Rabies in Sierra Leone: A Review of the Epidemiology, Public Health Burden, Control, and Challenges

Abstract

Rabies is a preventable yet fatal zoonotic disease that remains endemic in Sierra Leone. Despite the availability of effective vaccines, dog-mediated rabies continues to pose a major public health threat, largely due to poor knowledge in domestic animal management, low canine vaccination coverage, weak surveillance systems, and limited access to post-exposure prophylaxis (PEP). This review synthesises available evidence on the epidemiology of rabies and its implications for public health and animal health in Sierra Leone, focusing on transmission dynamics, dog ecology, vaccination coverage, and laboratory surveillance. Historical and contemporary data indicate that the rabies virus circulates within the canine population, as reflected by high antigen detection rates in suspected dogs and the presence of rabies antibodies in apparently healthy, unvaccinated animals. Human rabies remains endemic, driven primarily by frequent rabid dog bites, delayed health-seeking behaviour, reliance on traditional wound management practices, and structural barriers to PEP access. Rabies surveillance is largely dog bite-based, with diagnostic capacity centralised at the national level, resulting in under-reporting and delayed confirmation of cases. Although One Health initiatives and periodic vaccination campaigns have been implemented, these efforts remain unsustainably fragmented and insufficient to interrupt transmission. Achieving the global target of zero dog-mediated human rabies deaths by 2030 will require robust and sustained mass dog vaccination, decentralised diagnostics, improved access to PEP, strengthened surveillance, and integrated One Health strategies tailored to the Sierra Leonean context.

Keywords: Rabies; Sierra Leone; Dog-mediated rabies; Zoonoses; Vaccination