Towards one health for dog-mediated human rabies elimination in Bangladesh: Achieving zero by 30

Abstract Background: Bangladesh is making progress toward achieving zero human dog-mediated rabies deaths by 2030, a global goal set in 2015. Methods: Drawing from multiple datasets, including patient immunization record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between the years 2011 to 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences in Bangladesh and other South Asian countries from GenBank. Findings: The human-to-dog ratio in Bangladesh was 85.83 (95% CI 74.63, 97.03), with an average dog population density of 11.51 dogs/km2 (95% CI 10.09, 12.92). The mass dog vaccination (MDV) campaign has resulted in the vaccination of 81.46% (95% CI: 80.54-82.37) of the estimated 3,030,662 dogs in the country. A decreasing trend from predicted and observed human rabies cases was identified, and it is projected that Bangladesh will have zero human rabies cases by 2030 if the current trend persists. The phylogenetic analysis shows that rabies viruses in Bangladesh belong to the Arctic-like-1 group, which differs from those in Bhutan despite sharing a common ancestor. Interpretation: Bangladesh's One Health approach demonstrated that an increase in MDV and ARV resulted in a decline in the relative risk of human rabies cases, indicating that eliminating dog-mediated human rabies could be achievable.