Limits...
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

Division of costs associated with rabies, prevention and control across sectors by region.Inset shows proportional expenditure in different regions. The breakdown of costs by cluster is given in S1 Fig and Table 3 and detailed by country in S1 Table.
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pntd.0003709.g005: Division of costs associated with rabies, prevention and control across sectors by region.Inset shows proportional expenditure in different regions. The breakdown of costs by cluster is given in S1 Fig and Table 3 and detailed by country in S1 Table.

Mentions: The overall economic costs of canine rabies were estimated as 8.6 billion USD (95% CIs: 2.9–21.5 billion). These costs were mainly due to productivity losses from premature deaths (2.27 billion USD), direct expenditure on PEP (totalling 1.70 billion USD) and lost income whilst seeking PEP (1.31 billion USD). However, there was considerable variation in the breakdown of costs by region (Fig 5): the largest proportion of costs was due to premature death in Asia and Africa; much less was lost due to PEP (direct costs, and from travel and lost income whilst seeking PEP) in Africa compared to Asia and the Americas, and in the Americas a large proportion of costs were due to dog vaccination. Livestock deaths amounted to 512 million USD per year, with major losses in African countries with livestock-dependent economies (e.g. Ethiopia, Sudan, and Tanzania) and in more populous countries in Asia (China, India, Bangladesh and Pakistan). Table 3 provides a breakdown of estimated costs and a country breakdown is given in S1 Table.


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)

Division of costs associated with rabies, prevention and control across sectors by region.Inset shows proportional expenditure in different regions. The breakdown of costs by cluster is given in S1 Fig and Table 3 and detailed by country in S1 Table.
© Copyright Policy
Related In: Results  -  Collection

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

pntd.0003709.g005: Division of costs associated with rabies, prevention and control across sectors by region.Inset shows proportional expenditure in different regions. The breakdown of costs by cluster is given in S1 Fig and Table 3 and detailed by country in S1 Table.
Mentions: The overall economic costs of canine rabies were estimated as 8.6 billion USD (95% CIs: 2.9–21.5 billion). These costs were mainly due to productivity losses from premature deaths (2.27 billion USD), direct expenditure on PEP (totalling 1.70 billion USD) and lost income whilst seeking PEP (1.31 billion USD). However, there was considerable variation in the breakdown of costs by region (Fig 5): the largest proportion of costs was due to premature death in Asia and Africa; much less was lost due to PEP (direct costs, and from travel and lost income whilst seeking PEP) in Africa compared to Asia and the Americas, and in the Americas a large proportion of costs were due to dog vaccination. Livestock deaths amounted to 512 million USD per year, with major losses in African countries with livestock-dependent economies (e.g. Ethiopia, Sudan, and Tanzania) and in more populous countries in Asia (China, India, Bangladesh and Pakistan). Table 3 provides a breakdown of estimated costs and a country breakdown is given in S1 Table.

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