Estimating the Global Burden of Endemic Canine Rabies

Abstract

BackgroundRabies 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 FindingsWe 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/SignificanceThis 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.

The Pan-African Rabies Control Network (PARACON): A unified approach to eliminating canine rabies in Africa

“…Although rabies is entirely vaccine preventable, it remains a neglected zoonotic disease that results in an estimated 59 000 human deaths each year (Hampson et al, 2015). Although this number might not seem significant in comparison to other infectious diseases present in developing countries, rabies is clearly under-estimated with regards to the impact of this fatal disease on society.…”

“…Secondly, due to the limited availability of post-exposure prophylaxis (PEP) in many countries, victims are typically unable to receive timely treatment, and the costs of PEP tend to be very high considering the low income profiles of rural communities in the developing world. Lastly, despite rabies not being viewed as a disease that affects economically important animals, livestock losses are valued at US$279,546,173 per year in Africa, resulting in gross domestic product losses of US$773,352,665 per year (Hampson et al, 2015;Sambo et al, 2013). This has a major impact on the livelihood of communities, especially in low and middle income countries (LMICs) where the burden of the disease tends to be highest.…”

“…This has a major impact on the livelihood of communities, especially in low and middle income countries (LMICs) where the burden of the disease tends to be highest. Therefore, the indirect burden associated with rabies accentuates the need to control and eliminate this disease in humans (Hampson et al, 2015). At the same time, the impact on the health and wellbeing of reservoir populations, particularly dogs, are tremendous and often forgotten.…”

A case of rabies in a Kano brown doe

“…Despite this, it has been reported to cause about 59 000 humans deaths annually across Africa and Asia 1. In addition, economic costs due to rabies were estimated to be 8.6 billion USD annually 1. Naturally, its primary host is the domestic and wild dogs.…”

“…Exposure to rabies in developing countries of Africa and Asia is mainly through bites from rabid dogs, and this has been reported to account for about 98% of confirmed human rabies cases 1, 4. Reports from China show that most livestock cases occur as spillovers from rabid carnivores 5.…”