Long-term spatio-temporal trends in global rabies burden and its association with animal rabies vaccination during 1990-2019.

Rabies remains a major public health issue. Yet, trends in rabies burden associated with age, period, and cohort effects remain unknown, and the association between animal rabies vaccination and rabies burden is unclear. We aimed to understand the long-term spatio-temporal trends in global rabies burden, the impacts of age, periods, and birth cohorts, and the association between animal rabies vaccination and burden. Rabies burden data were extracted from Global Burden of Disease Study 2019. We used joinpoint regression to assess temporal trends in rabies burden and age-period-cohort model to evaluate age, period, and cohort effects on rabies incidence and mortality. Animal rabies vaccination data were obtained from World Animal Health Information System. The association between the ratio of vaccinated animals and age-standardized incidence rate was explored. From 1990 to 2019, the global rabies incident cases, deaths, and disability-adjusted life years (DALYs) decreased by 43.12%, 47.20%, and 54.59%, respectively. Age-standardized rates of incidence, mortality, and DALYs declined in all socio-demographic index (SDI) regions, yet consistently remained the highest in low SDI region. The highest rabies incidence rate and mortality rate were observed in children aged 0-9 years. Population living during 1990-1994 had the highest rabies incidence and mortality risks. Countries and territories with high rabies age-standardized incidence rate generally had low ratios of vaccinated animals. Globally, rabies burden decreased over past 30 years, yet disparities in rabies burden regarding gender, age, period, cohort and SDI region existed. Targeted strategies are needed, especially in low SDI region and among children aged 0-9 years.