Abstract
Background:
Since 2012, the northeast region of Tunisia has witnessed an increase in dog rabies cases, indicating a concerning emergence of the disease. Previous studies have indicated the widespread nature of rabies in northern Tunisia. However, there remains a lack of comprehensive understanding regarding the associated risk factors.

Aim:
This study aimed to identify potential risk factors associated with the occurrence of dog rabies in northeast Tunisia through a case-control approach.

Methods:
A case-control study was conducted, involving a cases group (n=77) consisting of dogs confirmed positive for rabies at the referral laboratory using the Fluorescent Antibody Test (FAT) between 2013 and 2019. The controls group (n=77) comprised both negative cases received at the laboratory and dogs that underwent a 15-day quarantine period and received a certificate of absence of rabies after observation. Univariate and multivariate logistic regression analyses were performed to explore various potential risk factors, including age, sex, breed, confinement, vaccination status, presence of bites, ownership status, origin of dogs, geographic sector, presence of rabies cases, and proximity to slaughterhouses.

Results:
The final logistic regression model revealed several significant findings. The odds of an unconfined dog being affected by rabies were nearly twice as high as for confined dogs (OR=1.9; 95% CI: 1.17 to 3.27). Furthermore, the odds of rabies occurrence were 25 times higher in areas where rabies cases had been reported within the previous three months to one year compared to uninfected areas (OR=25.7; 95% CI: 3.02-219.14). Dogs born at home to the owner's bitch were also found to be at significantly higher risk of rabies (OR=2.41; 95% CI: 1.14-5.13). Additionally, residing in areas with reported rabies cases in the last three months was found to increase the risk of rabies by 2.8 times (OR=2.8; 95% CI: 1.16-6.77). However, vaccination was associated with a 1.6-fold reduction in the risk of contracting rabies (OR=0.6; 95% CI: 0.38-0.97).

Conclusion:
This study provides valuable insights into the risk factors associated with dog rabies in northeast Tunisia. The findings underscore the importance of implementing targeted control measures, such as increased vaccination coverage and enhanced confinement measures, to mitigate the spread of rabies in the region. These findings can inform decision-making processes aimed at improving the effectiveness of national rabies control programs.

Key words: Case-control study, Dogs, Rabies, Risk factors, Tunisia