One bite, two worlds: understanding rabies in animals and humans

Rabies is a neurotropic viral zoonosis in which a seemingly routine animal bite can progress to a fatal neurological disease when appropriate preventive measures are delayed. Although the virus infects a wide range of mammals, the domestic dog remains the major link between animal infection and human rabies in many endemic regions. Rabies presents a distinctive public health challenge: once clinical signs develop, the disease is almost invariably fatal, yet infection following an exposure can be prevented effectively when timely and appropriate measures are taken. This article examines the disease across the complete transmission pathway, covering epidemiology, transmission, pathogenesis, clinical manifestations, laboratory diagnosis, post-exposure prophylaxis (PEP), treatment and supportive care, prevention, and One Health strategies. It also discusses the global objective of eliminating dog-mediated human rabies deaths by 2030. Current evidence indicates that human PEP and large-scale dog vaccination address complementary aspects of rabies control. While PEP protects individuals following exposure, sustained vaccination of dogs reduces viral transmission within the animal population and consequently lowers human exposure. Evidence from India further highlights the importance of strengthening rabies surveillance, ensuring timely and complete PEP, and maintaining effective canine vaccination programmes simultaneously. An integrated One Health approach, involving human and veterinary health services, diagnostic laboratories, communities, wildlife authorities, and local administration, provides a practical framework for advancing rabies control and supporting the long-term goal of elimination.