Renewed global partnerships and redesigned roadmaps for rabies prevention and control

Canine rabies, responsible for most human rabies deaths, is a serious global public health concern. This zoonosis is entirely preventable, but by focusing solely upon rabies prevention in humans, this "incurable wound" persists at high costs. Although preventing human deaths through canine rabies elimination is feasible, dog rabies control is often neglected, because dogs are not considered typical economic commodities by the animal health sector. Here, we demonstrate that the responsibility of managing rabies falls upon multiple sectors, that a truly integrated approach is the key to rabies elimination, and that considerable progress has been made to this effect. Achievements include the construction of global rabies networks and organizational partnerships; development of road maps, operational toolkits, and a blueprint for rabies prevention and control; and opportunities for scaling up and replication of successful programs. Progress must continue towards overcoming the remaining challenges preventing the ultimate goal of rabies elimination

Estimating the global burden of endemic canine rabies

Rabies is a fatal viral disease largely transmitted to humans from bites by infected animals —predominantly from domestic dogs. The disease is entirely preventable through prompt administration of post-exposure prophylaxis (PEP) to bite victims and can be controlled through mass vaccination of domestic dogs. Yet, rabies is still very prevalent in developing countries, affecting populations with limited access to health care. The disease is also grossly underreported in these areas because most victims die at home. This leads to insufficient prioritization of rabies prevention in public health agendas. To address this lack of information on the impacts of rabies, in this study, we compiled available data to provide a robust estimate of the health and economic implications of dog rabies globally. The most important impacts included: loss of human lives (approximately 59,000 annually) and productivity due to premature death from rabies, and costs of obtaining PEP once an exposure has occurred. The greatest risk of developing rabies fell upon the poorest regions of the world, where domestic dog vaccination is not widely implemented and access to PEP is most limited. A greater focus on mass dog vaccination could eliminate the disease at source, reducing the need for costly PEP and preventing the large and unnecessary burden of mortality on at-risk communities.S1 Text. Supporting bibliography.S1 Table. Estimates by country of rabies deaths, exposures, PEP use, prevented deaths, dog vaccination coverage, probability that a dog is rabid (RP), of bite victims receiving PEP (PP), DALYs, costs and 95% confidence intervals of estimates. Clusters to which countries are assigned are shown and inputs used for estimating parameters including the human development index and whetehr a country s rabies-free or endemic (RISK). Estimates of years of life lost (YLL) and DALYs (due to rabies and to adverse events from the use of nerve tissue vaccines) are shown under different assumptions (estimates under the assumption of no time discounting or age-weighting should be directly comparable to the 2010 Global Burden of Disease study).S1 Fig. Division of costs associated with rabies, prevention and control across sectors by cluster. Inset shows proportional expenditure in different clusters. Full details of countries by cluster are given in S1 Table. Asia 4 comprises: Philippines, Sri Lanka, Thailand (High PEP use); Asia 3 comprises Bhutan, Nepal, Bangladesh, Pakistan (Himalayan region); Asia 2 comprises Cambodia, Myanmar, Laos, Vietnam and Democratic People’s Republic of Korea; SADC comprises countries in the Southern African Development Community, Eurasia comprises Afghanistan, Kazakhstan, Kyrgyzstan, Mongolia, the Russian Federation, Turkmenistan, Tajikistan, and Uzbekistan.S1 Dataset. Model code and input data files including references, rationale and detail of Delphi process. The code folder contains seven R scripts: burden_model.R runs the model using data compiled in burden_1.R, after estimating parameters using: FitCovInc.R, FitPP.R, and creating Fig 2 (RabiesBurdenFig2.R). The script burden_results.R summarizes findings using the output of burden_model.R and burden_sensitivity.R runs the sensitivity analyses. The data folder contains 12 csv files called by the R code for the analyses, and one excel file (Vet. xlsx) with additional details about the data sources in vcountry2.csv and vcluster2.csv and with Delphi process estimates for dog vaccination coverage. Data sources are detailed in the relevant data sources and the details of the sources of data used in the analysis are in the supporting bibliography, S1 text.This study was funded by the UBS Optimus Foundation (http://www.ubs.com/optimusfoundation) and the Wellcome Trust (095787/Z/11/Z).http://www.plosntds.orgam201

Number of pre-exposure vaccination doses received by students in El Nido elementary schools based on municipal health office records, January to February 2012.

<p>Number of pre-exposure vaccination doses received by students in El Nido elementary schools based on municipal health office records, January to February 2012.</p

Parameters used to estimate cost of PrEP for the study cohort.

<p>Parameters used to estimate cost of PrEP for the study cohort.</p

Incidence of category II and III dog bites among 5–14 year old children in El Nido estimated from passive and active surveillance, 2011 to 2012.

<p>Incidence of category II and III dog bites among 5–14 year old children in El Nido estimated from passive and active surveillance, 2011 to 2012.</p

Costs of PEP according to PrEP status over 1 year.

<p>Costs of PEP according to PrEP status over 1 year.</p

Reasons for non-vaccination of children (N = 328) in school during mass vaccination campaign in El Nido elementary schools, January and February 2012.

<p>Reasons for non-vaccination of children (N = 328) in school during mass vaccination campaign in El Nido elementary schools, January and February 2012.</p

Sources of information on rabies of elementary school students in El Nido, July 2012 and March 2013.

<p>Sources of information on rabies of elementary school students in El Nido, July 2012 and March 2013.</p

Percentages of students who knew about rabies based on pre and post-tests of students in El Nido elementary schools, school year 2012–13.

<p>Percentages of students who knew about rabies based on pre and post-tests of students in El Nido elementary schools, school year 2012–13.</p

Timeline of study activities.

<p>Timeline of study activities.</p