25 research outputs found
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
Background: Rabies is a notoriously underreported and neglected disease of lowincome
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.<p></p>
Methodology/Principal Findings: We 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%).<p></p>
Conclusions/Significance: This 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.<p></p>
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
Rabies transmitted by vampire bats to humans: An emerging zoonotic disease in Latin America? Revista Panamericana Salud Pública
Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided
Rabies transmitted by vampire bats to humans: An emerging zoonotic disease in Latin America? Revista Panamericana Salud Pública
Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided
Current status of human rabies transmitted by dogs in Latin America
Latin American countries made the political decision to eliminate human rabies transmitted by dogs by the year 2005. The purpose of the current study is to evaluate to what extent this goal has been reached. The epidemiological situation and control measures were analyzed and broken down within the countries by georeferencing. The 27 human cases reported in 2003 occurred in some 0.2% of the second-level geopolitical units (municipalities or counties) in the region, suggesting that the disease is a local problem. Several areas within the countries reported no more transmission of rabies in dogs. Nearly 1 million people potentially exposed to rabies received treatment. On average, 34,383 inhabitants per health post receive anti-rabies treatment (range: 4,300-148,043). Nearly 42 million dogs are vaccinated annually. Surveillance is considered fair according to the epidemiological criteria adopted by the study. Samples sent for rabies testing represent 0.05% of the estimated canine population (range: 0.001 to 0.2%). The countries are quite close to achieving the goal
Rabies transmitted by vampire bats to humans: An emerging zoonotic disease in Latin America? Revista Panamericana Salud Pública
Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided
Rabies transmitted by vampire bats to humans: An emerging zoonotic disease in Latin America?
Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided