{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:13:20Z","timestamp":1788455600587,"version":"build-2803163510"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>WHO\u2019s \u2018Zero by 30\u2019 strategic plan relies on post-exposure prophylaxis guidelines designed for high-resource settings. This policy brief argues that the implementation gap of the 10-day observation rule in high-burden countries stems from fundamental infeasibility, exposing two paradigm defects in WHO guideline development: one-size-fits-all thinking and insufficient attention to implementation science. When the public misinterprets the 10-day rule as \u201cwait and see\u201d rather than \u201cinitiate PEP immediately while observing the animal,\u201d three biological facts render this misinterpretation fatal: symptomatic rabies is nearly 100% fatal and untreatable; a single vaccine dose cannot promptly induce sufficient neutralizing antibodies; and the incubation period for craniofacial Category III bites can be as short as 5\u201310\u202fdays\u2014shorter than the full observation window. Waiting for animal observation without initiating PEP during this window means missing the only opportunity for effective prevention. Evidence from multiple countries shows that the rule\u2019s preconditions are almost never met in settings where 95% of rabies deaths occur. This misinterpretation has led to preventable deaths and given rise to guideline-associated rabies phobia (GARP). We propose five revisions to refine\u2014not discard\u2014the rule. Reshaping the paradigm is an ethical prerequisite for achieving \u2018Zero by 30\u2019.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1934845","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:15:18Z","timestamp":1788452118000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From one-size-fits-all to context-specific: the 10-day observation rule-a need for change"],"prefix":"10.3389","volume":"14","author":[{"given":"Xin","family":"Wang","sequence":"first","affiliation":[{"name":"Wuxi No.8 People\u2019s Hospital","place":["Wuxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","volume-title":"Zero by 30: the Global Strategic plan to end human Deaths from dog-Mediated Rabies by 2030","year":"2018"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1086\/421556","article-title":"Survival of naturally infected rabid dogs and cats","volume":"39","author":"Tepsumethanon","year":"2004","journal-title":"Clin Infect Dis"},{"key":"ref3","first-page":"543","article-title":"Ten-day observation of live rabies suspected dogs","volume":"131","author":"Tepsumethanon","year":"2008","journal-title":"Dev Biol"},{"key":"ref4","first-page":"201","article-title":"Rabies vaccines: WHO position paper","volume":"93","year":"2018","journal-title":"Wkly Epidemiol Rec"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.46234\/ccdcw2025.208","article-title":"Surveillance and analysis of animal rabies-China, 2004\u20132024","volume":"7","author":"Sun","year":"2025","journal-title":"China CDC Wkly"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3760\/cma.j.issn.0254-6450.2016.02.001","article-title":"Technical guideline for human rabies prevention and control","volume":"37","author":"Zhou","year":"2016","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref7","article-title":"Public health inquiry on the 10-day observation rule for rabies post-exposure prophylaxis","year":"2026"},{"key":"ref8","article-title":"Standard for post-exposure prophylaxis of rabies (2023 edition) [EB\/OL]","year":"2023"},{"key":"ref9","volume-title":"Eighth grade Girl dies of Rabies with brain Death: Misunderstanding of the \"10-day Observation rule\" can be fatal","year":"2020"},{"key":"ref10","article-title":"Can you get rabies from cat or dog scratches and bites? 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Lessons learnt and the way forward","volume":"4","author":"Kipanyula","year":"2015","journal-title":"Infect Dis Poverty"},{"key":"ref16","article-title":"Post rabies exposure risk assessment","year":""},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e167","DOI":"10.1016\/S1473-3099(22)00641-7","article-title":"Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures","volume":"23","author":"Whitehouse","year":"2023","journal-title":"Lancet Infect Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2858","DOI":"10.3969\/j.issn.1007-9572.2016.32.026","article-title":"Cause and outpatient psychological intervention of rabies phobia: six cases report","volume":"19","author":"Jin","year":"2016","journal-title":"Chin Gen Pract"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e2317121","DOI":"10.1001\/jamanetworkopen.2023.17121","article-title":"Risk of rabies and implications for postexposure prophylaxis administration in the US","volume":"6","author":"Charniga","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"364","DOI":"10.17269\/s41997-018-0145-3","article-title":"Scoping decades of dog evidence: a scoping review of dog bite-related sequelae","volume":"110","author":"Dhillon","year":"2019","journal-title":"Can J Public Health"},{"key":"ref21","volume-title":"Implementation Research in Health: a Practical guide","author":"Peters","year":"2013"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1101\/2022.12.21.22283632","article-title":"Novel community-based rabies surveillance (CBRS) in urban Lilongwe, Malawi","author":"Mastala","year":"2022","journal-title":"medRxiv"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1934845\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:15:21Z","timestamp":1788452121000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1934845\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":22,"alternative-id":["10.3389\/fpubh.2026.1934845"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1934845","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1934845"}}