title: Transmission dynamics and economics of rabies control in dogs and humans in an African city.
abstract: 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.
authors.affiliation: Swiss Tropical Institute, PO Box, CH-4002 Basle, Switzerland. jakob.zinsstag@unibas.ch
authors.forename: J
authors.initials: J
authors.lastname: Zinsstag
authors.forename: S
authors.initials: S
authors.lastname: Dürr
authors.forename: M A
authors.initials: MA
authors.lastname: Penny
authors.forename: R
authors.initials: R
authors.lastname: Mindekem
authors.forename: F
authors.initials: F
authors.lastname: Roth
authors.forename: S
authors.initials: S
authors.lastname: Menendez Gonzalez
authors.forename: S
authors.initials: S
authors.lastname: Naissengar
authors.forename: J
authors.initials: J
authors.lastname: Hattendorf
mesh_terms: 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
chemical_list: D011819:Rabies Vaccines
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