A dual battle: rabies and snakebite envenoming in South-East Asia

Rabies and snakebite envenoming (SBE) are endemic in most countries in the WHO South-East Asia Region (SEAR), which bears the highest global burdens of both diseases, accounting for more than half of global deaths from rabies and 70% of annual deaths from snakebite envenoming, India bearing a disproportionate share. Despite their high fatality rates, both diseases remain neglected and disproportionately impact marginalized communities, especially in rural, tribal and agrarian settings that lack access to affordable health-care services and advocacy.

The rabies virus is a master of invisibility, as individuals are completely asymptomatic during most of the incubation period. There is no test for diagnosing infection before the virus has started replicating in the central nervous system and clinical signs appear. In contrast, SBE is almost immediately visible, although, even if the snake is killed and brought to a health facility, species identification requires extensive knowledge, and treatment usually relies on symptoms and the availability of high-quality matching antivenom.

For both diseases, a quick response, proper first aid and immediate health care are indispensable. Lack of awareness, social stigmatization, poor transport, myths, misbeliefs and a preference for faith healing and alternative medicine, however, delay timely, life-saving post-exposure prophylaxis (PEP) for rabies and envenoming treatment, resulting in many deaths that could have been prevented.

Sustainable control of rabies and SBE requires a holistic approach across various sectors, with communities at the centre. This includes human, animal and environmental components and broader factors such as housing and access to information and services, in a One Health approach. Development and implementation of effective policies and evidence-based decision-making are, however, limited by the absence of accurate, high-quality data. Surveillance for both diseases is lacking, and cases are often not detected or reported.

This article presents current data on rabies and SBE and on progress, achievements and momentum for controlling and eliminating these diseases in the SEAR.