Behavioral and structural barriers to human post-exposure prophylaxis and other preventive practices during a canine rabies epidemic

A canine rabies epidemic started in early 2015 in Arequipa, Peru; the rabies virus continues to circulate in the dog population. Some city residents who suffer dog bites do not seek care or do not complete indicated post-exposure prophylaxis (PEP) regimens, increasing the risk of human rabies. The objectives of our study were to qualitatively assess knowledge about rabies, and preventive practices, such as PEP vaccination, following a dog bite. We conducted eight focus group discussions in peri-urban and urban communities with 70 total participants. We observed low awareness of rabies severity and fatality. Participants, especially those in per-urban communities, recounted applying herbs or the hair of the dog that bit them to wounds rather than seeking appropriate care. Misconceptions about rabies vaccines and mistreatment at health centers also commonly prevents initiating or completing PEP vaccination. We identify important behavioral and structural barriers and knowledge gaps that limit evidence-based preventive strategies against rabies and may threaten successful prevention of dog-mediated human rabies in this setting.