Rabies-induced behavioural changes are key to rabies persistence in dog populations: Investigation using a network-based model.

Canine rabies was endemic pre-urbanisation, yet little is known about how it persists in small populations of dogs typically seen in rural and remote regions. By simulating rabies outbreaks in such populations (50-90 dogs) using a network-based model, our objective was to determine if rabies-induced behavioural changes influence disease persistence. Behavioural changes-increased bite frequency and increased number or duration of contacts (disease-induced roaming or paralysis, respectively)-were found to be essential for disease propagation. Spread occurred in approximately 50% of model simulations and in these, very low case rates (2.0-2.6 cases/month) over long durations (95% range 20-473 days) were observed. Consequently, disease detection is a challenge, risking human infection and spread to other communities via dog movements. Even with 70% pre-emptive vaccination, spread occurred in >30% of model simulations (in these, median case rate was 1.5/month with 95% range of 15-275 days duration). We conclude that the social disruption caused by rabies-induced behavioural change is the key to explaining how rabies persists in small populations of dogs. Results suggest that vaccination of substantially greater than the recommended 70% of dog populations is required to prevent rabies emergence in currently free rural areas.