Rabies and emerging infections: a one health review of the oldest zoonosis in an age of new spillovers

On 6 July 1885, Louis Pasteur administered the first rabies vaccine to a bitten child, a moment now commemorated annually as World Zoonoses Day. Almost a century and a half later, rabies endures as the most lethal zoonosis known to medicine, claiming an estimated fifty-nine thousand human lives every year despite being entirely vaccine-preventable. This review uses rabies as a lens through which to examine the broader landscape of emerging and re-emerging infections that arise at the animal–human–environment interface. We trace the biology of the rabies virus and its relatives within the genus Lyssavirus, the mechanisms by which the virus invades the nervous system, and the clinical and laboratory features that define the disease. We then summarise the global and Indian burden, the modern pillars of prevention—wound care, post-exposure prophylaxis, mass dog vaccination, the emerging use of oral vaccines and integrated surveillance—and the World Health Organization’s “Zero by 30” goal that India has adopted through its National Action Plan for Dog Mediated Rabies Elimination. Turning outward, we ask why the majority of newly emerging human pathogens originate in animals, and we consider the ecological and socio-economic drivers of spillover through detailed examples including highly pathogenic avian influenza H5N1, Nipah virus, SARS-CoV-2 and mpox. Throughout, we argue that the One Health framework is the connective tissue linking the elimination of an ancient disease to preparedness for novel outbreaks, and that veterinarians, positioned at this interface, are indispensable to both endeavours.