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[Preprint]. 2020 Aug 13:2020.08.06.20169581.
doi: 10.1101/2020.08.06.20169581.

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

Brinkley Raynor  1   2 , Elvis W Díaz  3 , Julianna Shinnick  2 , Edith Zegarra  4 , Ynes Monroy  4 , Claudia Mena  5 , Ricardo Castillo-Neyra  2   3
Affiliations

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

Brinkley Raynor et al. medRxiv. .

Update in

Abstract
in English, Spanish

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.

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.

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Figures

Figure 1:
Figure 1:
A flow diagram depicting 4 different population states (V-vaccinated, S-susceptible, E-exposed, I-infected) of dogs with arrows depicting the movement of individuals between states.
Figure 2:
Figure 2:. Rabies compartmental model results
Panel A shows the dynamics of all disease states in the best fit rabies model for Arequipa, Peru. The blue line shows the vaccinated dog population numbers over time and the yellow line shows the susceptible population dynamics. Because the proportion of rabies exposed (pink line) and infected dogs (red line) is so small, these dynamics are not apparent in Panel A. Panel B highlights these exposed and infectious dynamics with an adjusted scale. Panel C shows infected population dynamics for a range of R0 from 1.36–1.5. In other words, it represents the red line of infected population dynamics shown in B but for a range of R0. The trends extend for the full range of possible values of R0 [1.36, 2.0] which can be seen in supplementary materials (Fig S2).
Figure 3:
Figure 3:. Different simulations of disruption scenarios
Simulations were run for 1 year after the beginning of COVID-19 control measures in Arequipa, Peru (March 16, 2020- March 16, 2021). Panels A–C depict different vaccination scenarios with normal levels of surveillance and control measures leading to an average survival time (ST) of rabid dogs to be 2.5 days. Panels D–F show the same vaccination scenarios with decreased surveillance leading to an increased survival time of rabid dogs to 3.7 days. The vaccination scenarios depicted correspond to yearly vaccination campaigns reaching the optimal goal of 80% coverage (Panels A, D), a sub-optimal level of 58% coverage (Panels B, E), and a complete cancellation of the vaccination campaign were coverage is 0% (Panels C, F). Both the surface plots with a range of values of R0 (i) and a transect where R0=1.44 (ii) are displayed)
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References

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