The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study

Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in m...

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Bibliographic Details
Published in:	The Lancet infectious diseases Vol. 19; no. 1; pp. 102 - 111
Main Authors:	Hampson, Katie, Ventura, Francesco, Steenson, Rachel, Mancy, Rebecca, Trotter, Caroline, Cooper, Laura, Abela-Ridder, Bernadette, Knopf, Lea, Ringenier, Moniek, Tenzin, Tenzin, Ly, Sowath, Tarantola, Arnaud, Moyengar, Ronelngar, Oussiguéré, Assandi, Bonfoh, Bassirou, Narayana, DH Ashwath, Sudarshan, Mysore Kalappa, Muturi, Matthew, Mwatondo, Athman, Wambura, Gati, Andriamandimby, Soa Fy, Baril, Laurence, Edosoa, Glenn T, Traoré, Abdallah, Jayme, Sarah, Kotzé, Johann, Gunesekera, Amila, Chitnis, Nakul, Hattendorf, Jan, Laager, Mirjam, Lechenne, Monique, Zinsstag, Jakob, Changalucha, Joel, Mtema, Zac, Lugelo, Ahmed, Lushasi, Kennedy, Yurachai, Onphirul, Metcalf, Charlotte Jessica E., Rajeev, Malavika, Blanton, Jesse, Costa, Galileu Barbosa, Sreenivasan, Nandini, Wallace, Ryan, Briggs, Deborah, Taylor, Louise, Thumbi, Samuel M., Huong, Nguyen Thi Thanh
Format:	Journal Article
Language:	English
Published:	United States Elsevier Ltd 01.01.2019 Elsevier Limited New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001 Elsevier Science ;, The Lancet Pub. Group
Subjects:	Animal vaccines Animals Bites and Stings - virology Child, Preschool Cost-Benefit Analysis - methods Costs Dog Diseases - prevention & control Dogs Economic analysis Economic models Endemic Diseases - prevention & control Epidemiology Exposure Fatalities Female Human health and pathology Humans Immunization Immunoglobulins Immunoglobulins - therapeutic use Incidence Infectious diseases Investment policy Life Sciences Low income groups Male Models, Economic Post-Exposure Prophylaxis - economics Post-Exposure Prophylaxis - methods Prevention Production capacity Prophylaxis Quality-Adjusted Life Years Rabies Rabies - epidemiology Rabies - mortality Rabies - prevention & control Rabies - virology Rabies Vaccines - economics Rabies Vaccines - therapeutic use Rabies virus - immunology Rabies virus - isolation & purification Risk assessment Scaling Studies Vaccination - economics Vaccines World Health Organization Cambodia Asia United States > US Africa
ISSN:	1473-3099, 1474-4457, 1474-4457
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Summary:	Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply. We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs. We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use. Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies. World Health Organization.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 PMCID: PMC6300480 Contributors are listed in the appendix
ISSN:	1473-3099 1474-4457 1474-4457
DOI:	10.1016/S1473-3099(18)30512-7