Rabies remains one of the most fatal zoonotic diseases worldwide, causing almost certain death once clinical symptoms develop. Despite the availability of highly effective preventive measures, including post-exposure prophylaxis (PEP) and mass dog vaccination, rabies continues to claim approximately 59,000 human lives annually, with the overwhelming burden occurring in low- and middle-income countries. The persistence of rabies is driven by inadequate canine vaccination coverage, weak surveillance systems, delayed diagnosis, limited access to healthcare services, and insufficient coordination between human and animal health sectors. This thematic review examines the epidemiology of rabies, current surveillance and diagnostic validation pathways in both human and animal populations, key challenges affecting surveillance effectiveness, and emerging innovations that may strengthen rabies prevention and control efforts. Particular attention is given to the role of One Health approaches and Integrated Bite Case Management (IBCM) in improving case detection, risk assessment, and response mechanisms. The review identifies several critical gaps in existing surveillance systems, including substantial underreporting and misclassification of cases, delays in laboratory confirmation and specimen referral, fragmented and non-interoperable data systems, inadequate workforce capacity, weak community participation, and policy barriers limiting cross-sectoral information sharing. Emerging innovations include mobile-based reporting platforms, SMS and event-based alert systems, real-time surveillance dashboards, participatory community surveillance, integrated data platforms linking human and veterinary health services, rapid diagnostic technologies combined with molecular confirmation techniques such as reverse-transcription polymerase chain reaction (RT-PCR), and genomic surveillance for tracking viral transmission dynamics. Evidence suggests that strengthening surveillance within a One Health framework can significantly improve early case detection, optimize the use of post-exposure prophylaxis, enhance outbreak response, and facilitate targeted canine vaccination strategies in high-risk settings. The integration of digital technologies, laboratory strengthening, and multisectoral collaboration represents a promising pathway toward achieving the global target of zero human deaths from dog-mediated rabies by 2030. Future research should evaluate the cost-effectiveness, scalability, and equity implications of digital and genomic surveillance approaches in resource-limited settings.