CNS INFECTIONS: Edited by Matthijs C. BrouwerRabies: changing prophylaxis and new insights in pathophysiologyUgolini, Gabriellaa; Hemachudha, ThiravatbAuthor Information aParis-Saclay Institute of Neuroscience (UMR9197) CNRS - Université Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette, France bThai Red Cross Society Emerging Infectious Disease Health Science Centre and World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Correspondence to Dr Gabriella Ugolini, MD, PhD, Paris-Saclay Institute of Neuroscience (UMR9197) CNRS - Université Paris-Sud, Université Paris-Saclay, Bat 32 CNRS, 1 av de la Terrasse, 91198 Gif-sur-Yvette, France. Tel: +33 1 69824158; e-mail: [email protected] Current Opinion in Infectious Diseases: February 2018 - Volume 31 - Issue 1 - p 93-101 doi: 10.1097/QCO.0000000000000420 Buy Metrics Abstract Purpose of review Despite great progress in decoding disease mechanisms, rabies remains one of the leading causes of human death worldwide. Towards the elimination of human rabies deaths by 2030, feasible and affordable post (PEP) and pre-exposure prophylaxis (PrEP) must be available with expansion to rural areas in rabies endemic countries. Vaccination and population control of dogs, principal reservoirs and transmitters, must be done in concert. Recent finding Advances in the understanding of rabies neuropathogenesis and pathophysiology are reviewed, including recent experimental findings on host- and virus-specific mechanisms mediating neuronal survival and explaining clinical differences in furious and paralytic rabies. The forthcoming World Health Organization guide on rabies based on pathogenesis and immunization mechanisms data with support by clinical evidence provide new accelerated 1 week intradermal PrEP and PEP schedules. Rabies immunoglobulin injected into the wound only is endorsed at amounts not exceeding the dose interfering with active immunization. Potential therapeutics as designed in accord with rabies neuro-pathophysiology are plausible. Summary Clinical practice and rabies awareness can be leveraged by transboundary collaboration among different areas. Advancement in prophylaxis and perspectives on animal control offer a new path to conquer rabies by 2030. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.