Spatiotemporal analysis of human rabies exposure in Colombia during ten years: A challenge for implementing social inclusion in its surveillance and prevention

Based on reported cases of human rabies exposure to Colombia public health surveillance system between 2007 and 2016 we conducted a spatiotemporal analysis to identify epidemiological scenarios of human rabies exposure by dog, cat, bat or farm animal (n= 666,411 cases). Spatiotemporal analysis, incidence rate, cluster and outlier analysis were conducted for all Colombian cities (n= 1122). The incidence rate of human rabies exposure by dogs and cats showed an increasing trend while aggression by bats and farm animals fluctuated throughout the analyzed period. Human rabies transmitted by cat and bat occurred in Andean and Orinoquia region, where the larger scenario was observed. There, urban scenario showed high risk to human rabies exposure by cat and dog in cities characterized for having the highest human population density and greater economic development. In contrary, rural area where was observed high risk of human rabies exposure by farm animals in workers from agroforestry area (42.7%). exposed to rabies by contact of mucosa or injured skin with saliva infected with rabies virus (74.5%) composed rural scenario. In Inequality scenario, exposure by farm animals showed some outlier cities with high risk principally in Pacific region, where was observed the lowest incidence rates to human rabies exposure in all years studied and the highest poverty rates in Colombia. There, afro-descendant (55%) and indigenous (8.2%) people were mostly affected. High risk of exposure by bat bite was observed in indigenous (98.5%) located in cities of Amazon region with dispersed population (Amazonian scenario). Analysis presented here can encourage surveillance, care and prevention programs to focus both on ethnic, dispersed populations and areas with rabies viral circulation, since each scenario requires different approach strategies.