Rabies is one of the most ancient known diseases that can be effectively prevented by means of vaccination, yet is still one of the most devastating diseases to date. Morbidity and mortality caused by RABV outcompetes that of Ebola and Marburg virus infections, being the only virus known to kill approximately 100% of the affected persons. Without pre- or post exposure prophylaxis, the virus will migrate slowly to the central nervous system to cause an inevitable excruciating death. There are at least 55,000 deaths due to rabies reported annually, a figure that is likely an underestimation due to incomplete surveillance data. The reason for this devastating statistics is that no specific or supporting treatment exists to overcome fatal outcome of the disease.
Rabies can be considered a threat for Europe given the fact that almost 100,000 cases have been reported in wild life during the last decade and at least 10 human cases are reported annually. A great proportion of these cases occur in Central and Eastern Europe. Although the majority of rabies encephalitis is attributed to RABV, several other lyssaviruses have been identified in recent years with an underestimated impact on public health.
In Central and Eastern Europe the so-called urban cycle of rabies (maintained by dogs) was interrupted in the first half of the 20th century by compulsory, overall and regular vaccination of dog populations. However from the 1950’s onward the alternative, sylvatic cycle of rabies (maintained mainly by foxes) was maintained in several Central and Eastern European countries. Since the 1980’s oral bait immunisation programmes targeting the fox populations, were successfully applied in several Central and Eastern European countries to control sylvatic rabies. Thanks to these efforts the number of rabies cases decreased dramatically and some countries even became free from rabies. However, interruptions of the vaccination efforts gave rise to several re-emergence situations. Because the virus was eradicated even from the fox populations in several European countries, the public awareness has decreased and even clinicians may not think about a possible rabies infection after an animal bite or scratch encountered within or outside Europe, even in the early stage of clinical manifestation.