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Background <p>Two fatal human rabies cases were identified in Prathai District, Nakhon Ratchasima Province, Thailand, within 24 weeks in 2025. Both occurred in a setting with ongoing animal rabies transmission and high human–animal contact. This investigation aimed to characterize the epidemiologic situation, assess human and animal exposures, and identify gaps in prevention measures.</p> Methods <p>A field epidemiologic investigation was conducted using a One Health framework covering December 2024 to August 2025. We performed human case verification, hospital record reviews, bite surveillance, post-exposure prophylaxis (PEP) adherence assessment, dog population and vaccination analysis, and animal rabies testing. Spatial-clustering was evaluated using SaTScan. Estimated dog population size was calculated using regional dog-density methods.</p> Results <p>Two laboratory-confirmed human rabies deaths occurred following unvaccinated dog bites. A total of 3,427 bite and scratch injuries were reported, with an average monthly incidence of 14 per 100,000 population. PEP adherence was low; while 57% and 43% of patients completed the third and fourth doses, respectively, completion of the full five-dose regimen was negligible (&lt; 1%). Of 47 animals submitted for testing, 10 (21.3%) were positive, predominantly unowned dogs. Administrative records listed 7,412 dogs, but density-based estimates suggested ~ 14,958 dogs, reducing true vaccination coverage to ~ 40%. Three significant spatial clusters of rabies activity were identified.</p> Conclusion <p>Rabies transmission in Prathai District was sustained by high human–animal exposure, low PEP adherence, and inadequate vaccination among free-roaming dogs. Strengthening integrated surveillance, improving vaccination strategies, and promoting timely care after animal bites are essential to prevent further human cases.</p>

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Spatial and epidemiologic analysis of two human rabies fatalities reveals transmission drivers and prevention gaps in Prathai district Thailand 2025

  • 期刊论文

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  • 发表日期：

    2026年3月26日

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  • Waritnun Anupat,
  • Wichayaporn Wongbumru,
  • Chonlada Siri,
  • Kanidta Poobua,
  • Khaneugnij Yueyai,
  • Onphirul Yurachai,
  • Teerasak Chuxnum

摘要

Background

Two fatal human rabies cases were identified in Prathai District, Nakhon Ratchasima Province, Thailand, within 24 weeks in 2025. Both occurred in a setting with ongoing animal rabies transmission and high human–animal contact. This investigation aimed to characterize the epidemiologic situation, assess human and animal exposures, and identify gaps in prevention measures.

Methods

A field epidemiologic investigation was conducted using a One Health framework covering December 2024 to August 2025. We performed human case verification, hospital record reviews, bite surveillance, post-exposure prophylaxis (PEP) adherence assessment, dog population and vaccination analysis, and animal rabies testing. Spatial-clustering was evaluated using SaTScan. Estimated dog population size was calculated using regional dog-density methods.

Results

Two laboratory-confirmed human rabies deaths occurred following unvaccinated dog bites. A total of 3,427 bite and scratch injuries were reported, with an average monthly incidence of 14 per 100,000 population. PEP adherence was low; while 57% and 43% of patients completed the third and fourth doses, respectively, completion of the full five-dose regimen was negligible (< 1%). Of 47 animals submitted for testing, 10 (21.3%) were positive, predominantly unowned dogs. Administrative records listed 7,412 dogs, but density-based estimates suggested ~ 14,958 dogs, reducing true vaccination coverage to ~ 40%. Three significant spatial clusters of rabies activity were identified.

Conclusion

Rabies transmission in Prathai District was sustained by high human–animal exposure, low PEP adherence, and inadequate vaccination among free-roaming dogs. Strengthening integrated surveillance, improving vaccination strategies, and promoting timely care after animal bites are essential to prevent further human cases.