Spatial and epidemiologic analysis of two human rabies fatalities reveals transmission drivers and prevention gaps in Prathai district Thailand 2025

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.