Strategies to inTerrupt RAbies Transmission for the Elimination Goal by 2030 In China (STRATEGIC): a modelling study

Abstract

Background A global plan has been set to end human deaths from dog-mediated rabies by 2030 ("Zero-by-30"), but whether it could be achieved in some countries, such as China, remains unclear. Although elimination strategies through post-exposure prophylaxis (PEP) use, dog vaccination, and patient risk assessments with integrated bite case management (IBCM) were proposed to be cost-effective, evidence is still lacking in China. We aim to evaluate the future burdens of dog-mediated human rabies deaths in the next decade and provide quantitative evidence on the cost-effectiveness of different rabies-control strategies in China. Methods Based on data from China's national human rabies surveillance system, we used decision-analytic modelling to estimate dog-mediated human rabies death trends in China till 2035. We simulated and compared the expected consequences and costs of different combination strategies of the status quo, improved access to PEP, mass dog vaccination, and use of IBCM. Results The predicted human rabies deaths in 2030 in China will be 308 (95%UI: 214–411) and remain stable in the next decade under the status quo. The strategy of improved PEP access alone could only decrease deaths to 212 (95%UI: 147–284) in 2028, remaining unchanged till 2035. In contrast, scaling up dog vaccination to coverage of 70% could eliminate rabies deaths by 2033 and prevent approximately 3,265 (95%UI: 2,477–3,687) extra deaths compared to the status quo during 2024–2035. Moreover, with the addition of IBCM, the "One Health" approach through mass dog vaccination could avoid unnecessary PEP use and substantially reduce total cost from 12.53 (95%UI: 11.71–13.34) to 8.73 (95%UI: 8.09–9.85) billion US dollars. Even if increasing the total costs of IBCM from 100 thousand to 652.10 million US dollars during 2024–2035, the combined strategy of mass dog vaccination and use of IBCM will still dominate, suggesting the robustness of our results. Conclusions The combined strategy of mass dog vaccination and IBCM requires collaboration between health and livestock/veterinary sectors, and it could eliminate Chinese rabies deaths as early as 2033, with more deaths averted and less cost, indicating that adding IBCM could reduce unnecessary use of PEP and make the "One Health" rabies-control strategy most cost-effective.

Building a pathway to One Health surveillance and response in Asian countries

“…Each has its uses and limitations. Models which incorporate spatio-temporal features [ 159 ] and climatic influences [ 112 ] allow more targeted evaluation of the effects of diseases in specific locations, and models can be used to design national control policies linked to surveillance [ 160 ]. Models that incorporate AI components are increasingly being used, for example in dengue prediction [ [161] , [162] , [163] ].…”

Rabies vaccination adherence and associated factors among rabies-exposed patients in Shenzhen, China: a hospital-based cross-sectional study

“…In China, dog-mediated rabies accounts for 95% of rabies cases nationwide, with the rest being mediated by cats and wildlife [ 6 ]. Although studies have demonstrated that mass vaccination of dogs against rabies is the most cost-effective option for rabies eradication [ 7 ], the current level of canine rabies vaccination in China is still low [ 8 ], especially in the less economically developed rural areas of China, and falls far short of the 70% mark [ 9 , 10 ], so timely post-exposure prophylaxis (PEP) and post-exposure vaccination (PEV) for rabies-exposed patients remain important tools for rabies prevention and have important public health implications.…”