One Health 10 (2020) 100155

Contents lists available at ScienceDirect

One Health
journal homepage: www.elsevier.com/locate/onehlt

Review of rabies in Nepal T

a,⁎,1 a,⁎,1 a b c
Saurav Pantha , Deepak Subedi , Uddab Poudel , Sanju Subedi , Krishna Kaphle ,
Santosh Dhakald
a
Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Paklihawa, Rupandehi, Nepal
b
Bachelor of Public Health, Chitwan Medical College, Tribhuvan University, Chitwan, Nepal
c
Associate Professor and Director, Veterinary Teaching Hospital, Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Paklihawa,
Rupandehi, Nepal
d
W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States

A R T I C LE I N FO A B S T R A C T

Keywords: Rabies is a global problem, but the burden is higher in less developed or developing countries of Asia and Africa.
Rabies In Nepal, rabies is reported to kill around 500 animals and up to 32 human beings in recent years, with possible
Nepal under-reporting of cases and deaths. As a prophylactic measure, around 30,000 livestock and 300,000 humans
One health get vaccinated each year in Nepal. This review summarizes the past, present and future perspectives of rabies
Dog
control and prevention in Nepal. The global strategic plan of World Health Organization (WHO) aims to bring
Epidemiology
human deaths from dog-transmitted rabies to zero by 2030. To achieve this goal of ‘Zero by 30’, the concerned
governmental and non-governmental agencies in Nepal should work together using the One Health concept.

1. Introduction The government of Nepal along with the concerned authorities and
local bodies with the co-operation of various governmental and non-
Rabies is a fatal viral zoonosis caused by an RNA virus belonging to governmental organizations are working towards decreasing the rabies
the family Rhabdoviridae of genus Lyssavirus [1,2]. This virus can in- cases by mass vaccinations of dogs, animal birth control programs in
fect all the animals of group Mammalia, but dogs have been considered various densely populated areas of the country and awareness genera-
as the major source of infection. 95% of the human cases of rabies are tion campaigns. Despite these efforts, veterinary epidemiological center
due to dog bites but the tally reaches 99% in the endemic regions [3,4]. has reported 6 to 32 human deaths in the last five years in Nepal.
However, a slight proportion of the disease in humans is also reported Similarly, National Vaccine Production Laboratory has also been unable
via wildlife such as foxes, wolves, jackals, mongoose, raccoons, skunks to meet its target goal of rabies vaccine production in the last five years
and bats, especially in developed countries that have successfully con- as reported by the Animal Disease Investigation and Control Division.
trolled domestic cases of rabies [5,6]. The rabies-infected animals Also due to the geographical barriers, the people in hilly regions are less
transmit the virus to other animals and humans via saliva [7]. The in- fortunate in terms of facilities like transportation, education, medicine,
fection is on the central nervous system, primarily brain and spinal cord which leads to a lack of access to awareness campaigns and other rabies
resulting in encephalitis, thus leading to the highest documented case- control-related programs. Owing to such limitations, it is likely that the
fatality rate, nearing 100% [8]. Millions of the death reports have been actual rabies cases are under-represented in Nepal. This paper describes
on evidence since its introduction in 4000 BCE [9]. The incidence of the current situation of the dog borne rabies in Nepal, associated
rabies in the world is decreasing due to the development of pre- and campaigns and collaborations to minimize the risks and prospects of
post-prophylactic vaccines [10]. The disease has been eliminated in rabies control and prevention.
many countries due to strong control measures. Although many ne-
cessary measures are being undertaken to control and eradicate rabies, 2. History, causative agent and transmission of rabies
the virus is still prevailing worldwide and causing substantial health
and economic burden in the developing countries, mainly in Africa and Rabies, from the Latin word ‘rabere’ meaning “the rage,” has terri-
Asia [11]. fied mankind since antiquity [2,12]. The incidence in the world goes

⁎
Corresponding authors.
E-mail addresses: [email protected] (S. Pantha), [email protected] (D. Subedi).
1
Authors have equal contribution.

https://doi.org/10.1016/j.onehlt.2020.100155
Received 20 April 2020; Received in revised form 5 July 2020; Accepted 7 July 2020
Available online 03 August 2020
2352-7714/ © 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
S. Pantha, et al. One Health 10 (2020) 100155

back more than two millennia. Rabies has also been mentioned in compulsory vaccination of dogs and provision of good access to post-
Mesopotamian laws of Eshnunna that is dated around 2200 BCE [13]. exposure prophylaxis for human beings [20]. European Union en-
Likewise, Aristotle (384 BCE–322 BCE), a Greek Philosopher, has re- countered nine cases from the year 2011 and the origin was from a
ferenced rabies as ‘madness of the dog’ in ‘History of animals’. Con- visitor to endemic regions, the maximum number of cases was in the
sidering the present time, an Italian physician Girolamo Fracastoro year 2014 with 3 rabies cases [37–39]. Dog-mediated rabies has been
discovered rabies a fatal disease in the 16th century, calling it “an in- eliminated from Western Europe, Canada, the United States of America,
curable wound” [14,15]. The incidence of rabies in the Asian sub- Japan and some Latin American countries [22]. Australia and many
continent is assumed to be reported from the Vedic Period (1500- Pacific island nations have always been free from dog-mediated rabies
500 BCE) [16]. Similarly, Chinese and Indians described rabies as hy- [3].
drophobia in 500 BCE and 100 BCE respectively [15]. Only at the start
of the 19th-century rabies epizootics associated with the dogs were 4. Situation of rabies in Asia
reported [17]. Zinke, in 1804 CE, proved the fact that the causative
agent of rabies is associated with the saliva of rabid animals whereas World Health Organization (WHO) has named eleven members in
Galtier experimented in rabbits to support this conclusion [15]. Simi- its South East Asia (SEA) region (Bangladesh, Bhutan, Democratic
larly, it was in 1821, Magendie and Breschet concluded that the cau- People's Republic of Korea, India, Indonesia, Maldives, Myanmar,
sative agent is identical for both humans and animals [18]. The first Nepal, Sri Lanka, Thailand and Timor-Leste) and among them, eight of
vaccine of rabies was discovered by Louis Pasteur after he successfully the countries are endemic to rabies with more than 1 billion people
cured a rabid dog bitten boy, Joseph Meister, in July 1885 [2,19]. being at risk of the disease (Table 1) [26]. Each year more than 3.8
Rabies is caused by Lyssavirus belonging to the family million people in the SEA region receive post-exposure vaccines after
Rhabdoviridae which are enveloped viruses having single-stranded, being exposed to animals [3]. In India, more than 15,000 people die
negative-sense RNA genome of approximately 12 kilobytes size each year due to rabies infection [40] and there is one Indian death out
[1,2,20]. The genus, Lyssa, comes from the Greek goddess Lyssa, the 11 of every five global deaths due to rabies [41]. The number of patients
spirits of madness, frenzy, and rage [2,21]. Meanwhile, rabies on itself who receive the post-exposure vaccination each year in India is over 1
is derived from Latin term rabere that implies madness and raving million [42].
[2,22]. In Sanskrit, the word rabies is derived from an ancient word In Thailand, the number of dog bites each year is around 400,000
rabhas that implies ‘to create violence’ [23,24]. and the human deaths are less than 25 in number [26]. Until mid-Oc-
Dogs are responsible for the spread of rabies, which is true in 95% of tober 17 human deaths were reported in Thailand in 2018 [44]. About
the cases in regions like Asia and Africa [25]. Dogs alone are re- 54% (13,088/24332) dogs were found to be positive for the disease
sponsible for 99% of disease transmission in rabies endemic regions from the year 1987 to 1996 in Thailand [45]. In Vietnam, more than
[3,4]. But in nature, the transmission and maintenance of rabies occur 350,000 people per year were bitten by dogs and cats, on average,
in two interrelated cycles: the urban cycle, which involves domesticated while more than 80 human deaths have been reported yearly [46],
and stray dogs; and a sylvatic cycle, that involves wildlife like foxes, whereas 362 cases of human rabies were reported from 2007 to 2010
wolves, jackals, mongoose, raccoons, skunks and bats [26,27]. In South [47]. A total of 809 fatal human rabies cases were reported in
East Asian countries like Bangladesh, India, and Nepal, dogs are the Chongqing, China from 2007 to 2016. Approximately 3200 human
major reservoir host whereas wolves (Canis lupus), jackals (Canis deaths were reported from rabies in the year 2006 in China. In 1998, 5
aureus) and foxes (Vulpes bengalensis) are described as the wildlife re- million people and 130 million dogs were given post-exposure pro-
servoirs [26]. Rabies is mainly transmitted through the bite of the rabid phylaxis in China [48]. Even though these countries have progressed
animals [22,28], but in rare instances, the lick by the rabid animals into with development, dog-meat eating behavior has likely increased the
an open wound may also transmit the virus [15,22]. Very rarely, the dog bite incidence. Although the transmission through meat ingestion is
virus transmission by the organ transplant has also been reported not recorded but the bites during handling of the dogs while slaugh-
[22,29,30]. The bodily fluids like tears and nervous tissues can also tering may be the cause.
possibly transmit the disease but the virus is not reported in feces or In Bhutan, rabies was prevalent until 1990 but from the year 1996
blood [31]. Oral transmission of the disease, transmission through to 2009, 814 rabies cases (cattle 55% and dog 39%) were reported [43].
abrasions in the oral mucosa and transplacental transmission have also Around 2000–2500 rabies cases were encountered in Bangladesh yearly
been experimentally recorded [32]. Transmission through the con- with estimated dog bite of 300,000 [26] and around 50% of people did
sumption of milk and cooked meat has not been reported to date but the not get vaccinations and health care recommendations [49]. The reason
consumption of milk and meat from rabid animals is discouraged [31]. may be due to a lack of understanding about the disease and severity.
Few cases of aerosol transmission of the disease have also been reported The Maldives has always been free of rabies because it is an island so
previously [33]. the transmission of the virus through the oceans has been really difficult
[34].
3. Global situation of rabies
5. Situation of rabies in Nepal
Around 59,000 human deaths are estimated every year across the
world due to rabies, out of which 45% prevails in South Asian Nepal is a landlocked country which is surrounded from the South,
Association for Regional Cooperation (SAARC) countries [34] and the East, and West direction by India, the country carrying the heaviest
remaining deaths occur mainly in Africa, middle east and central Asia. rabies burden. Due to the open border, the eradication of the disease
Rabies is a major burden in Asia, mostly in the rural and under- has been difficult. Nepal used to have a high rate of human rabies
privileged regions, with an estimated over 35,000 human deaths per deaths per total population in the 1970s as compared to other countries
year (Fig. 1) [3]. India alone accounts for nearly 60% of rabies deaths in across the globe [43]. This has been reduced in recent years but there
Asia and 35% of deaths globally [3,35]. Likewise, over 20,000 deaths are several cases which do not get reported. Rabies can be transmitted
occur each year in Africa due to dog-mediated rabies [36]. in humans by domesticated and stray dogs (urban cycle) as well as some
The other reports are from Central Asia and the middle east which wild animals like foxes, raccoons, and bats (sylvatic cycle). The in-
indicate hundreds of deaths per year due to rabies [3]. Many European cidence of the urban cycle of rabies transmission is considerably higher
countries and countries in North and South America like Belize, Co- as compared to the sylvatic [26].
lombia, Costa Rica, Chile, Ecuador, Panama, Paraguay, and Uruguay The first attempt to carry out a dog census in Nepal was carried out
have already eliminated rabies as a public health problem through by National Zoonoses and Food Hygiene Research Center (NZFHRC) in

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S. Pantha, et al. One Health 10 (2020) 100155

Fig. 1. Burden of rabies around the world in 2017. A: Number of deaths per year, B: Deaths per 100,000 population [3].

Table 1 metropolitan, then sub-metropolitan had an estimated 8000 dog po-

Estimation of human rabies cases in South East Asian region (data as of 2011) pulation in 2008 which increased exponentially reaching 20,000 in
[26]. 2014 [57]. Despite the progress made lately in terms of anti-rabies
Countries Estimated number of human rabies cases vaccination and population birth control, owing to the continuous ef-
forts of educational and animal welfare organizations, the stray dogs'
India 18,000–20,000 number is still considerable in Nepal.
Pakistan 2000–5000
In the last five years, around 20,000 to 40,000 animal bites were
Afghanistan 2000–3000
Bangladesh 2000–2500 reported in Nepal (Fig. 2). The highest number of animal bites was
Myanmar 1000 reported in year 2016/17 while the lowest (20,610) number of animal
Indonesia 150–300 bites was reported in year 2014/15. Irrespective of the total number of
Nepal < 100 animal bites, dogs were responsible for more than 90% of the bites each
Sri Lanka < 60
Thailand < 25
year. According to the reports from Sukraraj Tropical and Infectious
Bhutan < 10 Disease Hospital, 150 people visit the hospital each day to receive anti-
rabies vaccination, out of which 30 visits are at night [63]. The sta-
tistics are appalling considering the efforts and finance invested every
1998, where they estimated the number of dog populations in Nepal to year to reduce the incidence. The urbanization in the major cities like
be nearly 2 million which was 1 dog per 10 human population [50]. Kathmandu, Pokhara, Bharatpur, Butwal, and Biratnagar has increased
Similarly, in the country capital, Kathmandu, the number of stray dogs the number of stray dogs as it offers greater food opportunities for dogs
was estimated 170,000 in 1997 [51]. In a similar survey, the stray dog which in turn increases the human-dog interactions. Children are more
population was found to be more than 22,000 in 2012 (5.18 dogs per susceptible to dog bites because of their high acquaintance with new-
hector) showing a decreasing trend compared to 30,000 in 2006 but the born pups while pedestrians also become the victim of stray dog bites.
number was still alarming [52]. In 2016, this number increased to In four years (2014–2017), eight districts of Nepal (Kanchanpur,
around 30,000 indicating that the stray dog population was highly Dailekh, Jajarkot, Chitwan, Dhading, Ramechhap, Siraha, and Morang)
fluctuating [53]. Around 1700 stray dogs were present inside Pokhara had more than 10 rabies outbreaks. Similarly, 4 districts (Jhapa, Siraha,
valley [52,54]. The dog census in Lalitpur, sponsored by French non- Sindhuli, and Surkhet) had more than 10 rabies outbreaks in the year
profit organization in 1989, reported the dog population to be 10,375 2018 [64]. The Year 2014 and 2017 had an equal number of 73 out-
[55], which was reduced to 2793 in the year 2015 [56]. Biratnagar breaks. The cumulative data of 2014 to 2017 indicated that a large

3
S. Pantha, et al. One Health 10 (2020) 100155

Fig. 2. The number of animal bites, dog bites and human deaths due to rabies in different fiscal years (2013/14–2017/18) in Nepal [58–62].

Fig. 3. Month wise rabies outbreak and animal deaths from the year 2014–2017. The outbreaks and deaths of each month during four subsequent years are combined
[64].

number of outbreaks occurred during the month of January (47), province 5, Rupandehi district, where lies the provincial capital and
February (31), March (29) and September (29) while the highest second-largest Nepal-India border has the maximum reported animal
number of animal deaths occurred during April (116), January (107), deaths due to rabies, followed by Kapilvastu (16 deaths) and Gulmi
September (84) and February (81) (Fig. 3). district (15 deaths). None of the infected cases in the country could be
The year 2018 showed an abrupt increase in the rabies outbreak treated but vaccinations of 30,076 animals were conducted in the
reaching to a total of 159 outbreaks (Fig. 4). As mentioned in the meantime. Similarly, 49, 48, 45 and 27 animal deaths were reported in
quarterly bulletin of Veterinary Epidemiology Centre, Province 5 had Bagmati province, Gandaki province, Sudurpaschim province and
the highest number of animal deaths (98) followed by Karnali province Province 2 respectively (Fig. 4). Maximum deaths from outbreaks in
(88) and province 1 (72) (Fig. 4). Province 5 is connected to the largest 2018 occurred in Surkhet (48), Jhapa (30), and Siraha (26) districts of
rabies bearing nation in the world, India, and shares an open border. Nepal [65].
Some districts under this province belong to the less fortunate areas in The risk of human rabies has been maximum in densely populated
terms of medical and educational facilities which can also be a factor areas of Terai, inner Terai and mid-hills of Nepal [66]. On a monthly
contributing to the high number of rabies associated animal deaths. In basis, the highest number of deaths were recorded in the winter seasons

4
S. Pantha, et al. One Health 10 (2020) 100155

Fig. 4. Animal rabies outbreaks and fatalities in different provinces of Nepal from January – December 2018 [65].

like January to April whereas the least from July to August. The 2019.
breeding season plays an important role in the outbreaks. In Nepal, Various organizations in both the national and international levels
dogs breed majorly in the October. With the gestation period of two have been actively participating in the dog mediated rabies elimination
months, the pups are born in cold seasons like January to March which in Nepal. For example, NZFHRC, an organization actively working in
consequently increases the number of animal fatalities due to rabies. the field of animal health since the 1980s, successfully vaccinated over
The densely populated Terai region offers better feeding opportunities 18,000 dogs and cats in 8 years from 2000 CE [74]. In 2007, with the
for the stray dogs, which in turn helps in survival and procreation re- support of WHO, a workshop was conducted with an aim to control
sulting in the increment of the stray dog population. Likewise, in the rabies by 2012 and eliminate rabies by 2027 [50]. Alliance Group for
less developed areas of the hilly region surrounded by the dense forests, Rabies control in Nepal was established in 2008 which included various
where animal domestication is the main sources of income, wild ca- institutions working in the field of disease control. Since its establish-
nines hunt the domesticated animals resulting in a large number of ment, the alliance has been actively participating in the vaccination of
rabies outbreaks and animal deaths. over 10,000 community and stray dogs [75]. Sneha's care is an orga-
nization that has been actively working in the field of stray dogs'
management, their treatment, health checkup, and sanitation. Due to
6. Programs undertaken for rabies control, prevention and
their vaccination programs, the number of infected stray dogs have
elimination in Nepal
been greatly reduced in recent years. In the same way, Kathmandu
Animal Treatment (KAT) Centre is significantly contributing to neu-
The treatment of 9 years old Joseph Meister, suffering from rabies,
tering dogs and also has been providing anti-rabies vaccination for dogs
by French biologist Louis Pasteur in 1885 brought a revolution in the
since 2004. KAT Centre has vaccinated over 37,000 street dogs against
efficacious measure to control rabies [19,67]. Despite the fact rabies
rabies to date and sterilized over 23,000 dogs [76]. Himalayan Animal
having 100% case fatality rate, the disease is entirely preventable by
Rescue Trust (HART) is another leading organization working in the
the application of pre- and post-prophylactic vaccinations [68,69]. The
field of dog health and management. They focus on dog population
mass vaccinations of the dogs have resulted in massive declination of
census, mass anti-rabies vaccination, sterilization, and public awareness
the disease in many countries of Europe. Rabies has been eradicated
generation. The other contributing organizations are, Animal Welfare
from several countries of Latin America and Europe, courtesy of the
Society, Animal Nepal, Institute of Agriculture and Animal Sciences
successful mass vaccinations during the past [20]. Rabies control pro-
(IAAS) and Agriculture and Forestry University (AFU). Various animal
gram in Nepal has been first referenced by Bahmanyar [50]. Although
health camps for canine and free anti-rabies vaccination campaigns are
the first committee for rabies elimination was established in 1979, the
organized by educational institutions including IAAS and AFU. IAAS,
first program was undertaken after 4 years, in 1983, with the support of
Paklihawa campus has also been providing free neutering services to
Department of Livestock Development and Animal Health. This led to
decrease the number of stray dogs in Rupandehi district. Various ve-
the vaccination of over 22,000 pet dogs in Kathmandu valley and over
terinary hospitals at local levels under Nepal government have also
14,000 dogs in other districts of Nepal through different veterinary
been providing free rabies vaccinations for both stray and pet dogs.
hospitals [70]. In Nepal, the first anti- rabies vaccine (ARV) production
Global Alliance for Rabies Control has also been actively participating
initiated in 1970 by Rabies Vaccine Production Laboratory (RVPL) [71]
in the rabies control programs in Nepal. The organization also initiated
and the collections and distributions were handled by the regional la-
the celebration of World Rabies Day in 2007. Free dog vaccination and
boratories. The vaccines were nerve tissue origin in the initial phases.
awareness campaigns are held across the nation on September 28th
The phenolized 5% and 5% beta propiolactone inactivated vaccines
each year to celebrate World Rabies day. World Organization for An-
phased out in 2004 and 2006 respectively following the WHO re-
imal Health (OIE) has been helping Nepal in this regard and had do-
commendation [73]. RVPL in association with Japan International
nated 200,000 vials of ARV in 2012 [50]. Rabies in Asia Foundation
Cooperation Agency (JICA) released the first batch of cell culture ARV,
held a conference in 2008 focusing several measures to eliminate rabies
NeJa Rab (trade name of the vaccine), for animal use in June 2006
from Nepal. Several new initiatives for rabies control from international
[72]. National Vaccine Production Laboratory (NVPL), earlier known as
agencies like WHO have also been started. WHO Regional Office for
RVPL, produced 120,000 doses of rabies vaccine in Nepal in the year

5
S. Pantha, et al. One Health 10 (2020) 100155

Fig. 5. Number of vials of anti-rabies vaccines consumed per year by humans in Nepal [58–62].

South East Asia, SAARC and Rabies in Asia Foundation have various Nepal, domestic vaccine production should be increased. Likewise,
initiatives that are currently in practice in Nepal. Nepal fully depends upon the import of both pre- and post-exposure
In humans, the uptake of anti-rabies vaccine ranged from around prophylaxis vaccines for human use, which are made available freely on
150,000 to 320,000 from 2008/9 to 2017/18 (Fig. 5). In order to buy several public hospitals of Nepal [34,50]. This may cost more than a
anti-rabies vaccines for the fiscal year 2018/19, Government of Nepal million USD which is a significantly high amount for a nation of this
had allocated around 1 million USD. Nepal bought anti-rabies vaccines stature and hence vaccine production through government laboratory
worth 70,000 USD in the previous fiscal year alone reported by the within the country should be initiated for human use. Nepal is a part of
Epidemiology and Disease Control Division (EDCD) [77]. Despite in- ‘united against rabies collaboration’ formed by WHO, FAO, OIE and
vesting the heavy sum of money, time, and efforts by the government GARC in 2015, which has a goal to end dog-mediated rabies by 2030
and the stakeholders, the rabies cases have not yet decreased as ex- worldwide: ‘Zero by 30’. To achieve this goal, the different govern-
pected. Kathmandu metropolitan city (KMC) had allocated a budget of mental and non-governmental agencies should collaborate and work
around 35,000 USD to manage the stray dogs' population in the fiscal jointly so that available resources will be utilized rationally. Programs
year 2015/16 and had the plan to eliminate all the stray dogs' popu- like mass dog vaccination campaigns should be launched under one
lations in the upcoming 3 to 4 years [78]. The plan execution and the umbrella. Rural areas, which in general lack education, transportation,
efforts turned out to be ineffective as more than 20,000 stray dogs still and medical facilities, should also be prioritized by the agencies
wandered the streets of the metropolitan city in the year 2019 [79] working in rabies control. The healthcare facilities in the rural areas
Different concerned authorities are contributing at their level to de- should be equipped with the manpower and equipment required for the
crease the cases so that Nepal can achieve zero rabies cases by 2030. diagnosis and prevention of rabies in human as well as animal health
sectors. In order to control the possible introduction of rabid animals
from the open Indian border, proper quarantine is necessary. Adoption
7. Future perspectives for rabies control, prevention and of stray dogs, together with birth control and rabies vaccination, should
elimination from Nepal be encouraged among the public to solve the issue of street dogs. Stray
dog population can also be controlled by the establishment of proper
Despite several attempts in the past decades to eliminate rabies, this waste management facilities. Rabies is a common problem of animal
disease still prevails in Nepal. The stray dog population is still large in and human health sectors. Therefore, short and long-term strategies of
major cities of the country; pet dogs are also abandoned once they lose rabies control should be formulated following the One Health (OH)
the aesthetic value or after they acquire some diseases; contact between approach.
pet dogs and stray dogs occurs frequently increasing the chance of bite At present, the leading departments of human and animal health
and virus transmission, and the rabid animals can be introduced sectors, Department of Health Services (DHS) and Department of
through Indian side due to open borders. All these reasons contribute to Livestock Services (DLS) have their sectoral priorities where OH ap-
the persistence of animal rabies in Nepal. There is also a lack of har- proach has been overlooked or not properly implemented.
mony and collaboration between various organizations working in ra- Establishment of a separate OH organizational framework involving the
bies control [77]. The ongoing rabies control programs mostly focus on representatives from the aforementioned departments can create a
the urban and developed areas but the rural and less developed areas, common platform for rabies surveillance, resource utilization, and de-
which contribute to the significant number of animal bites and rabies velopment and implementation of effective rabies control programs
cases in Nepal, are still neglected [50]. Moreover, there are limited [80]. Despite the initiation of various OH approaches in the past in-
number of laboratories, only in the major cities, for the proper diagnosis cluding development of tissue culture rabies vaccine for human use in
of the disease leading to inadequate reporting and ineffective surveil- 2010 by NVPL under the DLS [81]; World Bank funded ‘zoonoses
lance of rabies from rural areas [43]. control project’ (2012–2014) [82]; and establishment of OH hubs in the
Vaccination is the key to decrease the number of rabies in animals 75 districts of Nepal under One Health Network South Asia im-
and humans. NVPL produced 120,000 doses of vaccines in Nepal in the plemented by Massey University (2013) [83]; the outcomes did not
year 2019. Considering the number of streets and domesticated dogs in

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