. (Singh et al., 2017) posit, canine and feline vaccination, in conjunction with the management of stray
animal populations and public health education, represent fundamental elements of animal rabies control.

While Saudi Arabia's actions in the prevention, treatment, management, and control of rabies are praiseworthy, there
are shortcomings in its response, paralleling those observed in other countries within the broader Gulf region.
Memish et al. (Memish et al., 2015) argued that a more comprehensive understanding of the epidemiology of animal
bites and animal rabies in the largest country in the Peninsula would be of significant value. Indeed, reflecting the
overall paucity of statistical information in the larger Gulf area, Baghi et al. (Bannazadeh Baghi et al., 2018) found
that very little data on the problem are available in Oman, while several other countries, including Kuwait, Bahrain,
and Qatar, are also hampered by reporting inadequacies, with some localities having no data at all. The accessible
information is frequently out of date, as it does not account for changes over time and therefore may not be accurate
(Bannazadeh Baghi et al., 2018).

The implementation of robust surveillance, data reporting/sharing, and monitoring mechanisms could facilitate the
elimination of rabies in Saudi Arabia and the wider Gulf region, as proposed by Baghi et al. (Bannazadeh Baghi et
al., 2018). The availability of rigorous empirical epidemiological data on the problem could enhance the efficacy of
interventions. For Saudi Arabia, enhanced rabies control strategies are of particular significance, given the country’s
cultural and religious importance. Al-Tayib(Al-Tayib, 2019) reports that Saudi Arabia annually hosts the largest
assembly of Hajj, where millions of pilgrims congregate in a small geographical area. In light of the nature of this
gathering, Al-Tayib(Al-Tayib, 2019) acknowledges that the event places the country at the forefront of pandemic
threats. Consequently, it is of the utmost importance to maintain a high level of vigilance in monitoring the pathogen
in order to prevent the further spread of the virus locally, regionally, and internationally. Additionally, there is a
significant economic aspect to the necessity of a more robust response to rabies in Saudi Arabia and other Gulf
countries. This is particularly evident in the context of the livestock trade. Baghi et al. (Bannazadeh Baghi et al.,
2018) posit that rural areas in the Middle East often exhibit a higher incidence of human rabies, as residents are
more engaged in livestock farming and utilize canines for protection. Moreover, these populations have limited
awareness of the risks of the zoonosis, are misinformed about it, or fail to fully adhere to post-exposure prophylaxis
recommendations compared with their urban counterparts (Bannazadeh Baghi et al., 2018). Accordingly, Baghi et
al. (Bannazadeh Baghi et al., 2018) posit that it is imperative to reinforce biosecurity and management protocols for
farm animals to diminish the probability of pathogen emergence and mitigate the potential for economic losses.

Conclusions:-
Rabies remains a significant public health problem in the Kingdom of Saudi Arabia, exacerbated by the prevalence
of animal bites from both domestic and wild animals. Epidemiological data indicate the need for sustained and
coordinated efforts to control and prevent rabies. Despite the existence of vaccination programs and reporting
mechanisms, challenges remain due to incomplete data and the presence of stray animals. Enhanced public health
strategies, including comprehensive human and animal vaccination campaigns, improved diagnostic facilities, and
robust public awareness initiatives, are essential to reduce the spread of rabies. In addition, regional cooperation
among Gulf countries could strengthen rabies control efforts and ensure a unified approach to this zoonotic threat.
Continued research and surveillance are essential to adapt to the evolving epidemiological landscape and implement
effective measures to protect public health and reduce the incidence of rabies in the region.

References:-
1. Abdulkhazhieva, A.S. and Abdulkhazhieva, M.S. (2023): Vaccination of rabies in dogs to protect the
population. SHS Web Conf, 172: 02051.
2. Al-Tayib, O.A. (2019): An Overview of the Most Significant Zoonotic Viral Pathogens Transmitted from
Animal to Human in Saudi Arabia. Pathogens, 8.

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ISSN: 2320-5407 Int. J. Adv. Res. 12(08), 279-287

3. Algahtani, H., Shirah, B., Chtourou, E., Abuhawi, O., Abdelghaffar, N. and Alshehri, M. (2020): Feral dog bite
causing paralytic rabies: difficult diagnosis and failure of prevention. Saudi Journal for Health Sciences, 9: 260-
263.
4. Alknawy, M., Mohammed, I., Ulla, S.N. and Aboud, A.A. (2018): First confirmed case of human rabies in
Saudi Arabia. IDCases, 12: 29-31.
5. BannazadehBaghi, H., Alinezhad, F., Kuzmin, I. and Rupprecht, C.E. (2018): A perspective on rabies in the
Middle East—beyond neglect. Veterinary Sciences, 5: 67.
6. Bertozzi, M., Rinaldi, V.E., Cara, G.D. and Appignani, A. (2016): A glance at rabies pre-exposure and post-
exposure prophylaxis for dog bites. Afr J Paediatr Surg, 13: 107-108.
7. Burgos-Cáceres, S. (2011): Canine Rabies: A Looming Threat to Public Health. Animals (Basel), 1: 326-342.
8. Burrell, C.J., Howard, C.R. and Murphy, F.A. (2017) Pathogenesis of Virus Infections. In: Burrell CJ, Howard
CR and Murphy FA (eds) Fenner and White's Medical Virology (Fifth Edition). London: Academic Press, 77-
104.
9. Chhabra, S., Chhabra, N. and Gaba, S. (2015): Maxillofacial injuries due to animal bites. Journal of
Maxillofacial & Oral Surgery, 14: 142-153.
10. Consales, C. and Bolzan, V. (2007): Rabies review: immunopathology, clinical aspects and treatment. Journal
of Venomous Animals & Toxins Including Tropical Diseases, 13: 5-38.
11. Costescu Strachinaru, D.I., Levêque, A. and Damanet, B. (2024): Intradermal rabies pre- and post-exposure
prophylaxis: challenging analytical perspectives and advocating for access in high-risk resource-limited
settings. J Travel Med, 31.
12. Dhayhi, N.S., Arishi, H.M., Ibrahim, A.Y.A., Allah, M.B.K., Hawas, A.M., Alqasmi, H., et al. (2019): First
confirmed case of local human rabies in Saudi Arabia. Int J Infect Dis, 87: 117-118.
13. Duong, V., Tarantola, A., Ong, S., Mey, C., Choeung, R., Ly, S., et al. (2016): Laboratory diagnostics in dog-
mediated rabies: an overview of performance and a proposed strategy for various settings. Int J Infect Dis, 46:
107-114.
14. Dutta, T.K. (2014): Rabies: an overview. International Journal of Advanced Medical and Health Research, 1:
39-44.
15. Ekanem, E.E., Eyong, K.I., Philip-Ephraim, E.E., Eyong, M.E., Adams, E.B. and Asindi, A.A. (2013): Stray
dog trade fuelled by dog meat consumption as a risk factor for rabies infection in Calabar, southern Nigeria. Afr
Health Sci, 13: 1170-1173.
16. Elsohaby, I. and Villa, L. (2023): Zoonotic diseases: understanding the risks and mitigating the threats. BMC
Veterinary Research, 19: 186.
17. Feder, H.M., Jr., Petersen, B.W., Robertson, K.L. and Rupprecht, C.E. (2012): Rabies: still a uniformly fatal
disease? Historical occurrence, epidemiological trends, and paradigm shifts. Curr Infect Dis Rep, 14: 408-422.
18. Fooks, A.R., Banyard, A.C., Horton, D.L., Johnson, N., McElhinney, L.M. and Jackson, A.C. (2014): Current
status of rabies and prospects for elimination. Lancet, 384: 1389-1399.
19. Fooks, A.R., Cliquet, F., Finke, S., Freuling, C., Hemachudha, T., Mani, R.S., et al. (2017): Rabies. Nat Rev Dis
Primers, 3: 17091.
20. Frymus, T., Addie, D., Belák, S., Boucraut-Baralon, C., Egberink, H., Gruffydd-Jones, T., et al. (2009): Feline
rabies. ABCD guidelines on prevention and management. Journal of Feline Medicine & Surgery, 11: 585-593.
21. Garba, A., Dzikwi, A., Okewole, P., Bb, C.-W., Baba, T., Kazeem, H., et al. (2013): Evaluation of dog slaughter
and consumption practices related to the control of rabies in Nigeria. Journal of Experimental Biology and
Agricultural Sciences 2320 – 8694, 1: 125-130.
22. Gholami, A., Fayaz, A. and Farahtaj, F. (2014): Rabies in Iran: past, present and future. Journal of Medical
Microbiology and Infectious Diseases, 2: 1-10.
23. Ghosh, J.B., Roy, M., Lahiri, K., Bala, A.K. and Roy, M. (2009): Acute flaccid paralysis due to rabies. J
PediatrNeurosci, 4: 33-35.
24. Hemachudha, T., Ugolini, G., Wacharapluesadee, S., Sungkarat, W., Shuangshoti, S. and Laothamatas, J.
(2013): Human rabies: neuropathogenesis, diagnosis, and management. Lancet Neurol, 12: 498-513.
25. Hemachudha, T., Wacharapluesadee, S., Mitrabhakdi, E., Wilde, H., Morimoto, K. and Lewis, R.A. (2005):
Pathophysiology of human paralytic rabies. J Neurovirol, 11: 93-100.
26. Jackson, A.C. (2011): Update on rabies. Research & Reports in Tropical Medicine, 2: 31-43.
27. Kasem, S., Hussein, R., Al-Doweriej, A., Qasim, I., Abu-Obeida, A., Almulhim, I., et al. (2019): Rabies among
animals in Saudi Arabia. J Infect Public Health, 12: 445-447.
28. Lackay, S.N., Kuang, Y. and Fu, Z.F. (2008): Rabies in small animals. Veterinary Clinics of North America:
Small Animal Practice, 38: 851-861.

285
ISSN: 2320-5407 Int. J. Adv. Res. 12(08), 279-287

29. Lembo, T., Niezgoda, M., Velasco-Villa, A., Cleaveland, S., Ernest, E. and Rupprecht, C.E. (2006): Evaluation
of a direct, rapid immunohistochemical test for rabies diagnosis. Emerg Infect Dis, 12: 310-313.
30. Li, D., Liu, Q., Chen, F., Jiang, Q., Wang, T., Yin, X., et al. (2021): Knowledge, attitudes and practices
regarding to rabies and its prevention and control among bite victims by suspected rabid animals in China. One
Health, 13: 100264.
31. Lodha, L., Manoor Ananda, A. and Mani, R. (2023): Rabies control in high-burden countries: role of universal
pre-exposure immunization. The Lancet Regional Health - Southeast Asia, 19: 100258.
32. Lu, X.X., Zhu, W.Y. and Wu, G.Z. (2018): Rabies virus transmission via solid organs or tissue
allotransplantation. Infect Dis Poverty, 7: 82.
33. Mani, R.S. and Madhusudana, S.N. (2013): Laboratory diagnosis of human rabies: recent advances.
ScientificWorldJournal, 2013: 569712.
34. Manoj, S., Mukherjee, A., Johri, S. and Kumar, K.V. (2016): Recovery from rabies, a universally fatal disease.
Mil Med Res, 3: 21.
35. Mazarakis, N.D., Azzouz, M., Rohll, J.B., Ellard, F.M., Wilkes, F.J., Olsen, A.L., et al. (2001): Rabies virus
glycoprotein pseudotyping of lentiviral vectors enables retrograde axonal transport and access to the nervous
system after peripheral delivery. Hum Mol Genet, 10: 2109-2121.
36. Memish, Z.A., Assiri, A.M. and Gautret, P. (2015): Rabies in Saudi Arabia: a need for epidemiological data. Int
J Infect Dis, 34: 99-101.
37. Mshelbwala, P.P., Ogunkoya, A.B. and Maikai, B.V. (2013): Detection of rabies antigen in the saliva and brains
of apparently healthy dogs slaughtered for human consumption and its public health implications in abia state,
Nigeria. ISRN Vet Sci, 2013: 468043.
38. Ngugi, J.N., Maza, A.K., Omolo, O.J. and Obonyo, M. (2018): Epidemiology and surveillance of human
animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011–2016. BMC
Public Health, 18: 996.
39. Nguyen, A.K.T., Vu, A.H., Nguyen, T.T., Nguyen, D.V., Ngo, G.C., Pham, T.Q., et al. (2021): Risk Factors and
Protective Immunity Against Rabies in Unvaccinated Butchers Working at Dog Slaughterhouses in Northern
Vietnam. Am J Trop Med Hyg, 105: 788-793.
40. Noman, Z., Anika, T.T., Haque, Z.F., Rahman, A., Ward, M.P. and Martínez-López, B. (2021): Risk factors for
rabid animal bites: a study in domestic ruminants in Mymensingh district, Bangladesh. Epidemiol Infect, 149:
e76.
41. Otte, J. and Pica-Ciamarra, U. (2021): Emerging infectious zoonotic diseases: The neglected role of food
animals. One Health, 13: 100323.
42. Plotkin, S.A. (2000): Rabies. Clin Infect Dis, 30: 4-12.
43. Quesenberry, K.E. and de Matos, R. (2020) 2 - Basic Approach to Veterinary Care of Ferrets. In: Quesenberry
KE, Orcutt CJ, Mans C, et al. (eds) Ferrets, Rabbits, and Rodents (Fourth Edition). Philadelphia: W.B.
Saunders, 13-26.
44. Rahman, M.T., Sobur, M.A., Islam, M.S., Ievy, S., Hossain, M.J., El Zowalaty, M.E., et al. (2020): Zoonotic
Diseases: Etiology, Impact, and Control. Microorganisms, 8.
45. Rohde, R. (2016): The many faces of rabies: high- and low-risk animals, different ways to get rabies – and tips
to prevent it. Elsevier Connect.
46. Salomão, C., Nacima, A., Cuamba, L., Gujral, L., Amiel, O., Baltazar, C., et al. (2017): Epidemiology, clinical
features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola
cities, Mozambique, 2014: Implications for public health interventions for rabies control. PLoSNegl Trop Dis,
11: e0005787.
47. Samad, A., Naveed, A., Alam, A.N., Atique, R., Muazzam, A., Anwar, B., et al. (2024): Brief overview on
rabies: a fatal and preventable virus. Indonesian Health Journal, 3: 162-170.
48. Setiawan, K.H., Probandari, A.N., Pamungkasari, E.P. and Tamtomo, D.G. (2018): Human behaviour in
keeping dogs and its relationship to rabies. International research journal of management, IT and social
sciences, 5: 105-113.
49. Sharan, M., Vijay, D., Yadav, J.P., Bedi, J.S. and Dhaka, P. (2023): Surveillance and response strategies for
zoonotic diseases: a comprehensive review. Science in One Health, 2: 100050.
50. Singh, R., Singh, K.P., Cherian, S., Saminathan, M., Kapoor, S., Manjunatha Reddy, G.B., et al. (2017): Rabies
- epidemiology, pathogenesis, public health concerns and advances in diagnosis and control: a comprehensive
review. Vet Q, 37: 212-251.
51. Sujatha, A., Gs, A., Kumar, Abraham, S. and Jose, M. (2023): A report of rabies in a domestic rabbit
(Oryctolagus cuniculus) and its public health implications. APCRI J, 24: 7-9.

286
ISSN: 2320-5407 Int. J. Adv. Res. 12(08), 279-287

52. Takayama, N. (2008): Rabies: a preventable but incurable disease. J Infect Chemother, 14: 8-14.
53. Tasiame, W., El-Duah, P., Johnson, S.A.M., Owiredu, E.W., Bleicker, T., Veith, T., et al. (2022): Rabies virus
in slaughtered dogs for meat consumption in Ghana: A potential risk for rabies transmission. Transboundary &
Emerging Diseases, 69: e71-e81.
54. Warrell, M.J. and Warrell, D.A. (2004): Rabies and other lyssavirus diseases. Lancet, 363: 959-969.
55. Warrell, M.J. and Warrell, D.A. (2015): Rabies: the clinical features, management and prevention of the classic
zoonosis. Clin Med (Lond), 15: 78-81.
56. Weese, J.S. (2004): Barrier precautions, isolation protocols, and personal hygiene in veterinary hospitals. Vet
Clin North Am Equine Pract, 20: 543-559.
57. Wernery, U. (2014): Zoonoses in the Arabian Peninsula. Saudi Med J, 35: 1455-1462.

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