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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

The distribution of the global burden of rabies: A) human rabies deaths, B) per capita death rates (per 100,000 persons), and C) expenditure on dog vaccination (per 100,000 persons).Countries shaded in grey are free from canine rabies.
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pntd.0003709.g003: The distribution of the global burden of rabies: A) human rabies deaths, B) per capita death rates (per 100,000 persons), and C) expenditure on dog vaccination (per 100,000 persons).Countries shaded in grey are free from canine rabies.

Mentions: Results of predicted rabies mortality, morbidity and DALYs are provided by cluster in Table 2 and by country in S1 Table. We estimated that around 59,000 [95% CIs: 25,000–159,200] human rabies deaths occur annually globally, with the vast majority of these in Africa (36.4%) and Asia (59.6%). Less than 0.05% of estimated deaths occurred in the Americas [182, 95% CIs: 84–428], of which over 70% were from Haiti. India, with 35% of human rabies deaths, accounted for more deaths than any other country, but the estimated per-person death rate was highest in the poorest countries in sub-Saharan Africa. The global distribution of estimated human deaths and death rates due to rabies is illustrated in Fig 3. The parameters that had the greatest impact on variation in estimated human rabies mortality were bite incidence, followed by the probability of receiving PEP and the probability of developing rabies after a rabid animal bite in the absence of PEP (Fig 4).


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)

The distribution of the global burden of rabies: A) human rabies deaths, B) per capita death rates (per 100,000 persons), and C) expenditure on dog vaccination (per 100,000 persons).Countries shaded in grey are free from canine rabies.
© Copyright Policy
Related In: Results  -  Collection

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

pntd.0003709.g003: The distribution of the global burden of rabies: A) human rabies deaths, B) per capita death rates (per 100,000 persons), and C) expenditure on dog vaccination (per 100,000 persons).Countries shaded in grey are free from canine rabies.
Mentions: Results of predicted rabies mortality, morbidity and DALYs are provided by cluster in Table 2 and by country in S1 Table. We estimated that around 59,000 [95% CIs: 25,000–159,200] human rabies deaths occur annually globally, with the vast majority of these in Africa (36.4%) and Asia (59.6%). Less than 0.05% of estimated deaths occurred in the Americas [182, 95% CIs: 84–428], of which over 70% were from Haiti. India, with 35% of human rabies deaths, accounted for more deaths than any other country, but the estimated per-person death rate was highest in the poorest countries in sub-Saharan Africa. The global distribution of estimated human deaths and death rates due to rabies is illustrated in Fig 3. The parameters that had the greatest impact on variation in estimated human rabies mortality were bite incidence, followed by the probability of receiving PEP and the probability of developing rabies after a rabid animal bite in the absence of PEP (Fig 4).

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