Rabies epidemiology in Ukraine during wartime: a narrative review with insights into viral biology and a regional case study

Abstract

Rabies remains one of the most dangerous zoonotic diseases worldwide, with nearly 60,000 human deaths annually. It is caused by the rabies virus (RABV), a neurotropic RNA virus of the Lyssavirus genus (family Rhabdoviridae). Infection typically begins when the saliva of an infected animal enters a bite wound. Ukraine has long been endemic for rabies, with both wild (especially red foxes) and domestic carnivores serving as reservoirs. Before 2022, coordinated oral rabies vaccination (ORV) programs for wildlife and systematic immunization of domestic animals contributed to a gradual decline in disease incidence. However, the full-scale Russian invasion in February 2022 caused a collapse of veterinary infrastructure, disrupted vaccination logistics, and led to the displacement of millions of people and animals, which reversed much of the progress achieved. As a result, the increase in the stray animal population and the suspension of ORV campaigns led to the uncontrolled spread of the virus among both wild and domestic animals. Between 2022 and 2024, Ukraine reported a more than twofold increase in rabies cases among animals. In the Ivano-Frankivsk region (western Ukraine, a key EU buffer zone), cases doubled in 2024 relative to 2020–2021 despite distance from combat zones; by mid-2025, they matched 2021 pre-war levels. This narrative review synthesizes pre- and wartime epidemiology, integrates insights from viral biology relevant to control challenges, distinguishes wild vs. domestic transmission dynamics using species-specific data, compares the Ivano-Frankivsk case with neighboring western regions, and examines stray-animal dynamics. Restoring biannual ORV, rebuilding laboratories, strengthening cross-border surveillance, and advancing One Health integration are critical to mitigate post-war resurgence.