The formation of the Eastern Africa rabies network : a sub-regional approach to rabies elimination

International rabies networks have been formed in many of the canine-rabies endemic regions around the world to create unified and directed regional approaches towards elimination. The aim of the first sub-regional Eastern Africa rabies network meeting, which included Kenya, Ethiopia, Tanzania, Rwanda, and Uganda, was to discuss how individual country strategies could be coordinated to address the unique challenges that are faced within the network. The Stepwise Approach towards Rabies Elimination and the Global Dog Rabies Elimination Pathway tool were used to stimulate discussion and planning to achieve the elimination of canine-mediated human rabies by 2030. Our analysis estimated a total dog population of 18.3 million dogs in the Eastern Africa region. The current dog vaccination coverage was estimated to be approximately 5% (915,000 dogs), with an estimated 4910 vaccinators available. Assuming that every vaccinator performs rabies vaccination, this equated to each vaccinator currently vaccinating 186 dogs per year, whilst the target would be to vaccinate 2609 dogs every year for the community to reach 70% coverage. In order to achieve the World Health Organization-recommended 70% vaccination coverage, an additional 11 million dogs need to be vaccinated each year, pointing to an average annual shortfall of $ 23 million USD in current spending to achieve elimination by 2030 across the region. Improved vaccination efficiency within the region could be achieved by improving logistics and/or incorporating multiple vaccination methods to increase vaccinator efficiency, and could serve to reduce the financial burden associated with rabies elimination. Regional approaches to rabies control are of value, as neighboring countries can share their unique challenges while, at the same time, common approaches can be developed and resource-saving strategies can be implemented.http://www.mdpi.com/journal/tropicalmedam2018Microbiology and Plant Patholog

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

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

Sensitivity analysis and numerical simulations for the mathematical model of rabies in human and animal within and around Addis ababa

Research Article published by Asian Journal of Mathematics and ApplicationsRabies is one of the neglected tropical diseases that has persisted for centuries in Ethiopia, and it is endemic within and around Addis Ababa. For the purpose of studying the dynamics of the disease we propose a deterministic mathematical model with human, dog and livestock populations and formulated as a system of ordinary differential equations. Basic reproduction number 0 R and effective reproduction number e R are computed using next generation operator. Sensitivity analysis of e R shows the natural death rate of dogs , the annual birth rate of dogs , dog-to-dog transmission rate , and disease induced death rate are found to be the most sensitive parameters of e R . According to numerical simulations of our system rabies transmission will increase within and around Addis Ababa, and may peak in 2024 and 2026 in human and livestock populations respectively. Our simulation shows that 25% vaccination coverage in livestock populations will reduce the future infection by half. This study suggests that a combination of interventions consisting of 60% of vaccination coverage in dog populations, 15% culling of stray dogs, and reducing annual crop of newborn puppies by 25% will reduce the number of human and livestock infections by 70%, and the disease will be eradicated from the community

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

<div><p>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.</p></div

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

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

Map of Ethiopia showing the three study districts.

<p>Map of Ethiopia showing the three study districts.</p

Cost classification for burden of rabies exposure.

<p>Cost classification for burden of rabies exposure.</p

Number of dog bite cases, rabies suspected dog bite cases (RSDB cases), RSDB cases visiting a health center and RSDB cases receiving sufficient PEP (in absolute figures and relative to the number of RSDB cases (italic)).

<p>Number of dog bite cases, rabies suspected dog bite cases (RSDB cases), RSDB cases visiting a health center and RSDB cases receiving sufficient PEP (in absolute figures and relative to the number of RSDB cases (italic)).</p

Classification of total dog bite cases to those who visited health center or not (visit), the rabies status of the biting dog and the type of treatment (action) with corresponding cost diagram underneath.

<p>Numbers of cases per category are indicated between brackets.</p

Annual health burden due to rabies disease and adverse effects of Nervous Tissue Vaccine (NTV) in DALYs per 100,000 population.

<p>Annual health burden due to rabies disease and adverse effects of Nervous Tissue Vaccine (NTV) in DALYs per 100,000 population.</p