Xie Sherrie, Shinnick Julianna, Diaz Elvis W, Zegarra Edith, Monroy Ynes, Recuenco Sergio E, Castillo-Neyra Ricardo
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA.
Zoonotic Disease Research Lab, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
medRxiv. 2025 Apr 3:2025.04.02.25325110. doi: 10.1101/2025.04.02.25325110.
Dog-mediated human rabies is intuitively linked to poverty, but few studies have formally investigated the relationship between local socioeconomic disadvantage and dog rabies incidence.
We leveraged a unique, high-spatial-resolution surveillance database from the rabies-endemic city of Arequipa, Peru to probe the relationship between neighborhood socioeconomic status (SES) and dog rabies risk in 2015-2022. Rabies cases and samples were assigned to the SES level of their block or locality of origin, respectively. We tested the hypothesis that lower SES is associated with increased case positivity, and used a spatial statistical model to understand how sample positivity varied spatially.
Rabies cases were concentrated in socioeconomically disadvantaged blocks ( < 0·001), and sample positivity had a significant and positive association with neighborhood disadvantage ( < 0·05 for all periods), suggesting that surveillance effort was low relative to case incidence in disadvantaged areas. Stratifying samples by those collected via active vs. passive surveillance revealed that active surveillance reduced disparities in surveillance effort and sample positivity. Spatial analysis identified a sample positivity hotspot in a socioeconomically disadvantaged region with low access to health facilities.
Dog-mediated rabies is known to impact the poorest regions globally. We found similar patterns mirrored on a much smaller spatial scale - within a single city's limits. A balanced approach combining spatially-targeted ("active") and community-based ("passive") surveillance can help reduce rabies disparities. Mass dog vaccination and surveillance programs could target disadvantaged neighborhoods to decrease inequities in rabies risk to human populations and more effectively control dog rabies epidemics.
犬介导的人类狂犬病直观上与贫困相关，但很少有研究正式调查当地社会经济劣势与犬类狂犬病发病率之间的关系。
我们利用了来自秘鲁狂犬病流行城市阿雷基帕的一个独特的、高空间分辨率的监测数据库，以探究2015 - 2022年邻里社会经济地位（SES）与犬类狂犬病风险之间的关系。狂犬病病例和样本分别被分配到其所在街区或起源地的SES水平。我们检验了较低的SES与病例阳性率增加相关的假设，并使用空间统计模型来了解样本阳性率在空间上是如何变化的。
狂犬病病例集中在社会经济劣势街区（<0.001），样本阳性率与邻里劣势呈显著正相关（所有时期均<0.05），这表明相对于劣势地区的病例发病率，监测力度较低。按主动监测与被动监测收集的样本进行分层显示，主动监测减少了监测力度和样本阳性率的差异。空间分析在一个社会经济劣势地区且获得卫生设施机会较少的区域确定了一个样本阳性率热点。
已知犬介导的狂犬病会影响全球最贫困地区。我们发现在一个城市范围内更小的空间尺度上也存在类似模式。将空间靶向（“主动”）和基于社区（“被动”）的监测相结合的平衡方法有助于减少狂犬病差异。大规模犬类疫苗接种和监测项目可以针对劣势社区，以减少人类狂犬病风险的不平等，并更有效地控制犬类狂犬病流行。
