The Impact of the COVID-19 Pandemic on Rabies Reemergence in Latin America: the case of Arequipa, Peru

Abstract

Over the past decades, there has been tremendous progress towards eliminating canine rabies in Latin America. Major components of rabies prevention programs in Latin America leading to these successes have been constant and intense surveillance for rabid dogs and uninterrupted yearly mass dog vaccination campaigns. However, vital measures to control COVID-19 in Latin America have had the negative trade-off of jeopardizing these rabies elimination and prevention activities. In this paper, we aimed to assess the effect of interrupting canine rabies surveillance and mass dog vaccination campaigns on rabies trends. We built a deterministic compartment model of dog rabies dynamics parameterized for conditions found in Arequipa, Peru, where there is an ongoing dog rabies epidemic. Our model suggests that a decrease in canine vaccination coverage as well as decreased surveillance leading to an increased length of survival of infected dogs could lead to a sharp rise in canine rabies and, subsequently, human rabies risk. We examined our results over the best estimate of the basic reproductive number in Arequipa (R0 = 1.44) and a range of plausible values for R0 (1.36 - 2). The rising trend was consistent. It is very possible that COVID-19 will continue to challenge our public health departments in the short- and medium-term. Innovative strategies to conduct dog vaccination and rabies surveillance during these trying times should be considered to safeguard the achievements made in Latin America towards the elimination of dog-mediated human rabies. Resumen (Abstract in Spanish) En las últimas décadas ha habido un tremendo progreso hacia la eliminación de la rabia canina en América Latina. Los principales componentes de los programas de prevención de la rabia en América Latina que condujeron a estos éxitos han sido la vigilancia constante e intensa de los perros con rabia y las campañas anuales de vacunación masiva ininterrumpida. Sin embargo, las medidas esenciales para controlar el COVID-19 en América Latina han tenido el balance negativo de poner en peligro estas actividades de prevención y eliminación de rabia. En este artículo, nuestro objetivo fue evaluar el efecto que la interrupción de la vigilancia de la rabia canina y las campañas de vacunación masiva de perros tendría en las tendencias de la rabia. Modelamos la dinámica de la rabia canina mediante un modelo determinístico de comportamientos parametrizado para las condiciones que se encuentran en Arequipa, Perú, donde hay una epidemia de rabia canina en curso. Nuestro modelo sugiere que una disminución en la cobertura de vacunación canina, así como una disminución en la vigilancia (que llevaría a una mayor supervivencia de los perros infectados), podría llevar a un aumento súbito de rabia canina y, seguidamente, del riesgo de rabia humana. Examinamos nuestros resultados sobre la mejor estimación del número reproductivo básico en Arequipa (R0 = 1.44) y un rango de valores plausibles para R0 (1.36 - 2). La tendencia al alza fue consistente. Es muy posible que el COVID-19 continúe desafiando a nuestros departamentos de salud pública a corto y mediano plazo. Por lo tanto, deben considerarse estrategias innovadoras para llevar a cabo la vacunación de perros y la vigilancia de la rabia durante estos tiempos difíciles para salvaguardar los logros alcanzados en América Latina hacia la eliminación de la rabia humana mediada por perros.

The urgency of resuming disrupted dog rabies vaccination campaigns: a modeling and cost-effectiveness analysis

“…Haiti’s 2020 dog vaccination campaign was cancelled and funds were diverted to support the COVID-19 response; funds for 2021 have not yet been identified. Similar COVID-19 related postponements to dog vaccination campaigns have also been reported in other countries 12 .…”

“…Dog rabies vaccination campaigns may be disrupted for a variety of reasons including lack of funding, political instability, or natural disasters; most recently, the COVID-19 pandemic has interrupted dog vaccination in Haiti as well as other countries 12 . We adapted a mathematical model of dog rabies transmission to assess the urgency of resuming dog vaccination campaigns in Haiti by comparing the human health and cost implications if vaccination is resumed in 2021 compared to 2022.…”

“…Multiple researchers are raising concerns about the potential downstream impacts of the COVID-19 pandemic on the control of other diseases including HIV, tuberculosis, malaria, and neglected tropical diseases besides rabies 24 , 25 . A previous modeling study predicted that declines in surveillance and paused dog vaccination due to the impacts of COVID-19 could increase dog rabies cases in Peru 12 . In Haiti, the cancellation of the 2020 dog vaccination campaign was attributable to COVID-19 lockdowns and redirection of funds.…”

Rabies in Our Neighbourhood: Preparedness for an Emerging Infectious Disease

“…Focusing on response to one disease can be detrimental to the control of others, and the COVID-19 pandemic has highlighted that horizontal integration across diseases and human and animal health sectors is important and should not be overlooked. For example, a recent modelling study suggests that reduced dog vaccination and rabies surveillance due to COVID-19 control measures in Arequipa, Peru will result in increased human risk due to rabies [ 96 ]. In a broader context, it has also been suggested that frameworks for investigation and management of malaria could be extended horizontally, and used as surveillance for non-specific EID surveillance by investigating all reports of fever in people [ 97 ].…”

The urgency of resuming disrupted dog rabies vaccination campaigns: a modeling and cost-effectiveness analysis

“…Multiple researchers are raising concerns about the potential downstream impacts of the COVID-19 pandemic on the control of other diseases including HIV, tuberculosis, malaria, and neglected tropical diseases besides rabies 22,23 . A previous modeling study predicted that declines in surveillance and paused dog vaccination due to the impacts of COVID-19 could increase dog rabies cases in Peru 12 . In Haiti, the cancellation of the 2020 dog vaccination campaign was attributable to COVID-19 lockdowns and redirection of funds.…”