The rabies situation in the Middle East.

Rabies is a public health problem of significant importance in the majority of Southern and Eastern Mediterranean and Middle Eastern countries. In some of these countries, there is a considerable death rate due to rabies. Dogs are the main source of human infection, while cats constitute the second most important group of domestic animals followed by cattle, sheep, goats, camels, donkeys and then wild animals. There are around 300 reported human cases in these regions annually, with several hundred thousand post-exposure treatments. Laboratory confirmation of rabies cases is not always performed. In most countries, there is one central rabies diagnosis laboratory with trained staff and the diagnosis capability of district laboratories is weak. Animal rabies control consists of the vaccination of dogs and cats, the elimination of stray animals, health education for the public, etc. Mass vaccination of dogs is not implemented, and the effective coverage rate is not exactly known. The elimination of stray dogs and other animals by shooting and poisoning is still implemented in certain countries, however, this has a minimal effect on rabies transmission. Certain countries of the Middle East region are facing increasing problems due to wildlife rabies, including Saudi Arabia, Oman, Yemen, Israel, Iran and Turkey. The red fox (Vulpes vulpes) and golden jackal (Canis aureus) are usually involved. Coordinated actions to confront the serious rabies public health and economic problems should be undertaken by affected countries, with the assistance of international organisations, under conditions that are suitable for each country.