Notes on three periods of rabies focus in the Middle East: from progress during the cradle of civilization to neglected current history.
Rabies is a historical scourge as well as one of the most neglected infectious diseases. While the developed world has rolled back dog-mediated human rabies, thanks to social interventions and modern rabies vaccines, African and Asian countries still struggle with a significant burden due to this viral zoonosis. The Middle East, which includes both Asian and African countries, still has localities in which dog-mediated rabies remains endemic although it is the region that first documented rabies historically. The oldest putative record of this fatal encephalitis may date back at least 4,000 years and is believed to originate from ancient Mesopotamia. In this historical review, we describe rabies through three major time periods (ancient, the Islamic Golden Age and more recent history) of the Middle East. Inarguably, the Middle East experienced great medical development during the Islamic Golden Age. Proof of early rabies prevention, control and proposed treatment strategies existed which we only perceive anew via modern science. Such rabies strategies were neglected severely due in no small part to the influence of Middle Eastern rulers, who steered scholars away from this field to a broader toxicological focus, because they feared assassination from poisoning. Such setbacks are coupled with constant social and political unrest and continuous wars in the Middle East to modern times. This situation leads to an inconstancy in rabies surveillance and reporting of data, neglect of prevention and control strategies, and subsequently a devolvement of rabies management strategies in this unstable region of the world.