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

Rabies remains a fatal zoonotic disease of significant public health concern, particularly in regions where surveillance and vaccination campaigns are inconsistent. The COVID-19 pandemic disrupted routine healthcare and animal health programs worldwide, raising concerns about the continuity of rabies prevention strategies. This study evaluates the impact of the pandemic on post-exposure prophylaxis (PEP) administration in Serbia and North Macedonia, two Balkan countries historically considered at risk of rabies circulation. We conducted a retrospective analysis of medical records from the Pasteur Institute Novi Sad (PINS, Serbia) and the Clinic for Infectious Diseases in Skopje (CIDS, North Macedonia), comparing pre-pandemic (2018-2019) and post-pandemic (2022-2024) periods. A total of 5,128 patient records were included, with dog bites accounting for the majority of exposures in both countries. Findings revealed a significant increase in PEP administration in North Macedonia, rising from 6.7% to 16.4% of bite patients after the pandemic (p < 0.001), while Serbia maintained stable rates (0.98% to 1.65%, p > 0.05). Differences likely reflect disparities in rabies surveillance, information flow between veterinary and medical sectors, and the organization of national control programs. These results underscore the importance of integrated One Health approaches and real-time information exchange to optimize rabies prevention and ensure resilience against future disruptions.