Rabies in Ukraine: Pathogenesis, diagnostics, and epidemiological trends in the Lviv region

Rabies is an acute infectious zoonotic disease caused by the neurotropic Rabies virus (RABV), a member of the Lyssavirus genus. This review focuses on the pathogenesis, diagnostics, and epidemiological trends of rabies, with a particular emphasis on the Lviv region of Ukraine. The RABV exhibits remarkable pathogenicity, driven by its structural and functional genomic characteristics, immune evasion strategies, and ability to persist in diverse ecological conditions. Rabies pathogenesis involves local replication in muscle cells, followed by retrograde axonal transport to the central nervous system, leading to severe neurological symptoms and inevitable fatality without timely intervention. Domestic dogs (Canis lupus familiaris) remain the primary global reservoir of rabies, responsible for over 99% of human cases, particularly in resource-limited regions. In Ukraine, domestic dogs and cats (Felis catus), alongside wildlife such as red foxes (Vulpes vulpes) contribute significantly to the disease's epidemiology. Epidemiological data from the Lviv region between 2021 and 2024 indicate a sharp rise in rabies cases, with infections increasing fivefold over the study period. The ongoing large-scale war of russia against Ukraine has exacerbated the situation by disrupting vaccination campaigns and veterinary services, further amplifying the spread of the virus among wild and domestic animals. Molecular diagnostics, including DFA test, PCR, and vaccination programs targeting wildlife and domestic animals are critical for rabies control. This review highlights the need for integrated strategies, including vaccination, surveillance, wildlife population management, and public education, to mitigate rabies transmission. The findings underscore the importance of collaborative efforts to address the escalating challenges of rabies in the Lviv region and provide a foundation for future preventive measures in Ukraine and beyond.