One Health Prioritization of Rabies Risk in the Republic of Guinea: Integration of Human Knowledge, Canine Immunity, and Spatial Analysis

Background: Dog-mediated rabies remains a fatal but preventable zoonosis. Its elimination requires sufficient canine vaccination coverage, informed communities, and spatially targeted surveillance. In Guinea, human knowledge, attitudes, and practices (KAP) data and canine serological data had previously been analyzed separately, limiting their translation into operational priorities. Objective: To build an integrated One Health assessment of rabies risk by combining KAP indicators, canine immunity, and spatial analysis. Methods: A secondary integrated analysis was conducted using a KAP survey of 2733 respondents and canine rabies serology from 419 vaccinated dogs tested with the Platelia™ Rabies II ELISA, with a protection threshold set at 0.5 IU/mL. Indicators were regionalized, compared, and incorporated into a vulnerability index. Associations were estimated by logistic regression with 95% confidence intervals, and spatial findings were displayed on a real map of Guinea. Results: Knowledge was insufficient or intermediate among most respondents, unfavorable attitudes reached 88.84%, and poor practices reached 73.80%. Declared canine vaccination coverage remained below the 70% programmatic threshold in all regions. Overall canine seroprotection was high (88.78%), but 11.22% of dogs remained insufficiently protected. Among dog owners, knowledge of rabies was associated with dog vaccination (OR = 2.77; 95% CI: 1.49–6.29). The integrated One Health assessment ranked Kindia as priority 1, Siguiri as priority 2, Boké and Labé as priority 3, and N’Zérékoré as priority 4. Conclusions: The integrated analysis shows that a strong immune response among vaccinated dogs is not sufficient when coverage, human practices, and the spatial distribution of risk remain heterogeneous. The recommended strategy is a regionally differentiated intervention combining post-exposure education, proximity-based dog vaccination, and targeted surveillance.