Research Article: Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review

Date Published: February 12, 2016

Publisher: Public Library of Science

Author(s): Brecht Devleesschauwer, Arjun Aryal, Barun Kumar Sharma, Anita Ale, Anne Declercq, Stephanie Depraz, Tara Nath Gaire, Gyanendra Gongal, Surendra Karki, Basu Dev Pandey, Sher Bahadur Pun, Luc Duchateau, Pierre Dorny, Niko Speybroeck, Charles E Rupprecht.

Abstract: BackgroundRabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal.MethodsWe performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal.FindingsSo far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle.InterpretationBetter data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal.

Partial Text: Rabies is a neglected zoonotic disease caused by an RNA virus of the family Rhabdoviridae, genus Lyssavirus. All mammals can be infected with the rabies virus, but dogs are the most important source of human rabies. Although the necessary evidence and tools are in place to control and eliminate rabies, the virus still has a worldwide distribution and is causing a significant health and economic burden to mainly developing countries in Africa and Asia [1].

We used a variety of sources to search for information on the epidemiology, impact and control of rabies in Nepal (S1 and S2 Files). Rabies epidemiology was defined as transmission, geographical distribution, seasonality and molecular diversity, while rabies impact was defined as the number of outbreaks, cases, deaths and Disability-Adjusted Life Years (DALYs). We performed a systematic review of scientific literature indexed in PubMed, Web of Knowledge and Nepal Journals Online (, complemented by manual searches of the main Nepalese journals and the conference proceedings of the Rabies in Asia (RIA) foundation ( We searched for the following key words: (“rabies” OR “rabid” OR “dog”) AND “Nepal”. After removing duplicates, we first excluded items for which we could not retrieve an abstract or full text, and subsequently excluded items that did not pertain to rabies in Nepal. No time restrictions were applied. Further grey literature was collected through searching the WHO Digital Library ( and the library of the National Zoonoses and Food Hygiene Research Centre (NZFHRC), a non-governmental organization actively working in the prevention of zoonosis in Nepal. We also searched Google and Google Scholar for additional documents, but acknowledge that these searches are not replicable, due to the continuous updating of the Google databases and the user-specific ranking of database items. For each eligible document, a narrative synthesis was made, which were then further digested into a qualitative review.

A proper understanding of the epidemiology and impact of rabies is crucial for planning, implementing and evaluating rabies control programmes. In this review, we have tried to generate the best possible summary of data on animal and human rabies in Nepal. However, as our review was mainly narrative in nature, and as a substantial amount of information was obtained through grey literature searches, we acknowledge that replicability may be limited. To accommodate this limitation, we ensured full transparency by including full details on our search strategy and results as Supporting Information files.

Limited data indicate that rabies probably still is a major zoonosis in Nepal. However, more and better data are needed, especially from rural areas, to estimate the true burden of animal and human rabies and to plan, implement and evaluate rabies control programmes. The current control of rabies is hampered by insufficient vaccine availability across the country. The way forward for effective rabies control programmes lies in more collaboration, both within the country and within the region. We believe this disease can be controlled only through a coordinated one health approach [87,88]. To accomplish these recommendations, high-level political commitment is essential. Making rabies the model zoonosis for successful control could be a powerful step towards achieving this.



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