title: Designing programs for eliminating canine rabies from islands: Bali, Indonesia as a case study.
abstract: BACKGROUND
  Canine rabies is one of the most important and feared zoonotic diseases in the world. In some regions rabies elimination is being successfully coordinated, whereas in others rabies is endemic and continues to spread to uninfected areas. As epidemics emerge, both accepted and contentious control methods are used, as questions remain over the most effective strategy to eliminate rabies. The Indonesian island of Bali was rabies-free until 2008 when an epidemic in domestic dogs began, resulting in the deaths of over 100 people. Here we analyze data from the epidemic and compare the effectiveness of control methods at eliminating rabies.
  
  
  RESULTS
  Using data from Bali, we estimated the basic reproductive number, R(0), of rabies in dogs, to be ~1 · 2, almost identical to that obtained in ten-fold less dense dog populations and suggesting rabies will not be effectively controlled by reducing dog density. We then developed a model to compare options for mass dog vaccination. Comprehensive high coverage was the single most important factor for achieving elimination, with omission of even small areas (<0.5% of the dog population) jeopardizing success. Parameterizing the model with data from the 2010 and 2011 vaccination campaigns, we show that a comprehensive high coverage campaign in 2012 would likely result in elimination, saving ~550 human lives and ~$15 million in prophylaxis costs over the next ten years.
  
  
  CONCLUSIONS
  The elimination of rabies from Bali will not be achieved through achievable reductions in dog density. To ensure elimination, concerted high coverage, repeated, mass dog vaccination campaigns are necessary and the cooperation of all regions of the island is critical. Momentum is building towards development of a strategy for the global elimination of canine rabies, and this study offers valuable new insights about the dynamics and control of this disease, with immediate practical relevance.
authors.affiliation: Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom. sunnytownsend@gmail.com
authors.forename: Sunny E
authors.initials: SE
authors.lastname: Townsend
authors.forename: I Putu
authors.initials: IP
authors.lastname: Sumantra
authors.lastname: Pudjiatmoko
authors.forename: Gusti Ngurah
authors.initials: GN
authors.lastname: Bagus
authors.forename: Eric
authors.initials: E
authors.lastname: Brum
authors.forename: Sarah
authors.initials: S
authors.lastname: Cleaveland
authors.forename: Sally
authors.initials: S
authors.lastname: Crafter
authors.forename: Ayu P M
authors.initials: AP
authors.lastname: Dewi
authors.forename: Dewa Made Ngurah
authors.initials: DM
authors.lastname: Dharma
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dushoff
authors.forename: Janice
authors.initials: J
authors.lastname: Girardi
authors.forename: I Ketut
authors.initials: IK
authors.lastname: Gunata
authors.forename: Elly F
authors.initials: EF
authors.lastname: Hiby
authors.forename: Corlevin
authors.initials: C
authors.lastname: Kalalo
authors.forename: Darryn L
authors.initials: DL
authors.lastname: Knobel
authors.forename: I Wayan
authors.initials: IW
authors.lastname: Mardiana
authors.forename: Anak Agung Gde
authors.initials: AA
authors.lastname: Putra
authors.forename: Luuk
authors.initials: L
authors.lastname: Schoonman
authors.forename: Helen
authors.initials: H
authors.lastname: Scott-Orr
authors.forename: Mike
authors.initials: M
authors.lastname: Shand
authors.forename: I Wayan
authors.initials: IW
authors.lastname: Sukanadi
authors.forename: Pebi Purwo
authors.initials: PP
authors.lastname: Suseno
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Haydon
authors.forename: Katie
authors.initials: K
authors.lastname: Hampson
mesh_terms: D000818:Animals; D050936:Basic Reproduction Number; D060740:Disease Eradication / Q000379:methods / Q000458:organization & administration*; D004283:Dog Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D004285:Dogs; D007214:Indonesia / Q000453:epidemiology; D032541:Mass Vaccination / Q000379:methods; D015233:Models, Statistical; D011156:Population Density; D011818:Rabies / Q000453:epidemiology / Q000517:prevention & control / Q000662:veterinary*; D011819:Rabies Vaccines / Q000008:administration & dosage / Q000276:immunology
chemical_list: D011819:Rabies Vaccines