Two fatal human rabies cases were identified in Prathai District, Nakhon Ratchasima Province, Thailand, within 24 weeks in 2025. Both occurred in a setting with ongoing animal rabies transmission and high human–animal contact. This investigation aimed to characterize the epidemiologic situation, assess human and animal exposures, and identify gaps in prevention measures. A field epidemiologic investigation was conducted using a One Health framework covering December 2024 to August 2025. We performed human case verification, hospital record reviews, bite surveillance, post-exposure prophylaxis (PEP) adherence assessment, dog population and vaccination analysis, and animal rabies testing. Spatial-clustering was evaluated using SaTScan. Estimated dog population size was calculated using regional dog-density methods. Two laboratory-confirmed human rabies deaths occurred following unvaccinated dog bites. A total of 3,427 bite and scratch injuries were reported, with an average monthly incidence of 14 per 100,000 population. PEP adherence was low; while 57% and 43% of patients completed the third and fourth doses, respectively, completion of the full five-dose regimen was negligible (< 1%). Of 47 animals submitted for testing, 10 (21.3%) were positive, predominantly unowned dogs. Administrative records listed 7,412 dogs, but density-based estimates suggested ~ 14,958 dogs, reducing true vaccination coverage to ~ 40%. Three significant spatial clusters of rabies activity were identified. Rabies transmission in Prathai District was sustained by high human–animal exposure, low PEP adherence, and inadequate vaccination among free-roaming dogs. Strengthening integrated surveillance, improving vaccination strategies, and promoting timely care after animal bites are essential to prevent further human cases.
Anupat et al. (Thu,) studied this question.