Surveillance, territory, and interculturality: Challenges in managing a rabies outbreak among the Maxakali

In 2022, a human rabies outbreak in the Pradinho Village (Maxakali people, Bertópolis, Minas Gerais, Brazil) highlighted structural vulnerabilities and the need for integrated One Health responses in remote indigenous territories.

To describe the outbreak and the post-outbreak period, synthesizing challenges and lessons learned from a One Health perspective to improve prevention, surveillance, and response.

Descriptive outbreak report/case study with a mixed-methods approach, using surveillance records, field reports, and secondary data (April-May/2022). The information was organized by thematic axes and analyzed through exhaustive reading and thematic analysis, with triangulation between sources and ethical review of secondary data without individual identification.

Four pediatric cases were confirmed (ages 4-12 years; 2 male/2 female), all with exposure to bats and 100% lethality. The following were identified: (i) weaknesses in human surveillance; (ii) insufficient animal surveillance/control, with a lack of systematic monitoring of bats; (iii) logistical and access barriers; (iv) intercultural challenges affecting risk communication and adherence; (v) intersectoral fragmentation and decreased intensity of post-outbreak actions; and (vi) gaps in prophylaxis and the need for pre-exposure strategies for at-risk groups.

The outbreak reinforces the urgency of institutionalizing sustainable intersectoral routines, decentralizing inputs and capacities (including diagnosis and cold chain network), adapting risk communication in an intercultural manner, and integrating human-animal-environmental surveillance. The lessons are transferable to other indigenous populations and remote territories with high human-wildlife interaction and access barriers.