Time Series and Pattern of Dog Bites and Rabies in the Ashanti Region, Ghana, 2009-2019: A Call for Inter-Sectoral Collaboration in the Fight Against Rabies.

Dog-mediated human rabies is a vaccine-preventable neglected zoonotic disease, causing thousands of deaths every year across Africa and Asia. Information to generate the appropriate attention and action to avert human rabies is lacking due to disaggregation of available data. This study sought to understand the burden of dog-mediated rabies transmission and response patterns in Ghana's Ashanti Region, and analyzed dog-bite surveillance, rabies laboratory investigations, and hospital visitation data from 2009 to 2019. A total of 442 bite incidents were recorded, with most occurring in the Kumasi metropolis, particularly in the Oforikrom and Manhyia sub-metros. Many victims sought healthcare outside their bite-incident districts, often at the Manhyia Government Hospital, likely due to vaccine availability. Bite incidents were generally reported promptly within two days, although final investigations took about fourteen days. The sale of implicated dogs for human consumption during observation periods posed an additional rabies risk. There was a 67.53% positivity for animal rabies (n = 156/231) in laboratory investigations, and dogs accounted for most confirmed cases (141/210), though livestock and non-human primates were also affected. More than 70% of dog-bite victims were linked to rabies-positive animals, showing a significant association between bites and confirmed rabies cases. Reported dog-bite frequency varied considerably over time, with the highest monthly frequencies occurring between 2010 and 2013, and with a sustained positive seasonal effect from August to November within a year. The findings highlight that dog-mediated rabies remains a major public health threat in the region and emphasize the need for improved One Health investigations, surveillance, and public education to reduce rabies transmission and exposure risks.