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
