The History of Rabies in Bolivia

In Bolivia, little is known about rabies during the pre-Colonial and Colonial periods. It was not until 1931 that the newspaper “La Palabra” in Santa Cruz de la Sierra reported the first human case. In 1932, there are records of the first reports of canine rabies that occurred in La Paz. By 1947, a German shepherd and a Danish dog were diagnosed as positive for rabies in the city of La Paz. In 1965, a national canine rabies campaign began, with approximately 13,725 dogs vaccinated. In the same year, 5 human cases were reported. During the 1970s, countries in Latin America began to work with the Pan American Health Organization on a regional plan for canine rabies prevention and control. During 1980, international assistance supported the Ministry of Health and Social Welfare for the implementation of mass vaccination campaigns against rabies in dogs. This began initially in La Paz, Cochabamba, and Santa Cruz. From 1994 to date, campaigns have been carried out throughout the country. The highest incidence of human and canine rabies registered was from 1980 to 1993. During this period, 171 cases of human rabies and 23,190 cases of canine rabies were reported, with an average of 1656 rabid dogs each year (e.g., in 1987, 2774 rabies cases in dogs; in 1992, 25 cases of human rabies). From 1994 to 2000, an average of 7 human cases and 271 canine rabies were reported. In this period, the reduction of canine rabies cases occurred, due in part to the implementation of massive national campaigns. However, these programs had heterogeneous coverage. For example, in 1994, the national coverage was reported at 77%, but in 1995 it was only 38%, and in 2000 the coverage was back up to 72%. This inadequate response affected the accumulation of susceptible animals that have not received a single dose of the vaccine. As a result, in 2005, Bolivia registered the largest outbreak of canine and human rabies in the Americas. Canine rabies increased exponentially, with 855 cases of dog rabies and 9 cases of human rabies. Regionally, the Pan American Health Organization reported 1450 cases of canine rabies in the Americas, whereas 62% of these cases were in Bolivia. In 2006, the Ministry of Health and Social Welfare endorsed a “National Operational Plan for Rabies Control”. During 2010, 124 cases of canine rabies and 1 case of human rabies were reported, the lowest number of rabid dogs since the 2005 outbreak. Unfortunately, in 2011, the country saw a setback and registered 264 cases of canine rabies. From 2011 to 2016, even with an apparently low incidence of rabies in dogs, activities such as mass vaccination, focused control, and epidemiological surveillance were less than ideal. Thereafter, in 2017, 965 cases of canine rabies and 6 human cases were reported, as the highest frequency of canine and human rabies recorded in the Americas that year. This outbreak was greater than the epizootic in 2005. In 2017, a new strategy for mass vaccination was used to achieve coverage greater than 80% in dogs. Locally, in Santa Cruz de la Sierra, the vaccination coverage was estimated at 74%. This progress allowed other cities with a high incidence, such as Oruro and Cochabamba, to apply this same strategy. After massive campaigns, a remarkable reduction in canine rabies cases was obvious. For example, by 2020, only 69 cases of canine rabies were reported country wide, with no human cases. However, in 2021, canine rabies cases increased again. Cochabamba registered the highest frequency of canine rabies in the country and reported 4 cases of human rabies. In 2022, the departments of Cochabamba, Chuquisaca, and Potosi registered 82% of the cases of canine rabies reported in the country. In retrospect, compared to the situation during the twentieth century, Bolivia improved substantially in the management of canine rabies. Yet, despite these historical advances, the overall control process for this zoonosis remains fragile. The Ministry of Health, municipalities, and other institutions should develop a more strategic plan for the next 5 years. This plan would outline comprehensicve steps for surveillance, prevention, control, and elimination of canine rabies. This proposal would include a participatory approach, in the context of each local department. A strong advocacy by the authorities is highly recommended, to achieve a lasting political commitment towards modern prevention and control, such that Bolivia will be free of human rabies transmitted by dogs by 2030.