Animal Rabies in Kazakhstan: Stable Endemicity, Surveillance Pitfalls, and Priority Actions.

Rabies is endemic in Kazakhstan, with the primary reservoirs being wild canids, such as foxes and dogs, maintaining distinct sylvatic and urban cycles. This paper outlines three high-return priorities for rabies control in the country, informed by the epidemiological patterns of the disease, the national regulatory framework (Order No. 7-1/587), and evidence on the knowledge, attitudes, and practices (KAP) of the Kazakh population. The three priorities are (a) transition into a One Health, real-time surveillance system featuring standardized digital reporting and GIS-guided interventions; (b) implementation of biannual oral rabies vaccination (ORV) of foxes in high-risk districts, incorporating mandatory quality assurance (via tetracycline biomarkers and/or serology) aligned with EU/EFSA standards; and (c) adopt an urban strategy focused on dogs to increase vaccination coverage and reduce delays in human post-exposure prophylaxis (PEP). These measures align with the WOAH Terrestrial Code and the "Zero by 30" roadmap, leveraging existing national assets like risk maps and laboratory capacity, such as dFAT, RT-PCR, and sequencing. Kazakhstan's predictable rabies pattern allows for targeting district-level strategies and transparent measurement of risk reduction, contingent on enforcing standardized reporting and rigorous quality assurance programs. The opinions introduced in this paper are based on the scientific evidence collected in Kazakhstan over the last decade and summarize the need for urgent actions to promote rabies control in the country.