Review on Dog Rabies Vaccination Coverage in Africa: A Question of Dog Accessibility or Cost Recovery?

Rabies is one of the most fatal diseases in both humans and animals. A bite by a rabid dog is the main cause of human rabies in Africa. Parenteral mass dog vaccination is the most cost-effective tool to prevent rabies in humans. Our main objective was to review research articles on the parenteral dog rabies vaccination coverage in Africa. We aimed to review published research articles on percentage of dogs owned and percentage of dogs vaccinated against rabies, and on the relation between vaccination coverage and cost recovery.We followed the standard procedures of a systematic literature review resulting in a final review of 16 scientific articles. Our review results indicate that only a small percentage of African dogs is ownerless. Puppies younger than 3 months of age constitute a considerable proportion of the African dog population. There are considerably more male dogs than female dogs present within the dog population. The dog rabies parenteral vaccination coverage following a “free of charge” vaccination scheme (68%) is closer to World Health Organization recommended threshold coverage rate (70%) compared to the coverage rate achieved in “owner-charged” dog rabies vaccination schemes (18%). In conclusion, most dogs in Africa are owned and accessible for vaccination once the necessary financial arrangements have been made

Economic impacts of constrained replacement heifer supply in dairy herds

CONTEXT: In recent years, environmental policies, especially in North-western European countries have put pressure on the total livestock on a dairy farm. On closed dairy farms this primarily has resulted in a reduction of the heifer rearing unit to maintain the production unit. The economic consequences of constrained replacement heifer supply on herd level have not been investigated. OBJECTIVE: The objective of this study is to study on herd level the economic impact of suboptimal replacement decisions due to a constrained replacement heifer supply. METHODS: In this study, we combine a single-cow MDP (Markov Decision Process) optimization model with dairy herd dynamics simulation of 10 years to account for the interdependency among dairy cows within the herd of 100 cows. Besides the base scenario of following optimal replacement policy, we simulated three input scenarios of constrained, excess, and variable replacement heifer supply. RESULTS AND CONCLUSION: In the base scenario, optimal replacement policy resulted in a herd gross margin of €155,108, 11% voluntary replacement rate, 24% involuntary disposal rate annually for a herd of 100 cows. Constrained as well as excess heifer supply resulted in lower gross margins of €85,878 and €138,406 respectively, compared to the base scenario. Constrained heifer supply also resulted in 39% reduction of herd size, involuntary disposal of 17.5% and no voluntary replacements (0.1%) on average per year. Variable heifer supply scenario resulted in lower gross margins (€115,127), lower voluntary replacement rate (4%), highest involuntary disposal rate (28%) but did not result in reduction of herd size, compared to the base scenario. In conclusion, we developed a combination of cow level optimization with a herd level simulation to study the economic impacts of constrained replacement heifer supply. We found that severely constrained, excess, and variable heifer supply result in reduced herd average gross margin. SIGNIFICANCE: Optimization replacement policy in case of limited heifer availability requires an inter-cow comparison to determine which cows need to be replaced first as this study shows. By demonstrating a simplified approach of combining individual cow optimization with herd dynamics simulation, we accounted for the inter-dependencies within herd. Such an approach can be instrumental in studying environmental impacts, longevity, and welfare of cows when heifer supply is constrained on a herd level

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

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

The effect of hormone therapy on breast density following risk-reducing salpingo-oophorectomy in women with an increased risk for breast and ovarian cancer

OBJECTIVE: To compare the effect of tibolone to conjugated estrogens with medroxyprogesterone-acetate (CEE + MPA) on breast density, as a predictor for breast cancer risk, in women with a high risk of breast and ovarian cancer. METHODS: Women aged 30-50 (N = 114) who had undergone risk-reducing salpingo-oophorectomy (RRSO) were randomized to tibolone or CEE + MPA. RESULTS: Breast density decreased 46% after RRSO in untreated women, 39% after treatment with tibolone, and 17% after treatment with CEE + MPA; the decrease in breast density after CEE + MPA was significantly different compared with that of untreated women (P = 0.017). CONCLUSIONS: A decline in breast density is seen after premenopausal RRSO despite the use of both CEE + MPA or tibolone, although lower breast density is seen after tibolone use

Economic Analysis of HPAI Control in the Netherlands II: Comparison of Control Strategies

A combined epidemiological-economic modelling approach was used to analyse strategies for highly pathogenic avian influenza (HPAI) control for the Netherlands. The modelling framework used was InterSpread Plus (ISP), a spatially based, stochastic and dynamic simulation model. A total of eight control strategies were analysed, including pre-emptive depopulation and vaccination strategies. The analysis was carried out for three different regions in the Netherlands: high-, medium- and low-density areas (HDA, MDA and LDA, respectively). The analysis included the veterinary impact (e.g. number of infected premises and duration), but was particularly focused on the impact on direct costs (DC) and direct consequential costs. The efficient set of control strategies for HDA and MDA included strategies based on either pre-emptive depopulation only or combined vaccination and pre-emptive depopulation: D2 (pre-emptive depopulation within a radius of 2 km), RV3 + D1 (ring vaccination within a radius of 3 km and additional pre-emptive depopulation within a radius of 1 km) and PV + D1 (preventive vaccination in non-affected HDAs and pre-emptive depopulation within a radius of 1 km in the affected HDA). Although control solely based on depopulation in most cases showed to be effective for LDA, pre-emptive depopulation showed to have an additional advantage in these areas, that is, prevention of 'virus jumps' to other areas. The pros and cons of the efficient control strategies were discussed, for example, public perception and risk of export restrictions. It was concluded that for the Netherlands control of HPAI preferably should be carried out using strategies including pre-emptive depopulation with or without vaccination. Particularly, the short- and long-term implications on export, that is, indirect consequential costs (ICC) and aftermath costs of these strategies, should be analysed further

Intention of dog owners to participate in rabies control measures in Flores Island, Indonesia

The success of a rabies control strategy depends on the commitment and collaboration of dog owners. In this study the theory of planned behaviour (TPB) was used to identify the factors, which are associated with the intention of dog owners to participate in rabies control measures in the Manggarai and Sikka regencies of Flores Island, Indonesia. Questionnaires were administered to 450 dog owners from 44 randomly selected villages in the two regencies. Ninety-six percent of the dog owners intended to participate in a free-of-charge vaccination campaign. The intention decreased to 24% when dog owners were asked to pay a vaccination fee equal to the market price of the vaccine (Rp 18.000 per dose = US$2). Approximately 81% of the dog owners intended to keep their dogs inside their house or to leash them day and night during a period of at least three months in case of an incidence of rabies in the dog population within their village. Only 40% intended to cull their dogs in case of a rabies incident within their village. Using multivariable logistic regression analysis, the attitude item 'vaccinating dogs reduces rabies cases in humans', and the perceived behavioural control items 'availability of time' and 'ability to confine dogs' were shown to be significantly associated with the intention to participate in a free-of-charge vaccination campaign. The attitude item 'culling dogs reduces rabies cases in humans' was significantly associated with the intention to participate in a culling measure. The attitude item 'leashing of dogs reduces human rabies cases' and perceived behavioural controls 'availability of time' and 'money to buy a leash' were associated with the intention to leash dogs during a rabies outbreak. As the attitude variables were often significantly associated with intention to participate in a rabies control measure, an educational rabies campaign focusing on the benefit of rabies control measures is expected to increase the intention of dog owners to participate in future rabies control measures. The significant association between perceived behavioural controls and intention to participate points to other relevant policy interventions. Providing dog owners with a skill to confine dogs and creating a subsidy program for the vaccine and leash costs, by involving non-governmental organisations or charitable organisations, may be useful policy interventions. Moreover appropriate time management, such as implementing vaccination campaigns during the weekend, could increase the intention to participate in vaccination campaigns, by relaxing the constraints on the availability of dog owners' time

Cost-effectiveness of mass dog rabies vaccination strategies to reduce human health burden in Flores Island, Indonesia

The cost-effectiveness of different mass dog rabies vaccination strategies, defined as the costs per year of life lost (YLL) averted was evaluated for a period of 10 years by means of a dynamic simulation study for a typical village on Flores Island.In the base strategy (no dog vaccination and no post-exposure treatment (PET) of human bite cases), the model showed that the introduction of the virus by one infectious dog into an isolated village with 1500 inhabitants and 400 dogs resulted in 881 YLLs during a 10-year simulation period, which is equivalent to 30 human rabies cases. An annual dog vaccination campaign with a coverage of 70% using a short-acting vaccine saved 832 YLLs, while the cumulative costs for the public sector were US$3646 or US$4.38 per YLL averted. Switching to a long-acting vaccine, the annual vaccination strategies with a coverage of 50% (AV_156_50) or 70% (AV_156_70) reduced the baseline YLLs from 881 to respectively 78 and 26 YLLs with cumulative costs of US$3716 and US$2264 or US$4.63 and US$2.65 per YLL averted, respectively. In general, dog vaccination was more cost-effective than PET alone (US$2.65-4.63 per YLL averted versus US$23.29 per YLL averted). Although a combination of PET with AV_156_70 was less cost-effective compared to AV_156_70 alone, this strategy was able to prevent all human deaths due to rabies. A combination of PET with annual vaccination using a short-acting vaccine at a coverage of 50% was far from being cost-effective, suggesting that the currently applied rabies control in Flores Island is not an efficient investment in reducing human rabies burden. An increased investment in either an increase in the current coverage or in a switch from the short-acting vaccine to the long-acting vaccine type would certainly pay off

Dog rabies data reported to multinational organizations from Southern and Eastern African countries

Objective: Rabies is one of the viral diseases with the highest case fatality rate in humans. The main transmission route to humans is through bites, especially of infected dogs. Decisions on the allocation of resources to control and reduce the socio-economic impacts of rabies require reliable data. Several national, regional and international organizations have been gathering rabies data for more than a decade. The objective of this paper was to examine the consistencies in the number of dog rabies cases reported to different multinational organizations by Southern and Eastern African countries and to explore the presence of any time trend among the reported rabies data. Results: Data was systematically extracted from the databases of the Southern and Eastern African Rabies Group - SEARG and the World Organization for Animal Health/World animal health information - OIE/WAHID. Despite differences in entities by which data have been reported to the two organisations, reported numbers were significantly correlated (Spearman's rho = 0.52, P < 0.001). The reported data did not indicate the presence of any trend in the number of reported dog rabies outbreaks. Inconsistencies in the reported numbers were observed between the databases, possibly due to the fact that human and animal health authorities report separately to the organisations involved in addition to the use of indefinite definitions of report categories set by report receiving organizations.</p

Economic impact of foot and mouth disease outbreaks onsmallholder farmers in Ethiopia

Foot and mouth disease is endemic in Ethiopia with occurrences of several outbreaks everyyear. Quantitative information about the impact of the disease on smallholder farming sys-tems in the country is, however, scarce. This study presents a quantitative assessment ofthe clinical and direct economic impacts of foot and mouth disease outbreaks on house-hold level in smallholder livestock farming systems. Impacts were assessed based on dataobtained from case outbreaks in cattle in crop–livestock mixed and pastoral smallholderfarming systems that occurred in 2012 and 2013. Data were collected by using question-naires administered to 512 smallholder farmers in six districts within two administratezones that represent the two smallholder farming systems. Foot and mouth disease morbid-ity rates of 85.2% and 94.9% at herd level; and 74.3% and 60.8% at animal level in the affectedherds were determined for crop–livestock mixed system and pastoral system, respectively.The overall and calf specific mortality rates were 2.4% and 9.7% for the crop–livestock mixedsystem, and 0.7% and 2.6% for the pastoral system, respectively. Herd level morbidity ratewas statistically significantly higher in the pastoral system than in the crop–livestock mixedsystem (P <0.001). The economic losses of foot and mouth disease outbreak due to milkloss, draft power loss and mortality were on average USD 76 per affected herd and USD 9.8per head of cattle in the affected herds in crop–livestock mixed system; and USD 174 peraffected herd and USD 5.3 per head of cattle in the affected herds in the pastoral system.The herd level economic losses were statistically significantly higher for the pastoral sys-tem than for the crop–livestock mixed system (P <0.001). The major loss due to the diseaseoccurred as a result of milk losses and draft power losses whereas mortality losses wererelatively low. Although the presented estimates on the economic losses accounted only forthe visible direct impacts of the disease on herd level, these conservative estimates signifya potential socioeconomic gain from a control intervention