title: One Health approach to cost-effective rabies control in India.
abstract: Over 20,000 rabies deaths occur annually in India, representing one-third of global human rabies. The Indian state of Tamil Nadu has pioneered a "One Health" committee to address the challenge of rabies in dogs and humans. Currently, rabies control in Tamil Nadu involves postexposure vaccination of humans after dog bites, whereas potential supplemental approaches include canine vaccination and sterilization. We developed a data-driven rabies transmission model fit to human rabies autopsy data and human rabies surveillance data from Tamil Nadu. Integrating local estimates for canine demography and costs, we predicted the impact of canine vaccination and sterilization on human health outcomes and evaluated cost-effectiveness according to the WHO criteria for India, which correspond to thresholds of $1,582 and $4,746 per disability-adjusted life-years (DALYs) for very cost-effective and cost-effective strategies, respectively. We found that highly feasible strategies focused on stray dogs, vaccinating as few as 7% of dogs annually, could very cost-effectively reduce human rabies deaths by 70% within 5 y, and a modest expansion to vaccinating 13% of stray dogs could cost-effectively reduce human rabies by almost 90%. Through integration over parameter uncertainty, we find that, for a cost-effectiveness threshold above $1,400 per DALY, canine interventions are at least 95% likely to be optimal. If owners are willing to bring dogs to central point campaigns at double the rate that campaign teams can capture strays, expanded annual targets become cost-effective. This case study of cost-effective canine interventions in Tamil Nadu may have applicability to other settings in India and beyond.
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.|Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201.
authors.forename: Meagan C
authors.identifier: 0000-0002-5248-2668
authors.initials: MC
authors.lastname: Fitzpatrick
authors.affiliation: Research Division, Public Health Foundation of India, Gurgaon, Haryana 122002, India.
authors.forename: Hiral A
authors.initials: HA
authors.lastname: Shah
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115.
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Bilinski
authors.affiliation: Research Division, Public Health Foundation of India, Gurgaon, Haryana 122002, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Kakkar
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, United Kingdom.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Clark
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510.|Department of Computational Biology and Bioinformatics, Yale University, New Haven, CT 06511.|Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06511.
authors.forename: Jeffrey P
authors.identifier: 0000-0002-9890-3907
authors.initials: JP
authors.lastname: Townsend
authors.affiliation: Research Division, Public Health Foundation of India, Gurgaon, Haryana 122002, India; s.abbas@ids.ac.uk alison.galvani@yale.edu.|Health & Nutrition Cluster, Institute of Development Studies, Brighton BN1 9RE, United Kingdom.
authors.forename: Syed Shahid
authors.identifier: 0000-0003-1964-5303
authors.initials: SS
authors.lastname: Abbas
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510; s.abbas@ids.ac.uk alison.galvani@yale.edu.|Department of Computational Biology and Bioinformatics, Yale University, New Haven, CT 06511.|Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06511.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D000818:Animals; D001733:Bites and Stings / Q000191:economics; D003140:Communicable Disease Control / Q000191:economics*; D003362:Cost-Benefit Analysis; D003710:Demography; D004283:Dog Diseases / Q000191:economics / Q000517:prevention & control; D004285:Dogs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D000074823:One Health; D011818:Rabies / Q000191:economics* / Q000517:prevention & control*; D012680:Sensitivity and Specificity; D014611:Vaccination / Q000191:economics
keywords: cost-effectiveness; mathematical modeling; rabies; sterilization; vaccination