The return of human rabies - A foretold case in Latin America Through the Lens of One Health

Sep 29, 2026

Rabies control efforts in Arequipa, Peru failed to reduce rabid dog numbers despite mass dog vaccination campaigns and reactive ring interventions, resulting in the first reported human dog-mediated rabies case after eight years. The study integrates epidemiologic, socio-ecological, and policy evidence to determine why the 2023 case occurred and which stakeholder and surveillance gaps enabled breaches in protective layers. Using stakeholder mapping and Swiss Cheese analysis, the work proposes targeted actions to prevent future events.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages34

Reading Time1 h 26 min

AccessFree to download

Summary

Background

Objective

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Introduction

medRxiv preprint doi: [https://doi.org/10.64898/2025.12.31.25343275](https://doi.org/10.64898/2025.12.31.25343275); this version posted January 2, 2026. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . The return of human rabies: A foretold case in Latin America Through the Lens of One Health Ricardo Castillo-Neyra, PhD 1,2,3,\#*, Lizzie Ortiz-Cam, DVM3,4,\# , Elvis W. Díaz, DVM3 , Jorge L. Cañari-Casaño, PhD3 , Sergio E. Recuenco, DrPH5 , Valerie A. Paz-Soldán, PhD3,4 1 Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America 2 Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America 3 One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru 4 Department of Tropical Medicine and Infectious Disease, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 5 Department of Preventive Medicine and Public Health, Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru \# These two authors contributed equally to this work. * Corresponding Author: [cricardo@upenn.edu](cricardo@upenn.edu) (RCN) 423 Guardian Drive Room 715, Blockley Hall Philadelphia , PA 19104-6021 Summary Background: Despite ongoing rabies control efforts in Arequipa, Peru—including mass dog vaccination campaigns and reactive ring interventions—the region has failed to reduce the number of rabid dogs, leading to the first reported human dog-mediated rabies case after 8 years. The gaps in the rabies control program and the complex dynamics among stakeholders are unknown. Objective: To integrate epidemiologic, socio-ecological, and policy data to identify the factors contributing to the 2023 human rabies case and propose strategies to make this a‘never event’. Methods: We used stakeholder mapping and field quantitative and qualitative data to identify the roles and connections of key actors in rabies control, identifying gaps in their functions. We then applied the Swiss Cheese model to characterize the defense layers against dog-mediated rabies, highlighting critical vulnerabilities across these protective barriers. Conclusions: We identified multiple breaches in the defense against dog-mediated human rabies. Weak surveillance, insufficient dog vaccination, and inadequate management of freeroaming and feral dogs, coupled with bureaucratic inefficiencies, were key gaps. Outbreak responses were delayed and insufficient, and access to post-exposure prophylaxis (PEP) remained limited. Communication breakdowns exacerbated the problem. Systemic issues, such as outdated public health policies, insufficient training of health professionals, and fEm: Tehnistrpreitfetosrt,sfnueesaihntt rhntoitmbeelnycerifpieeeeinsdes.hlgnoet eouleo ide clinical practice. demographic factors also contributed to dog rabies spread. These failures in policy, medRxiv preprint doi: [https://doi.org/10.64898/2025.12.31.25343275](https://doi.org/10.64898/2025.12.31.25343275); this version posted January 2, 2026. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . response, capacity, and external factors led to the 2023 human rabies case. Despite awareness of these challenges, the contributing conditions remain unchanged. Eliminating dog-mediated human rabies by 2030 will require targeted interventions, including enhanced surveillance, context-specific pol

FAQs

Why did the 2023 human dog-mediated rabies case occur in Arequipa, Peru?

The study links the case to multiple breaches in rabies defenses, including weak surveillance, insufficient dog vaccination, poor management of free-roaming and feral dogs, delayed outbreak response, limited access to post-exposure prophylaxis (PEP), and communication breakdowns.

What methods were used to analyze the failures in rabies control?

The researchers used stakeholder mapping plus field quantitative and qualitative data to identify roles and connections among key actors. They then applied the Swiss Cheese model to characterize defense layers and vulnerabilities against dog-mediated rabies.

What strategies does the paper propose to prevent future cases?

Eliminating dog-mediated human rabies by 2030 is described as requiring enhanced surveillance, context-specific policy reforms, stronger community and institutional collaboration, and better management of free-roaming dogs.

Sep 29, 2026

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