**5. Prevention**

Due to the general ineffectiveness of post-exposure treatment, the rabies virus has a remarkably high mortality rate despite the availability of vaccines that have shown a near perfect success rate when administered prior to infection. This indicates that the main issue with prevention is the lack of accessibility in the impoverished countries of Asia and Africa. In 2015, the World Health Organization (WHO) and the World Organization for Animal Health (OIE) with the help of the Food and Agriculture Organization of the United Nations (FAO) set a goal to rid the world of dog-mediated rabies by 2030 (Zero by 30) [65]. After assessing cost and general accessibility, it was decided that the best way to eliminate dog-mediated rabies is to vaccinate dogs rather than humans. Vaccinating at least 70% of dogs should effectively break the cycle of rabies transmission.

To reach this goal, WHO, OIE, FAO and many smaller agencies collaborated to create the Stepwise Approach towards Rabies Elimination (SARE) [66, 67]. A similar stepwise approach proved successful in the elimination of fox RABV from Europe [68]. SARE consists of five stages for each country to work through. Stage 0 is simply the lack of information and data on RABV cases in a country where rabies is believed to be present. Stage 1 is an assessment phase in which data are gathered to determine the extent to which RABV pervades the country of interest. During this phase, the government assesses the current guidelines or structures in place as well as collects and analyzes all available data on previous or existing RABV cases. The beginning of an action plan is usually concocted in Stage 1. Evolution of this plan happens in Stage 2; it is important to develop an understanding of the available funding at this point as that has been the biggest limitation for developing countries in the past. Stage 3 is the implementation of the country's rabies control strategy. During this phase, the plan will likely need to be adapted to address any challenges that arise; these may include the exposure of wildlife reservoirs of RABV such as the fox rabies previously found in Europe. When reported human cases have decreased to zero, the country will shift into Stage 4 – elimination of dog RABV. This requires the maintenance of the reduced dog-to-human rabies transmission

#### *The Diagnosis, Clinical Course, Treatment, and Prevention of the Rabies Virus DOI: http://dx.doi.org/10.5772/intechopen.97691*

as well as continued implementation of the action plan to continue to reduce dog rabies cases. Lastly, in Stage 5, the country must develop a post-elimination strategy to maintain the freedom from human and dog rabies.

While the SARE tool has been developed to be adaptable enough to succeed worldwide, there are likely to be some setbacks in the different landscapes. Specifically, areas of poverty will be constrained by the financial resources they can acquire. Many parts of Asia have political instability that will greatly challenge the need for nation-wide commitment to this goal. Similarly, Africa's linguistic and cultural complexity will oppose the need for excellent communication and tracking [66]. Ultimately, it will take a dedicated and educated global population to eliminate rabies as a whole; until then, vaccinating animals and at-risk populations is the most efficient means of prevention.
