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Estimating the global burden of endemic canine rabies.

Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, Barrat J, Blanton JD, Briggs DJ, Cleaveland S, Costa P, Freuling CM, Hiby E, Knopf L, Leanes F, Meslin FX, Metlin A, Miranda ME, Müller T, Nel LH, Recuenco S, Rupprecht CE, Schumacher C, Taylor L, Vigilato MA, Zinsstag J, Dushoff J, Global Alliance for Rabies Control Partners for Rabies Preventi - PLoS Negl Trop Dis (2015)

Bottom Line: The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%).This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving.Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

View Article: PubMed Central - PubMed

Affiliation: Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.

ABSTRACT

Background: Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.

Methodology/principal findings: We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%).

Conclusions/significance: This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

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Related in: MedlinePlus

Model framework used in this study for estimating the global burden of canine rabies.Probability steps correspond to the probability that a bite is by a rabid animal (RP); that the victim received post-exposure prophylaxis, PEP, (PP); and, in the absence of PEP, that the bite victim developed rabies (DP). Data inputs (Table 1) are shown in red and model outputs in blue. Red arrows show estimated relationships (Fig 2). DALY = Disability-Adjusted Life Year; HDI = Human Development Index. Further details are given in Table 1.
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pntd.0003709.g001: Model framework used in this study for estimating the global burden of canine rabies.Probability steps correspond to the probability that a bite is by a rabid animal (RP); that the victim received post-exposure prophylaxis, PEP, (PP); and, in the absence of PEP, that the bite victim developed rabies (DP). Data inputs (Table 1) are shown in red and model outputs in blue. Red arrows show estimated relationships (Fig 2). DALY = Disability-Adjusted Life Year; HDI = Human Development Index. Further details are given in Table 1.

Mentions: We adapted the probability decision-tree framework developed by Cleaveland et al. [8] for Tanzania and used by Knobel et al. [18] to estimate the burden of rabies in Africa and Asia. The model uses the product of bite incidence, the probabilities of (i) a biting animal being rabid, RP, (ii) a bite victim receiving PEP, PP, and (iii) in the absence of PEP, developing rabies, DP, to extrapolate human rabies deaths and DALYs. An economic component is included to calculate the costs of rabies prevention and control, such as PEP administration, surveillance and livestock losses from rabies (Fig 1 and Table 1). We parameterized the model using country-specific data or aggregated cluster estimates as described below.


Estimating the global burden of endemic canine rabies.

Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, Barrat J, Blanton JD, Briggs DJ, Cleaveland S, Costa P, Freuling CM, Hiby E, Knopf L, Leanes F, Meslin FX, Metlin A, Miranda ME, Müller T, Nel LH, Recuenco S, Rupprecht CE, Schumacher C, Taylor L, Vigilato MA, Zinsstag J, Dushoff J, Global Alliance for Rabies Control Partners for Rabies Preventi - PLoS Negl Trop Dis (2015)

Model framework used in this study for estimating the global burden of canine rabies.Probability steps correspond to the probability that a bite is by a rabid animal (RP); that the victim received post-exposure prophylaxis, PEP, (PP); and, in the absence of PEP, that the bite victim developed rabies (DP). Data inputs (Table 1) are shown in red and model outputs in blue. Red arrows show estimated relationships (Fig 2). DALY = Disability-Adjusted Life Year; HDI = Human Development Index. Further details are given in Table 1.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400070&req=5

pntd.0003709.g001: Model framework used in this study for estimating the global burden of canine rabies.Probability steps correspond to the probability that a bite is by a rabid animal (RP); that the victim received post-exposure prophylaxis, PEP, (PP); and, in the absence of PEP, that the bite victim developed rabies (DP). Data inputs (Table 1) are shown in red and model outputs in blue. Red arrows show estimated relationships (Fig 2). DALY = Disability-Adjusted Life Year; HDI = Human Development Index. Further details are given in Table 1.
Mentions: We adapted the probability decision-tree framework developed by Cleaveland et al. [8] for Tanzania and used by Knobel et al. [18] to estimate the burden of rabies in Africa and Asia. The model uses the product of bite incidence, the probabilities of (i) a biting animal being rabid, RP, (ii) a bite victim receiving PEP, PP, and (iii) in the absence of PEP, developing rabies, DP, to extrapolate human rabies deaths and DALYs. An economic component is included to calculate the costs of rabies prevention and control, such as PEP administration, surveillance and livestock losses from rabies (Fig 1 and Table 1). We parameterized the model using country-specific data or aggregated cluster estimates as described below.

Bottom Line: The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%).This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving.Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

View Article: PubMed Central - PubMed

Affiliation: Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.

ABSTRACT

Background: Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.

Methodology/principal findings: We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%).

Conclusions/significance: This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

Show MeSH
Related in: MedlinePlus