Timeliness in canine rabies outbreak report and response.

Introduction: Timely response to zoonotic disease outbreaks is crucial to minimizing their impact on the health and wellbeing of people and animals. Monitoring and improving the speed of response, using established outbreak milestones and timeliness metrics, is key to preventing further spread. Despite training and a decade of expertise in case response, persistent delays in these processes continue to hinder effective outbreak responses. Dog-mediated rabies, a classic One Health challenge, remains a significant public health concern in many parts of the world. In Arequipa, Peru, rabies has re-emerged and caused recurrent outbreaks over the past decade, despite substantial control efforts. Addressing the drivers of these delays is vital for improving rabies control. In this study, we use dog rabies as a model to examine delays in zoonotic outbreak response, as well as potential solutions, applying and adapting the Outbreak Milestones and Timeliness Metrics framework. We calculated the timeliness of rabies surveillance and response activities in Arequipa from 2015 to 2024 and identified key barriers contributing to delays. Methods: Using canine rabies outbreak response reports from 2015 to 2024 in Arequipa, Peru, we classified One Health outbreak milestones pertaining to the report and response system and calculated timeliness metrics between key processes. Kruskal-Wallis and Dunn tests were applied to measure delays by process, year, and micro-health network. Qualitative analysis of narrative field reports identified underlying causes of delays. Results: The longest delay occurred between the detection of behavior change in dogs and initial reporting, averaging 2.52 days (SD = 2.28), while the shortest delay was between diagnosis and outbreak control, averaging 0.76 days (SD = 0.92). Intermediate delays were observed between report and sample shipment and diagnosis and control with averages of 1.28 days (SD = 1.30) and 1.09 days (SD = 1.38), respectively. Delay-related barriers included dog owners' lack of awareness and reluctance to report symptoms, logistical challenges in sample collection, and delays in implementing outbreak control measures. Additional barriers included confusion about reporting procedures and reluctance from dog owners to share information about their dogs which hindered timely response. Conclusions: Delays in rabies reporting and response in Arequipa are primarily driven by slow reporting following behavior changes in dogs and logistical problems with sample collection and control and containment measures. Although diagnosis and outbreak responses are comparatively more efficient, inconsistencies remain. Strengthening community awareness and engagement for reporting, improving intersectoral coordination between health authorities, and optimizing logistics are critical to reducing delays and improving outbreak control.