Rabies epidemiology in the central of Tunisia: A Call for a One-Health Approach

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Abstract Background Advocating for a One-Health approach is crucial for ensuring effective rabies surveillance in Africa, including Tunisia. Collecting information is essential to evaluate the prevalence of dog bites and rabies in Tunisia. To address this, we conducted an analysis of reported incidents in the central region of Tunisia from 2019 to 2022. This analysis aimed to generate valuable insights that can inform strategies for rabies elimination in Tunisia, highlighting the importance of the One-Health approach. Methods We carried out a descriptive study using surveillance data from Monastir governorate in Central Tunisia. All humans exposed to animals, residents in Monastir Governorate and declared to the regional directorate of primary health care from January 1, 2019 to December 31, 2022 were included in our study. Data were entered, cleaned, and analyzed using Excel. Results During the studied period, 7789 cases of human exposures to animals were reported with an annual average of 1969 ± 207 exposures per year. The annual incidence rate of exposure to animal bites was 324 per 100,000 population. The sex-ratio was 2.07 and almost one third of exposed humans were aged less than 15 years-old. The most listed offending animals were dogs (65.2%), followed by cats (24.4%). The number of exposures by unvaccinated dogs increased significantly during our study period. Post-exposure prophylaxis (PEP) was applied among 99% (n = 7772) of declared exposures. Among them, 2.5% (n = 202) did not complete the PEP recommended protocol. During our study period, rabies was confirmed in 39 animals. Two fatal human rabies cases were declared respectively in 2021 and 2022. Conclusions Rabies remains a worrying health problem in Tunisia with a high percentage reported among youth and males. Targeting children and adolescents by education and information campaigns about preventive measures and mass dog vaccination are the key to ending this scourge. Key messages • It is crucial to reinforce preventive strategies, such as mass dog vaccination programs. • Public awareness about rabies prevention should be enforced in order to decrease Human rabies risks.

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