Spatial inequality hides the burden of dog bites and the risk of dog-mediated human rabies

Currently, there is an active rabies outbreak in the dog population of Arequipa, Peru. Inhabitants of the city are bitten by both pets and free-roaming dogs; therefore, the risk of human rabies transmission is concerning. Our objective was to estimate the rate of dog bites in the city and to identify factors associated with going or not going to a medical facility for rabies follow-up. To this end, we conducted a door-to-door survey of 4,000 houses in 21 urban and 21 peri-urban communities. We then analyzed associations between attaining follow-up rabies care and various socioeconomic factors, stratifying by urban and peri-urban localities. We found that the rate of dog bites in peri-urban communities (12.4%) was approximately three times higher than urban areas (4.0%). Among the people who were bitten, a significantly greater number of people in urban areas got follow-up rabies care than those in peri-urban areas.