More accurate insight into the incidence of human rabies in developing countries through validated laboratory techniques

Overview

Over the past 10 years, new techniques and protocols have been proposed for rabies diagnosis, especially in humans. However, the reported number of laboratory-confirmed human rabies cases remains limited and underestimates the real impact of this neglected zoonotic disease, particularly in enzo-epizootic areas of Asia and Africa. The regular reporting of diagnostic data through the structures of the World Organization for Animal Health and the World Health Organization (WHO) (using the RABNET network, for example), together with the importance of the status of rabies as a notifiable disease in all countries, remain crucial for the surveillance and control of rabies, especially in humans. There is clearly a need to improve diagnostic tools appropriate for the facilities in these countries. This paper provides a review of recent publications relating to the evaluation of methods for human rabies diagnosis in developing country settings in order to highlight the sampling methods and techniques that are likely to give the most reliable results.

In their recent review entitled ‘‘Emerging technologies for the detection of rabies virus: challenges and hopes in the 21st century’’, Fooks et al. provide information on some of the latest techniques to detect rabies virus or nucleic acid in diagnostic samples. However, additional major techniques not mentioned by Fooks et al. are also available, some concerning recent studies addressing the broader challenge of human rabies diagnosis in developing countries, which we aim to describe here.