Current issues and gaps in the implementation of rabies prevention in Ukraine in recent decades

Abstract

Ukraine remains the only country in Europe where rabies is widespread among animals and humans. Annually there are about 1,600 rabies cases in animals in Ukraine and sporadic cases in humans have been registered despite the conducting of preventive measures. Therefore, the aim of the study was to inspect the failures in rabies prevention, indicate the top reasons for human cases and highlights the risk of animal attacks in view of their species and geographical distribution in Ukraine during 1996–2020. The following archival state materials were used for analysis: from the Ministry of Health of Ukraine and from the annual reports of oblast departments of the State Service of Ukraine for Food Safety and Consumer Protection. In general, more than 84,000 people (187.4 per 100,000 of the population) were affected by bites or harmful contact with animals every year, among them, 2,155 people were victims of rabid animals. Post-exposure prophylaxis (PEP) was prescribed annually, on average, for 21,434 patients (25.5% of all victims). Most people were attacked by cats and dogs that had owners (71.5%). The frequency of the proportion of the risk of attacks by rabid dogs on humans was (1:124), from cats (1:25), wild animals (1:7), and farm animals (1:2), but the largest general proportion of animal attacks on people was from dogs – 838,635 attacks (77.7%). Thus, due to the permanently higher level of contact with people, attacks by dogs remains more dangerous. Geographically attacks on humans by domestic carnivores were observed most commonly in the east part of Ukraine due to the high urbanization of the region and the high density of the human population. A large number of attacks by foxes was observed in the west part of Ukraine due to the larger area of forests and fields. During the last 25 years, there have been 63 human rabies cases. The main sources of rabies were dogs (24 cases) and cats (22 cases). The main causes of development of rabies were: failure to receive the PEP due to the absence of a visit to a hospital after an attack of an animal (n = 38), failures in prescribing PEP (n = 15), failure of PEP (n = 10). In conclusion, the gaps in the control measures against rabies are the lack of agreed coordination of inter-sectoral links, the lack of significant efforts to raise public awareness and the lack of funding for prophylaxis programmes for humans and animals. Our future research will be aimed at modelling the transmission of rabies from the pet population to humans.