title: Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review.
abstract: BACKGROUND
  Rabies 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  So 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.
  
  
  CONCLUSIONS
  Better 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.
authors.affiliation: Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.|Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.|Emerging Pathogens Institute and Department of Animal Sciences, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Brecht
authors.initials: B
authors.lastname: Devleesschauwer
authors.affiliation: Central Veterinary Hospital, Ministry of Agricultural Development, Kathmandu, Nepal.
authors.forename: Arjun
authors.initials: A
authors.lastname: Aryal
authors.affiliation: Department of Livestock Services, Ministry of Agricultural Development, Kathmandu, Nepal.|Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand.
authors.forename: Barun Kumar
authors.initials: BK
authors.lastname: Sharma
authors.affiliation: National Zoonoses and Food Hygiene Research Centre, Kathmandu, Nepal.
authors.forename: Anita
authors.initials: A
authors.lastname: Ale
authors.affiliation: Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Declercq
authors.affiliation: Unité Mixte de Recherche - Contrôle des Maladies Animales, Exotiques et Émergentes (UMR CMAEE), CIRAD, Petit-Bourg, Guadeloupe, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Depraz
authors.affiliation: Department of Livestock Services, Ministry of Agricultural Development, Kathmandu, Nepal.
authors.forename: Tara Nath
authors.initials: TN
authors.lastname: Gaire
authors.affiliation: Disease Surveillance and Epidemiology, WHO Regional Office for South East Asia, New Delhi, India.
authors.forename: Gyanendra
authors.initials: G
authors.lastname: Gongal
authors.affiliation: Department of Pathobiology, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, United States of America.
authors.forename: Surendra
authors.initials: S
authors.lastname: Karki
authors.affiliation: Leprosy Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.
authors.forename: Basu Dev
authors.initials: BD
authors.lastname: Pandey
authors.affiliation: Clinical Research Unit, Sukraraj Tropical & Infectious Disease Hospital, Teku, Kathmandu, Nepal.
authors.forename: Sher Bahadur
authors.initials: SB
authors.lastname: Pun
authors.affiliation: Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Duchateau
authors.affiliation: Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.|Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Dorny
authors.affiliation: Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
mesh_terms: D000818:Animals; D004283:Dog Diseases / Q000453:epidemiology / Q000517:prevention & control*; D004285:Dogs; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D011818:Rabies / Q000453:epidemiology* / Q000517:prevention & control / Q000662:veterinary*; D015047:Zoonoses / Q000453:epidemiology / Q000517:prevention & control*