title: Estimating the global burden of endemic canine rabies.
abstract: BACKGROUND
  Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.
  
  
  RESULTS
  We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%).
  
  
  CONCLUSIONS
  This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.
authors.affiliation: Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Katie
authors.initials: K
authors.lastname: Hampson
authors.affiliation: Sanofi Pasteur, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Coudeville
authors.affiliation: Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lembo
authors.affiliation: Ifakara Health Institute, Ifakara, Tanzania.
authors.forename: Maganga
authors.initials: M
authors.lastname: Sambo
authors.affiliation: Sanofi Pasteur, Lyon, France.
authors.forename: Alexia
authors.initials: A
authors.lastname: Kieffer
authors.affiliation: Sanofi Pasteur, Lyon, France.
authors.forename: Michaël
authors.initials: M
authors.lastname: Attlan
authors.affiliation: ANSES-French Agency for Food, Environmental and Occupational Health and Safety, Rabies and Wildlife laboratory of Nancy, Atton, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Barrat
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Blanton
authors.affiliation: Global Alliance for Rabies Control, Manhattan, Kansas, United States of America.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Briggs
authors.affiliation: Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cleaveland
authors.affiliation: Global Alliance for Rabies Control, Manhattan, Kansas, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Costa
authors.affiliation: Friedrich-Loeffler-Institute-Federal Research Institute for Animal Health, Greifswald-Insel Riems, Germany.
authors.forename: Conrad M
authors.initials: CM
authors.lastname: Freuling
authors.affiliation: International Companion Animal Management Coalition, Cambridge, United Kingdom.
authors.forename: Elly
authors.initials: E
authors.lastname: Hiby
authors.affiliation: Global Alliance for Rabies Control, Manhattan, Kansas, United States of America.
authors.forename: Lea
authors.initials: L
authors.lastname: Knopf
authors.affiliation: Pan-American Health Organization, Rio de Janeiro, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Leanes
authors.affiliation: Independent rabies scientist, Geneva, Switzerland.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Meslin
authors.affiliation: Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
authors.forename: Artem
authors.initials: A
authors.lastname: Metlin
authors.affiliation: Global Alliance for Rabies Control, Manhattan, Kansas, United States of America.
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Miranda
authors.affiliation: Friedrich-Loeffler-Institute-Federal Research Institute for Animal Health, Greifswald-Insel Riems, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.affiliation: University of Pretoria, Pretoria, South Africa.
authors.forename: Louis H
authors.initials: LH
authors.lastname: Nel
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Sergio
authors.initials: S
authors.lastname: Recuenco
authors.affiliation: Global Alliance for Rabies Control, Manhattan, Kansas, United States of America; Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indes.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rupprecht
authors.affiliation: Merial, Lyon, France.
authors.forename: Carolin
authors.initials: C
authors.lastname: Schumacher
authors.affiliation: Global Alliance for Rabies Control, Manhattan, Kansas, United States of America.
authors.forename: Louise
authors.initials: L
authors.lastname: Taylor
authors.affiliation: Pan-American Health Organization, Rio de Janeiro, Brazil.
authors.forename: Marco Antonio Natal
authors.initials: MA
authors.lastname: Vigilato
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Zinsstag
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dushoff
mesh_terms: D000818:Animals; D004283:Dog Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology*; D004285:Dogs; D019353:Endemic Diseases / Q000662:veterinary*; D014943:Global Health; D006801:Humans; D056990:Post-Exposure Prophylaxis / Q000191:economics; D011634:Public Health / Q000191:economics; D011818:Rabies / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000662:veterinary*; D011819:Rabies Vaccines / Q000191:economics / Q000276:immunology*; D014611:Vaccination / Q000191:economics
chemical_list: D011819:Rabies Vaccines