Rabies in Tunisia: a 30-year retrospective study (1994–2023)

Abstract

Introduction Rabies remains a public health and veterinary concern, with both animal and human cases regularly documented. To gain insight into the rise and persistence of rabies in Tunisia, a comprehensive retrospective study was conducted from 1994 to 2023. Methods The total number of animal cases recorded over this period was 6 920, with 90 human cases also documented. Analysis of data included species distribution, temporal patterns, and spatial dynamics. To assess the temporal distribution of dog rabies at larger scale, we applied a Markov-Switching Autoregressive (MS-AR) model to the annual time series of canine rabies cases from 1961 to 2023. The spatial distribution of the disease was examined using Anselin's Local Moran's I index applied at the governorate level. Results Analysis of data showed that dogs accounted for 61.9% of the total confirmed rabies cases, with ruminants (24% of the cases) being the victims of bites from rabid dogs. Comparison between months indicated that the occurrence of dog rabies was more frequent during the months of March, April and May. The MS-AR model indicates the presence of two patterns: a low transmission pattern (average of 83.4 cases per year) and a high transmission pattern (average of 218.0 cases per year). The probability of persistence in each regime was estimated as moderate (50.0% for “low” and 62.1% for “high”), with average episode durations of 2.0 and 2.6 years, respectively. The country has been in an unprecedented 12-year phase of high transmission since 2012, which suggests an important change in the profile of the disease in Tunisia. The spatial distribution of the disease indicated that cases moved from a governorate to another over time. Anselin's Local Moran's I index reveals that areas of significant clustering (High-High) regularly extended in the north-east and north-west of the country. The incidence of human rabies varied significantly among the different regions (governorates) of the country. Discussion The findings of this study highlight the urgency of revising current rabies control strategies considering the unprecedented 12-year high-transmission phase since 2012. Strengthening public awareness, optimizing resource allocation, and establishing integrated One Health rabies task forces in high-risk governorates are critical steps toward interrupting the persistence and transmission of rabies in Tunisia.