The impact of the COVID-19 pandemic on rabies control and health-seeking behavior for postexposure prophylaxis (PEP) in Serbia and North Macedonia and lessons learnt
Dragana Mijatović, Ana Marija Radevska, Edmond Brava, Fadil Cana, Verica Simin, Ivana Bogdan, Dragana Gazibara, Alejandro Cabezas-Cruz, Eleftherios Meletis, Polychronis Kostoulas, Olympia Lioupi, Perica Stojanac, Dejan Jakimovski & Pavle Banović
Rabies remains one of the most serious zoonotic diseases because it is almost always fatal once clinical symptoms appear, while timely post-exposure prophylaxis can prevent disease after a risky animal bite or exposure. The COVID-19 pandemic disrupted healthcare systems, veterinary surveillance and oral rabies vaccination campaigns worldwide, raising important questions about the resilience of rabies prevention systems in the Balkans.
The authors retrospectively analyzed 5,128 patient records from two key institutions: the Pasteur Institute Novi Sad in Serbia and the Clinic for Infectious Diseases in Skopje, North Macedonia. The study compared the pre-pandemic period of 2018-2019 with the post-pandemic period of 2022-2024.
Dog bites were the dominant cause of animal-related injuries in both settings. However, the patterns of PEP administration differed substantially between the two countries. In North Macedonia, the proportion of bite patients receiving PEP increased significantly after the pandemic, from 6.7% to 16.4%. In Serbia, PEP rates remained comparatively stable, increasing from 0.98% to 1.65%, without a statistically significant change.
The study suggests that these differences may reflect how rabies surveillance, veterinary information, public-health decision-making and vaccine distribution are organized. Serbia’s more centralized and integrated model, with real-time access to rabies surveillance information through the Pasteur Institute Novi Sad, may have supported more consistent risk assessment. In North Macedonia, limited real-time linkage between veterinary surveillance and clinicians may have contributed to more precautionary PEP administration after the pandemic.
A central conclusion of the article is that resilient rabies prevention requires a functional One Health pathway connecting human healthcare, veterinary services, wildlife surveillance, municipal dog-population management and laboratory data. The authors also propose the development of an online notification platform to provide healthcare workers with timely information on animal rabies surveillance, oral vaccination campaigns and outbreak alerts.
This publication highlights the importance of regional cooperation, data sharing and integrated preparedness for zoonotic disease threats in the Balkans. It also reflects BAVBD’s role as a platform connecting clinical medicine, diagnostics, laboratory research, epidemiology, biostatistics and One Health expertise across the region.
BAVBD congratulates all authors on this important contribution to rabies prevention, pandemic preparedness and cross-border public-health collaboration.
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