Spatially responsive mass vaccination strategies for urban rabies

About This Grant

Epidemics of vaccine-preventable zoonotic diseases are ongoing in major urban centers in the US and worldwide. Mass vaccination campaigns can prevent and control epidemics of infectious diseases among humans and animals. The realities of mass vaccination efforts, however, often fall short of their promise. In place of high and even vaccination coverage, many campaigns leave spatial "pockets" of under-vaccinated individuals. Pathogens, taking advantage of these under-vaccinated areas, can persist, diversify, and re-emerge. Modern computational approaches can mitigate geographic imbalances through the careful placement of vaccination sites. The main hypothesis of our study is that participation in mass vaccination campaigns can be significantly increased through spatially responsive vaccination strategies. These strategies have the potential to maximize coverage, minimize waiting time at vaccination sites, and increase immunization in high-risk populations. We test our methods in the context of an ongoing canine rabies epidemic in the city of Arequipa, Peru. This foreign component is scientifically indispensable and cannot be replicated domestically; while US urban zoonoses (such as raccoon rabies) rely on oral baiting or wildlife trapping, Arequipa presents a high-density parenteral vaccination system, where people must attend vaccination sites to immunize their animals. This setting allows us to uniquely integrate human movement, and queueing theory at active, high-throughput centralized vaccination sites under real-world epidemic stress. Importantly, in Arequipa, these mass dog vaccination campaigns are conducted annually, allowing us to implement an efficient stepped-wedge cluster randomized trial to achieve our aims. In the first aim we test spatially optimized mass vaccination sites. In the second test precision mop-up vaccination campaigns. In the third aim we assess the acceptability, scalability, and transferability of spatially responsive vaccination strategies for local, regional, and national stakeholders. Crucially, this research directly benefits the health of US populations by providing a scalable framework for rapid-response mass vaccination logistics and improving strategies to control vaccine-preventable diseases. These optimized strategies can be directly translated to US public health systems to counter localized outbreaks of emerging zoonoses, mitigate border health threats, and optimize domestic immunization delivery during public health emergencies.