Rabies is a neglected disease, disproportionately affecting impoverished communities in Africa and Asia, despite the availability of effective vaccines for both animals and humans for over a century. Domestic dogs are the primary reservoirs of the rabies virus in these regions. Unfortunately, concerted efforts to control rabies among dog populations have been lacking in many countries in Asia and Africa. As a result, each year, tens of thousands of human lives in lower- and middle-income countries (LMICs) are lost to dog-mediated rabies. India, in particular, grapples with an alarming estimate of 17.4 million dog-bite cases annually [1].
Human rabies prevention in India has encountered significant hurdles, primarily stemming from limited knowledge about proper postexposure prophylaxis (PEP) and inconsistent access to rabies biologics [2,3]. Regrettably, the lack of readily available guidance on the clinical management of human rabies condemns individuals to endure excruciating suffering, ultimately culminating in a tragic and inevitable loss of life [4].
The prompt administration of appropriate PEP following a dog bite is critical to prevent rabies [5]. However, many healthcare workers in low- and middle-income countries (LMICs) often lack the necessary knowledge about proper PEP [2]. Additionally, rabies biologics, such as the rabies vaccine (RV), rabies immune globulin (RIG), and Rabies Human Monoclonal antibody (mAb) used in PEP are frequently scarce in developing regions, particularly in Africa and Asia [6,7].
Typically, dog-bite patients or their caregivers, often residing in remote rural areas, must embark on arduous journeys to acquire these biologics for PEP, resulting in delays or even the inability to receive treatment. In addition to promoting public awareness about dog bite prevention and proper medical care after such incidents, there is a pressing need for a mechanism to track the real-time availability of PEP products.
To address these challenges, we have created an online web application called ZeroRabiesAPP (ZRA), utilizing the Shiny package in R software. ZRA has been designed as an interactive point-of-care tool for bite-management, granting users access to the latest guidelines developed by the World Health Organization (https://www.who.int/news-room/fact-sheets/detail/rabies) and the U.S. Advisory Committee on Immunization Practices (https://www.cdc.gov/rabies/medical_care/vaccine.html).
Furthermore, the ZRA can generate a customized PEP schedule based on the user-provided bite date (day of exposure), as illustrated in Figure 1. This customized PEP schedule can then be saved as a snapshot (if accessed on a smartphone) or printed (if accessed on a computer) for sharing with a healthcare provider. The PEP schedule generated by the ZRA eliminates any uncertainty regarding the timing of rabies biologics administration.