Anthropogenic and environmental risk factors for rabies occurrence in Bhutan.

Anthropogenic and environmental factors were assessed as predictors of sub-districts in Bhutan that reported rabies in domestic animals during the period 1996-2009. Rabies surveillance data were retrieved from the Veterinary Information System database. Anthropogenic and environmental information were obtained from public data sources. Using the total number of rabies cases reported in domestic animals, the 205 sub-districts of Bhutan were categorized as those sub-districts that reported rabies and those that did not report rabies (n=146). Logistic regression models were fit to the data and odds ratios and 95% confidence intervals were estimated. Sub-districts that share a border with India (OR 10.43; 95% CI: 4.42-24.64; P<0.001); sub-districts connected by major roads (OR 3.09; 95% CI: 1.24-7.68; P=0.015); and greater human population density (OR 3.26; 95% CI: 1.48-7.21, P=0.003) were significantly associated with a sub-district reporting animal rabies in Bhutan during 1996-2009. Results suggest that human population characteristics play an important role in rabies occurrence.