Resurgence of multistate rabies amid ongoing conflict in Sudan: Strengthening a One Health response

Objectives: The ongoing-armed conflict in Sudan has precipitated a resurgence of multistate rabies outbreaks, alongside other infectious diseases, due to destruction of health care infrastructure and increased population displacement. Rabies remains a critical public health threat, primarily transmitted through dog bites, with significant mortality in affected regions. Methods: This retrospective cross-sectional study analyzed national surveillance data from Sudan between 2023 and 2024. Variables included case counts, fatalities, vaccination coverage, and case fatality rates across six states. Data were obtained from the National Surveillance Interactive Dashboard, and analyses were conducted using R software. Results: A total of 367 rabies cases and six deaths were reported, predominantly in Khartoum (329 cases), with an overall case fatality rate of 1.6 %. The current control measure score remains low (1.5 of 5 on the Stepwise Approach towards Rabies Elimination framework), indicating critical gaps in national rabies management strategies. Notably, the proliferation of stray dogs and limited access to post-exposure prophylaxis have exacerbated the outbreak. Conclusions: The resurgence underscores an urgent need to strengthen rabies prevention, detection, and response strategies in Sudan. An effective control approach requires an integrated One Health framework, fostering collaboration among human health, animal health, and environmental sectors. International support for vaccine and immunoglobulin provision, capacity building of health care providers, and enhanced surveillance are crucial. Implementing a comprehensive rabies control plan aligned with global elimination efforts is vital to prevent future outbreaks, protect public and animal health, and inform policy interventions in conflict-affected settings.