Cost Description and Comparative Cost Efficiency of Post-Exposure Prophylaxis and Canine Mass Vaccination against Rabies in N’Djamena, Chad

Abstract

Rabies claims approximately 59,000 human lives annually and is a potential risk to 3.3 billion people in over 100 countries worldwide. Despite being fatal in almost 100% of cases, human rabies can be prevented by vaccinating dogs, the most common vector, and the timely administration of post-exposure prophylaxis (PEP) to exposed victims. For the control and prevention of human rabies in N’Djamena, the capital city of Chad, a free mass vaccination campaign for dogs was organized in 2012 and 2013. The campaigns were monitored by parallel studies on the incidence of canine rabies based on diagnostic testing of suspect animals and the incidence of human bite exposure recorded at selected health facilities. Based on the cost description of the campaign and the need for PEP registered in health centers, three cost scenarios were compared: cumulative cost-efficiency of (1) PEP alone, (2) dog mass vaccination and PEP, (3) dog mass vaccination, PEP, and maximal communication between human health and veterinary workers (One Health communication). Assuming ideal One Health communication, the cumulative prospective cost of dog vaccination and PEP break even with the cumulative prospective cost of PEP alone in the 10th year from the start of the calculation (2012). The cost efficiency expressed in cost per human exposure averted is much higher with canine vaccination and One Health communication than with PEP alone. As shown in other studies, our cost-effectiveness analysis highlights that canine vaccination is financially the best option for animal rabies control and rabies prevention in humans. This study also provides evidence of the beneficial effect of One Health communication. Only with close communication between the human and animal health sectors will the decrease in animal rabies incidence be translated into a decline for PEP. An efficiently applied One Health concept would largely reduce the cost of PEP in resource poor countries and should be implemented for zoonosis control in general.

Dog Bites and Rabies in the Eastern Region of Ghana in 2013–2015: A Call for a One-Health Approach

“…In the circumstances, and where available, clinicians initiate presumptive postexposure prophylaxis once a report of dog bite is made and the dog cannot be traced, with a low prior probability of rabies this leads to wasteful use of highly expensive rabies vaccines. This was well-demonstrated in the city of N'Djaména in Chad where, following mass dog vaccination, the monthly animal rabies incidence dropped from 1.1/10,000 dogs to 0.061/10,000 dogs in 2014, and yet the demand for PEP remained largely unaffected [21, 22]. The path to rabies prevention following a dog bite is thus an arduous one for the affected person, the attending health worker, and the public health system.…”

Health Data in Dentistry: An Attempt to Master the Digital Challenge

“…We assumed that vaccine administration time is equivalent for all regimens. For this analysis we did not include RIG because it is rarely available to bite victims in endemic countries [10][11][12][13][14].…”

Situation of Rabies in the Republic of Chad

“…In Chad, the risk of human rabies is higher because more than 70 per cent of the population lives in poverty, and the cost of post-exposure prophylaxis is also very higher than the minimum wage [17]. There is also the non availability of the vaccine in country; most often, you have to go to neighboring countries to get them.…”

“…Every year, many victims of dog bites are registered in the city of N'Djamena. In this city, rabies studies began in 2000 and proved that many people are victims of dog bites (25,17). The purpose of this manuscript is to describe a canine rabies situation in The Republic of Tchad since 1990 to date.…”