Epidemiology of human exposure to rabies in Nunavik: incidence, the role of dog bites and their context, and victim profiles

BACKGROUND: In Nunavik, Arctic rabies is still endemic due to a spillover from wildlife to dogs. The prevention of human exposure and the management of potential exposure is a significant public health concern in this region. METHODS: This study retrospectively describes cases of potential exposure to rabies in humans as reported to the Nunavik Public Health Board through their registry of reported cases. We used multi-correspondence analysis as well as univariable and multivariable regression models to test for differences between children and adults in reported cases, and to examine the contexts of exposure to dogs and dog attacks. RESULTS: From 2008 to 2017, 320 cases of potential exposure to rabies were reported, 92% of which were linked to dogs. The annual incidence rate was 2.5 per 1000 people. The incidence increased significantly during the study period, although the reasons for this are unclear. Fifteen cases of exposure were with rabid animals, mostly dogs (9 of 15). No human cases of rabies occurred thanks to adequate medical case management. Two specific profiles for potential exposure to rabies were identified based on age and gender. The first was children (< 15 y/o), male or female, who were more likely to be exposed through playing with dogs and were more often injured in the head and/or neck. The second was young male adults (aged 15 to 34 y/o), who were more involved with wildlife than other age groups and mostly injured in the upper limbs and as a result of a reaction by the animal. CONCLUSION: Rabies is a real public health threat in Nunavik. Potential human exposure needs to be prevented, and prevention measures should be tailored to the two risk profiles identified based on age, gender and animal species involved.