Elimination Of Human Rabies Deaths Research Articles

The evaluation of operating Animal Bite Treatment Centers in the Philippines from a health provider perspective.

BackgroundThe Philippine government has an extensive network of 513 Animal Bite Treatment Centers (ABTCs) to supply rabies post exposure prophylaxis (PEP), reaching over 1 million bite victims in 2016. The network was evaluated using a review of existing national and provincial data, key informant interviews and surveys in sample ABTCs to determine the cost-effectiveness of this network in preventing human rabies deaths.Methodology and principal findingsOne urban and one rural ABTC in each of three selected provinces were studied in more detail. PEP delivery generally followed national guidance based on best practices, but there was evidence of operational challenges in supplying all ABTCs with adequate biologics and recently trained staff. Funding was contributed by different levels of government and in some clinics, patients paid for a significant fraction of the total cost. From a health provider perspective including both fixed and variable costs, the average PEP course delivered cost USD 32.91 /patient across urban ABTCs (with higher patient throughput) and USD 57.21 /patient across rural ABTCs. These costs suggests that PEP provision in the Philippines cost USD 37.6 million in 2016, with a cost per life saved of USD 8,290. An analysis of the 2,239 suspected rabies deaths from 2008 to 2016 showed no significant decline, and from 2014–16 an average of 8,534 years of life were lost annually. The incidence of rabies deaths from 2014–16 was not clearly related to the provision of ABTCs (per 100,000 population) or human population density, but deaths were more common in higher income provinces.Conclusions/SignificanceIn the context of comprehensive rabies control (including dog vaccination and public awareness) ways to reduce this high expenditure on PEP should be explored, to most cost-effectively reach the elimination of human rabies deaths. This paper is accompanied by another containing data on the operation of ABTCs network from a patient perspective.

Rabies: changing prophylaxis and new insights in pathophysiology.

Despite great progress in decoding disease mechanisms, rabies remains one of the leading causes of human death worldwide. Towards the elimination of human rabies deaths by 2030, feasible and affordable post (PEP) and pre-exposure prophylaxis (PrEP) must be available with expansion to rural areas in rabies endemic countries. Vaccination and population control of dogs, principal reservoirs and transmitters, must be done in concert. Advances in the understanding of rabies neuropathogenesis and pathophysiology are reviewed, including recent experimental findings on host- and virus-specific mechanisms mediating neuronal survival and explaining clinical differences in furious and paralytic rabies. The forthcoming World Health Organization guide on rabies based on pathogenesis and immunization mechanisms data with support by clinical evidence provide new accelerated 1 week intradermal PrEP and PEP schedules. Rabies immunoglobulin injected into the wound only is endorsed at amounts not exceeding the dose interfering with active immunization. Potential therapeutics as designed in accord with rabies neuro-pathophysiology are plausible. Clinical practice and rabies awareness can be leveraged by transboundary collaboration among different areas. Advancement in prophylaxis and perspectives on animal control offer a new path to conquer rabies by 2030.

Current Situation of Rabies Prevention and Control in Developing Countries: Ethiopia Perspective

Rabies is a neglected zoonotic disease which kills up to 60,000 people a year, most of them in Africa and Asia. In the majority of developing countries, the number of patients receiving post exposure prophylaxis has steadily increased over time, particularly in urban areas due to dog related rabies. Studies conducted in sub-Saharan Africa show that most of the rabies cases in animals and humans are caused by canine rabies virus, mostly transmitted by domestic dogs and thus comprehensive and sustained dog vaccination is sufficient intervention in reduction and eventual elimination of human rabies in the region. In many developing countries, progress in preventing human rabies through control of the disease in the dog reservoir were slow due to technical, intersectoral, organizational and financial barriers. For developing countries like Ethiopia, strategy should be developed to prevent and control the disease. Sustainable resources for effective dog vaccination are likely to be available through the development of intersectoral financing schemes involving both medical and veterinary sectors. Prevention of animal rabies through dog vaccination, better public awareness, improved access to cost-effective and high-quality human rabies vaccines, and improved local capacity in rabies surveillance and diagnostics are essential for the elimination of human rabies. Generally, elimination of canine rabies is epidemiologically and practically feasible through mass vaccination of domestic dogs which is cost-effective approach to the prevention and elimination of human rabies deaths. The purpose of this paper is to show the burden of the disease and to give direction for effective prevention and control following developed countries experience.

The Feasibility of Canine Rabies Elimination in Africa: Dispelling Doubts with Data

BackgroundCanine rabies causes many thousands of human deaths every year in Africa, and continues to increase throughout much of the continent.Methodology/Principal FindingsThis paper identifies four common reasons given for the lack of effective canine rabies control in Africa: (a) a low priority given for disease control as a result of lack of awareness of the rabies burden; (b) epidemiological constraints such as uncertainties about the required levels of vaccination coverage and the possibility of sustained cycles of infection in wildlife; (c) operational constraints including accessibility of dogs for vaccination and insufficient knowledge of dog population sizes for planning of vaccination campaigns; and (d) limited resources for implementation of rabies surveillance and control. We address each of these issues in turn, presenting data from field studies and modelling approaches used in Tanzania, including burden of disease evaluations, detailed epidemiological studies, operational data from vaccination campaigns in different demographic and ecological settings, and economic analyses of the cost-effectiveness of dog vaccination for human rabies prevention.Conclusions/SignificanceWe conclude that there are no insurmountable problems to canine rabies control in most of Africa; that elimination of canine rabies is epidemiologically and practically feasible through mass vaccination of domestic dogs; and that domestic dog vaccination provides a cost-effective approach to the prevention and elimination of human rabies deaths.