Transmission dynamics and economics of rabies control in dogs and humans in an African city.
Human rabies in developing countries can be prevented through interventions directed at dogs. Potential cost-savings for the public health sector of interventions aimed at animal-host reservoirs should be assessed. Available deterministic models of rabies transmission between dogs were extended to include dog-to-human rabies transmission. Model parameters were fitted to routine weekly rabid-dog and exposed-human cases reported in N'Djaména, the capital of Chad. The estimated transmission rates between dogs (beta(d)) were 0.0807 km2/(dogs x week) and between dogs and humans (beta(dh)) 0.0002 km2/(dogs x week). The effective reproductive ratio (R(e)) at the onset of our observations was estimated at 1.01, indicating low-level endemic stability of rabies transmission. Human rabies incidence depended critically on dog-related transmission parameters. We simulated the effects of mass dog vaccination and the culling of a percentage of the dog population on human rabies incidence. A single parenteral dog rabies-mass vaccination campaign achieving a coverage of least 70% appears to be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to postexposure prophylaxis (PEP), which is the current practice in Chad. PEP does not reduce future human exposure. Its cost-effectiveness is estimated at US $46 per disability adjusted life-years averted. Cost-effectiveness for PEP, together with a dog-vaccination campaign, breaks even with cost-effectiveness of PEP alone after almost 5 years. Beyond a time-frame of 7 years, it appears to be more cost-effective to combine parenteral dog-vaccination campaigns with human PEP compared to human PEP alone.
Zinsstag
J
J
Swiss Tropical Institute, PO Box, CH-4002 Basle, Switzerland. jakob.zinsstag@unibas.ch
Dürr
S
S
Penny
M A
MA
Mindekem
R
R
Roth
F
F
Menendez Gonzalez
S
S
Naissengar
S
S
Hattendorf
J
J
D000818:Animals; D002596:Chad; D003362:Cost-Benefit Analysis; D004283:Dog Diseases / Q000191:economics / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D004285:Dogs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D008297:Male; D011818:Rabies / Q000191:economics / Q000517:prevention & control* / Q000635:transmission / Q000662:veterinary*; D011819:Rabies Vaccines / Q000276:immunology; D014504:Urban Health
D011819:Rabies Vaccines
Bull World Health Organ. 2002;80(4):304-10
12075367
Vaccine. 1996 Feb;14(3):185-6
8920697
Virus Res. 2005 Jul;111(1):5-12
15896398
Trop Med Int Health. 2006 Jul;11(7):1058-65
16827706
Rev Sci Tech. 1993 Mar;12(1):51-71
8518447
Bull World Health Organ. 1994;72(3):429-45
8062401
Rev Infect Dis. 1988 Nov-Dec;10 Suppl 4:S697-702
3206083
Bull World Health Organ. 2003;81(12):867-76
14997239
Emerg Infect Dis. 2007 Apr;13(4):527-31
17553265
Bull World Health Organ. 1990;68(3):281-91
2118428
World Health Organ Tech Rep Ser. 2005;931:1-88, back cover
16485446
Emerg Infect Dis. 2008 Oct;14(10):1650-2
18826838
PLoS Negl Trop Dis. 2008 Mar 26;2(3):e206
18365035
Epidemiol Infect. 2002 Aug;129(1):215-22
12211590
Emerg Infect Dis. 2004 Jan;10(1):140-2
15078611
Dakar Med. 1993;38(2):123-8
7758368
Med Trop (Mars). 2005;65(1):53-8
15903078
Bull World Health Organ. 2003;81(10):739-44
14758434
Vaccine. 2006 Feb 20;24(8):1063-72
16213633
Proc Natl Acad Sci U S A. 2007 May 1;104(18):7717-22
17452645
Prev Vet Med. 2003 Nov 12;61(3):227-33
14554145
Bull World Health Organ. 2005 May;83(5):360-8
15976877