The impact of the COVID-19 pandemic on rabies reemergence in Latin America: The case of Arequipa, Peru

In Latin America, there has been tremendous progress towards eliminating canine rabies. Major components of rabies elimination programs leading to these successes have been constant and regular surveillance for rabid dogs and uninterrupted yearly mass dog vaccination campaigns. Unfortunately, vital measures to control COVID-19 have had the negative trade-off of jeopardizing these rabies elimination and prevention activities. 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 to create a conceptual framework for how different disruptions may affect rabies virus transmission. We parameterized the model for conditions found in Arequipa, Peru, a city with active rabies virus transmission. We examined our results over a range of plausible values for R-0 (1.36-2.0). Also, we prospectively evaluated surveillance data during the pandemic to detect temporal changes. Our model suggests that a decrease in canine vaccination coverage as well as decreased surveillance could lead to a sharp rise in canine rabies within months. These results were consistent over all plausible values of R-0. Surveillance data from late 2020 and early 2021 confirms that in Arequipa, Peru, rabies cases are on an increasing trajectory. The rising rabies trends in Arequipa, if indicative to the region as whole, suggest that the achievements made in Latin America towards the elimination of dog-mediated human rabies may be in jeopardy. Author summary Effective strategies to control and eliminate canine rabies (and thus dog-transmitted human rabies) are uninterrupted mass dog vaccination campaigns and surveillance for rabid dogs. However, due to the COVID-19 pandemic, these vital control activities have been diminished or suspended due to restrictions implemented to decrease the spread of SARS-CoV-2 and redirection of funds. Almost a year after Peru's response to COVID-19 began, canine rabies cases in Arequipa, a city with ongoing rabies virus transmission, are increasing rapidly. In recent months, reported canine rabies cases have surpassed previous years' averages despite lower than average sample submissions. A mathematical model describes the mechanisms that might have created this rising trend: COVID-19-associated disruptions of mass dog vaccination campaigns and surveillance activities. As the COVID-19 pandemic is presenting obstacles to rabies elimination programs across Latin America, it is very likely that the region will face an increased canine rabies burden in the coming months to years if control efforts continue to be delayed, diminished, or suspended.