Optimal frequency of rabies vaccination campaigns in Sub-Saharan Africa

Bilinski, Alyssa; Fitzpatrick, Meagan C.; Rupprecht, Charles E.; Paltiel, A. David; Galvani, Alison P.

doi:10.1098/rspb.2016.1211

Cited by 14 publications

(21 citation statements)

References 19 publications

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“…Studies in sub-Saharan Africa countries, where rabies is a public health concern, have shown that investments made to vaccinate a sufficient proportion of dogs would likely minimize the health burden and expenditures related to PET [ 50 ; 51 ; 52 ]. Strategies to reduce human rabies in Ethiopia should, therefore, include mass dog vaccination.…”

Section: Discussionmentioning

confidence: 99%

Estimating the burden of rabies in Ethiopia by tracing dog bite victims

et al. 2018

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In developing countries where financial resources are limited and numerous interests compete, there is a need for quantitative data on the public health burden and costs of diseases to support intervention prioritization. This study aimed at estimating the health burden and post-exposure treatment (PET) costs of canine rabies in Ethiopia by an investigation of exposed human cases. Data on registered animal bite victims during the period of one year were collected from health centers in three districts, i.e. Bishoftu, Lemuna-bilbilo and Yabelo, to account for variation in urban highland and lowland areas. This data collection was followed by an extensive case search for unregistered victims in the same districts as the registered cases. Victims were visited and questioned on their use of PET, incurred treatment costs and the behavioral manifestations of the animal that had bitten them. Based on the collected data PET costs were evaluated by financial accounting and the health burden was estimated in Disability-Adjusted Life Years (DALYs). In total 655 animal bite cases were traced of which 96.5% was caused by dog bites. 73.6% of the biting dogs were suspected to be potentially rabid dog. Annual suspected rabid dog exposures were estimated per evaluated urban, rural highland and rural lowland district at, respectively, 135, 101 and 86 bites, which led, respectively, to about 1, 4 and 3 deaths per 100,000 population. In the same district order average costs per completed PET equaled to 23, 31 and 40 USD, which was significantly higher in rural districts. Extrapolation of the district results to the national level indicated an annual estimate of approximately 3,000 human deaths resulting in about 194,000 DALYs per year and 97,000 exposed persons requiring on average 2 million USD treatment costs per year countrywide. These estimations of the burden of rabies to the Ethiopian society provide decision makers insights into the potential benefits of implementing effective interventions.

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Section: Discussionmentioning

confidence: 99%

Estimating the burden of rabies in Ethiopia by tracing dog bite victims

et al. 2018

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“…V-S interventions are likely to be conducted on relatively small spatial scales due to longer implementation time, and expanding them geographically is likely to be challenging [59]. Geographical co-ordination is key as reintroduction of rabies from non-vaccinated areas is a challenge in rabies control [60].…”

Section: Role Of Sterilisationmentioning

confidence: 99%

Evaluating the role of surgical sterilisation in canine rabies control: A systematic review of impact and outcomes

Collinson

Bennett

Dean³

et al. 2020

PLoS Negl Trop Dis

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Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB Abstracts, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation.

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“…This cost-effectiveness analysis is the first study to include cattle rabies-related losses, a component which has particular importance for livestock-dependent communities. Previous canine vaccination evaluations in Africa and elsewhere have focused primarily on the prevention of human rabies [6,19,[44], [45], [46], [47], [48]]. These studies indicated that high canine vaccination coverage would be cost-effective on the basis of the human health burden alone.…”

Section: Discussionmentioning

confidence: 99%

Impact of One-Health framework on vaccination cost-effectiveness: A case study of rabies in Ethiopia

et al. 2019

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Livestock losses due to rabies and health and the corresponding benefits of controlling the disease are not often considered when the cost-effectiveness of rabies control is evaluated. In this research, assessed the benefits of applying a One Health perspective that includes these losses to the case of canine rabies vaccination in Ethiopia. We constructed a dynamic epidemiological model of rabies transmission. The model was fit to district-specific data on human rabies exposures and canine demography for two districts with distinct agro-ecologies. The epidemiological model was coupled with human and livestock economic outcomes to predict the health and economic impacts under a range of vaccination scenarios. The model indicates that human exposures, human deaths, and rabies-related livestock losses would decrease monotonically with increasing vaccination coverage. In the rural district, all vaccination scenarios were found to be cost-saving compared to the status quo of no vaccination, as more money could be saved by preventing livestock losses than would be required to fund the vaccination campaigns. Vaccination coverages of 70% and 80% were identified as most likely to provide the greatest net health benefits at the WHO cost-effectiveness threshold over a period of 5 years, in urban and rural districts respectively. Shorter time frames led to recommendations for higher coverage in both districts, as did even a minor threat of rabies re-introduction. Exclusion of rabies-related livestock losses reduced the optimal vaccination coverage for the rural district to 50%. This study demonstrated the importance of including all economic consequences of zoonotic disease into control decisions. Analyses that include cattle and other rabies-susceptible livestock are likely better suited to many rural communities in Africa wishing to maximize the benefits of canine vaccination.

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Optimal frequency of rabies vaccination campaigns in Sub-Saharan Africa

Cited by 14 publications

References 19 publications

Estimating the burden of rabies in Ethiopia by tracing dog bite victims

Estimating the burden of rabies in Ethiopia by tracing dog bite victims

Evaluating the role of surgical sterilisation in canine rabies control: A systematic review of impact and outcomes

Impact of One-Health framework on vaccination cost-effectiveness: A case study of rabies in Ethiopia

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