Abstract
Close to 69,000 humans die of rabies each year, most of them in Africa and Asia. Clinical rabies can be prevented by post-exposure prophylaxis (PEP). However, PEP is commonly not available or not affordable in developing countries. Another strategy besides treating exposed humans is the vaccination of vector species. In developing countries, the main vector is the domestic dog, that, once infected, is a serious threat to humans. After a successful mass vaccination of 70% of the dogs in N’Djaména, we report here a cost-estimate for a national rabies elimination campaign for Chad. In a cross-sectional survey in four rural zones, we established the canine : human ratio at the household level. Based on human census data and the prevailing socio-cultural composition of rural zones of Chad, the total canine population was estimated at 1,205,361 dogs (95% Confidence interval 1,128,008–1,736,774 dogs). Cost data were collected from government sources and the recent canine mass vaccination campaign in N’Djaména. A Monte Carlo simulation was used for the simulation of the average cost and its variability, using probability distributions for dog numbers and cost items. Assuming the vaccination of 100 dogs on average per vaccination post and a duration of one year, the total cost for the vaccination of the national Chadian canine population is estimated at 2,716,359 Euros (95% CI 2,417,353–3,035,081) for one vaccination round. A development impact bond (DIB) organizational structure and cash flow scenario were then developed for the elimination of canine rabies in Chad. Cumulative discounted cost of 28.3 million Euros over ten years would be shared between the government of Chad, private investors and institutional donors as outcome funders. In this way, the risk of the investment could be shared and the necessary investment could be made available upfront – a key element for the elimination of canine rabies in Chad.
Highlights
The most recent analysis estimates that annually worldwide, canine rabies causes 59,000 human deaths, over 3.7 million disability-adjusted life years (DALYs) and 8.6 billion USD economic loss (Hampson et al, 2015)
Using an estimated canine population of 1.2 million dogs the social cost per vaccinated dog varies between 1,047-2,575 FCFA (1.5-3.9 Euros, 1 Euros = 655 FCFA) (Table 4)
The high turnover of the canine populations in Chad, with an average live-span of not more than three years (Mindekem et al, 2005), indicates that scenarios favouring the vaccination of the total Chadian canine population should be prioritized
Summary
The most recent analysis estimates that annually worldwide, canine rabies causes 59,000 human deaths, over 3.7 million disability-adjusted life years (DALYs) and 8.6 billion USD economic loss (Hampson et al, 2015). Clinical rabies can be prevented by post-exposure prophylaxis (PEP). Often PEP is either not available or not affordable in developing countries. Even if PEP were subsidized, out-of-pocket expenses remain a huge cost burden to affected families, exceeding 2–3 months wages (Zinsstag et al, 2009; Frey et al, 2013). Any human exposed to a suspected rabid animal bite must receive PEP. The use of PEP alone will never interrupt rabies transmission. The most important vector is the domestic dog, which once infected, is a serious threat to humans (Wandeler et al, 1993). Mass vaccination of dogs can eventually interrupt transmission and lead to the elimination of the disease
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
