Human Postexposure Prophylaxis Research Articles

Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California.

Pharmacies are a promising setting through which to expand access to human immunodeficiency virus (HIV) prevention, including pre-exposure and post-exposure prophylaxis (PrEP and PEP, respectively). We aimed to evaluate and inform the implementation of California's Senate Bill 159 (2019), allowing pharmacists to independently prescribe PrEP and PEP. From October through December 2022, we conducted a cross-sectional study of 919 California pharmacists and pharmacy students, primarily recruited via the email listservs of professional organizations. Participants completed an online survey assessing the implementation of pharmacist-initiated PrEP/PEP, including knowledge, attitudes, practices, perceived barriers, and implementation preferences elicited through a discrete choice experiment. Among 919 participants (84% practicing pharmacists, 43% in community pharmacies), 11% and 13% reported that pharmacists at their pharmacy initiate PrEP and PEP, respectively. Most believed that pharmacist-initiated PrEP/PEP is important (96%) and were willing to provide PrEP (81%); fewer (27%) had PrEP/PEP training. Common implementation barriers were lack of staff/time and payment for pharmacist services. Participants preferred PrEP implementation models with in-pharmacy rapid oral HIV testing and pharmacists specifically hired to provide PrEP services. Despite pharmacists' supportive attitudes, Senate Bill 159 implementation in California pharmacies remains limited, in part due to policy-level and organizational-level barriers. Ensuring PrEP/PEP-related payment for services and sufficient workforce capacity is key to leveraging pharmacists' role in HIV prevention.

RABIES IN RODENTS AND LAGOMORPHS IN THE USA, 2011-20.

Rabies is an acute progressive encephalitis caused by infection with rabies viruses, with reservoirs among bats and mesocarnivores, but all mammals are susceptible. Despite its distribution and abundance, cases of rabies are much less common in rodents and lagomorphs. Familiarity with current rabies prevalence data is important for informed decisions on human postexposure prophylaxis after rodent and lagomorph bites. This study is an update of rabies cases reported in rodents and lagomorphs in the US from 2011 to 2020. Rabies reports were collected passively from laboratory testing agencies in the US and Puerto Rico from 2011 to 2020. Descriptive analysis was conducted to determine the percent positivity of rabies cases by species. A total of 401 cases of rabies in rodents and lagomorphs were reported from 2011 to 2020. Most reported cases were in groundhogs (Marmota monax), representing >90% of cases, and the trend closely aligned with rabies in raccoons (Procyon lotor). In any given year, the percent positivity of rabies in rodents and lagomorphs was <2.5%, and the trend of percent positivity from 2011 to 2020 was stable. Groundhog and North American beaver (Castor canadensis) percent positivity was significantly higher than the rest of the rodents and lagomorphs. Most rabies cases occurred during the months of May-September. Documented cases of rabies in rodents and lagomorphs are generally rare, but with variation between species. Groundhogs and North American beavers had rabies percent positivity similar to high-risk species, such as bats and raccoons, and constituted 97% of all rodent and lagomorph positive cases. Since 1993, the trend in rabies cases in groundhogs has significantly declined. These results can be used to help inform public health officials on rodent and lagomorph prevention and control efforts, as well as rabies postexposure prophylaxis.

Pharmacist Prescribing Models for HIV Pre-exposure and Post-exposure Prophylaxis.

State strategies for pharmacist prescribing exist on a continuum from most restrictive to least restrictive. Using human immunodeficiency virus (HIV) pre-exposure prophylaxis and post-exposure prophylaxis as a case study, there are 3 viable pharmacist prescribing models: (1) population-based collaborative practice agreements; (2) government protocols; and (3) standard of care prescribing. The advantages and disadvantages of these 3 models are reviewed.

Patterns of Occupational Exposure to Human Immunodeficiency Virus and Post-Exposure Prophylaxis Among Health Care Personnel in a Tertiary Care Institute in South India - A Retrospective Case Series.

Post-exposure prophylaxis (PEP) for occupational human immunodeficiency virus (HIV) exposure involves the comprehensive measures used to prevent transmission of blood-borne pathogens such as HIV, hepatitis B virus, and hepatitis C virus through various strategies such as first aid, counseling, risk assessment, relevant laboratory investigations with informed consent, the provision of short-term anti-retroviral drugs, and follow-up testing. We sought to investigate the patterns and causes of occupational exposure in health care workers (HCWs) in our institute and the usage of PEP in our center, a tertiary care hospital in south India. The study involved a retrospective analysis of data extracted from the records of PEP usage from the anti-retroviral treatment (ART) center attached to the dermatology, venereology and leprosy out-patient department of a tertiary care center in south India. The data were extracted into a pre-designed proforma and analyzed using descriptive statistics. A total of 352 health care professionals reported to the ART center for PEP from 2010 to 2020. One hundred and thirty-four patients took only the first dose as the source patient later tested to be HIV-negative. Among the 218 remaining patients, 84 were male and 134 were female patients. Only 56 health care workers started the regimen within 2 hours. One hundred and thirty-four patients completed the full course of PEP. Most HCWs (n = 68, 31%) sustained the exposure while doing a procedure on the patient followed by re-capping a needle (n = 64, 29%). Gastritis and drowsiness were the most common adverse effects. The study was limited by the retrospective nature of data collection and the lack of detailed interviews with HCWs. Knowledge about PEP, needle safety training, and training of early first aid measures should be increased among health care workers.

Profile of human anti-rabies care and post-exposure prophylaxis in the state of São Paulo

Rabies is an anthropozoonosis that greatly impacts public health and is transmitted by infected mammals. Aggression by animals is notifiable and may result in anti-rabies post-exposure prophylaxis (PEP). This study aimed to characterize anti-rabies PEP notifications in São Paulo state, Brazil. A descriptive study was conducted using data provided by the SINAN between 2013 and 2017. A total of 572,889 aggressions were recorded during the study period, characterized mostly by dogs (83.5%), single wounds (56.9%), superficial wounds (58.6%), and hands/feet (34.6%). Animal observation was the most frequent recommendation, even in cases of attacks from non-domestic animals.

Determinants of Rabies Post-exposure Prophylaxis Drop-Out in the Region of San-Pedro, Côte d'Ivoire.

Despite the fact that death from rabies is 100% preventable with a course of post-exposure prophylaxis (PEP) treatment, canine rabies still causes about 59,000 human deaths worldwide annually, half of which are occurring in Africa. In Côte d'Ivoire, rabies remains a threat partly due to the high drop-out rate of the life-saving human PEP treatment among people exposed to dog bites. Each year, half of the victims starting treatment, do not complete the course. The current study therefore assessed the determinants for drop-out of the life-saving treatment among people exposed to rabies in the department of San-Pedro in Côte d'Ivoire.MethodsA mixed-methods approach was used, including questionnaires, observation, individual interviews and focus group discussions, to gather socio-demographic and economic data from 235 participants about possible reasons for abandoning treatment. The study population consisted of patients and medical and veterinary health professionals who were selected using stratified sampling and purposive selection from a database available at the Rabies Center of San Pedro.ResultThe drop-out of PEP treatment was related to perception bias and a habit of low attendance of health care and vaccination centers in the population. Quantitative analysis shows differences between rural and urban areas and an association with age when it comes to treatment completion. The dropout rate was most significant among patients who, in case of other illness, did not routinely see a doctor or go to vaccination centers. The rate of abandonment was higher among those who believed that dog-related injuries could be easily treated at home, and who believed that a person with rabies could be cured without completing the preventive treatment. Insufficient provision of health information on rabies and logistic constraints related to the practical organization of treatment, including the long distance to the anti-rabies center and weaknesses in the patient follow-up procedure, did not contribute to the completion of PEP.ConclusionEstablished determinants for drop-out provide a framework for effective design and implementation of rabies control strategies to accelerate rabies deaths elimination efforts. In particular, access to PEP and community knowledge about rabies need to be improved and integrated in the health system and education system, respectively.

Identifying high-risk areas for dog-mediated rabies using Bayesian spatial regression

Despite ongoing control efforts, rabies remains an endemic zoonotic disease in many countries. Determining high-risk areas and the space-time patterns of rabies spread, as it relates to epidemiologically important factors, can support policymakers and program managers alike to develop evidence-based targeted surveillance and control programs. In this One Health approach which selected Thailand as the example site, the location-based risk of contracting dog-mediated rabies by both human and animal populations was quantified using a Bayesian spatial regression model. Specifically, a conditional autoregressive (CAR) Bayesian zero-inflated Poisson (ZIP) regression was fitted to the reported human and animal rabies case counts of each district, from the 2012–2017 period. The human population was used as an offset. The epidemiologically important factors hypothesized as risk modifiers and therefore tested as predictors included: number of dog bites/attacks, the population of dogs and cats, number of Buddhist temples, garbage dumps, animal vaccination, post-exposure prophylaxis, poverty, and shared administrative borders. Disparate sources of data were used to improve the estimated associations and predictions. Model performance was assessed using cross-validation. Results suggested that accounting for the association between human and animal rabies with number of dog bites/attacks, number of owned and un-owned dogs; shared country borders, number of Buddhist temples, poverty levels, and accounting for spatial dependence between districts, may help to predict the risk districts for dog-mediated rabies in Thailand. The fitted values of the spatial regression were mapped to illustrate the risk of dog-mediated rabies. The cross-validation indicated an adequate performance of the spatial regression model (AUC = 0.81), suggesting that had this spatial regression approach been used to identify districts at risk in 2015, the cases reported in 2016/17 would have been predicted with model sensitivity and specificity of 0.71 and 0.80, respectively. While active surveillance is ideal, this approach of using multiple data sources to improve risk estimation may inform current rabies surveillance and control efforts including determining rabies-free zones, and the roll-out of human post-exposure prophylaxis and anti-rabies vaccines for animals in determining high-risk areas.

Recombinant adeno-associated virus serotype 9 AAV-RABVG expressing a Rabies Virus G protein confers long-lasting immune responses in mice and non-human primates

ABSTRACT Three or four intramuscular doses of the inactivated human rabies virus vaccines are needed for pre- or post-exposure prophylaxis in humans. This procedure has made a great contribution to prevent human rabies deaths, which bring huge economic burdens in developing countries. Herein, a recombinant adeno-associated virus serotype 9, AAV9-RABVG, harbouring a RABV G gene, was generated to serve as a single dose rabies vaccine candidate. The RABV G protein was stably expressed in the 293T cells infected with AAV9-RABVG. A single dose of 2 × 1011 v.p. of AAV9-RABVG induced robust and long-term positive seroconversions in BALB/c mice with a 100% survival from a lethal RABV challenge. In Cynomolgus Macaques vaccinated with a single dose of 1 × 1013 v.p. of AAV9-RABVG, the titres of rabies VNAs increased remarkably from 2 weeks after immunity, and maintained over 31.525 IU/ml at 52 weeks. More DCs were activated significantly for efficient antigen presentations of RABV G protein, and more B cells were activated to be responsible for antibody responses. Significantly more RABV G specific IFN-γ-secreting CD4+ and CD8+ T cells, and IL-4-secreting CD4+ T cells were activated, and significantly higher levels of IL-2, IFN-γ, IL-4, and IL-10 were secreted to aid immune responses. Overall, the AAV9-RABVG was a single dose rabies vaccine candidate with great promising by inducing robust, long-term humoral responses and both Th1 and Th2 cell-mediated immune responses in mice and non-human primates.

Prophylactic treatment abandonment in people bitten by suspected rabid animals, El Salvador, 2013-2017.

Around the world 60,000 people die from rabies each year. The main form of exposure to rabies is by the bite of animals infected with the virus. More than 20,000 cases of rabies-transmitting animal bites are reported each year, in El Salvador, a country located in Central America. People exposed should be managed with rabies prophylaxis. To determine the abandonment of post-exposure prophylaxis (PEP) cumulative incidence (CI) in humans bitten by suspected rabid animals in El Salvador from 2013 to 2017. This is an ecological study based on the cases of bites by suspected rabid animals reported between 2013 and 2017 in the public health system of El Salvador. Descriptive and correlation analysis was performed using Statistical Package for the Social Sciences (SPSS) version 24. The municipality CI, expressed per 100,000 inhabitants. The national CI of abandonment PEP in humans bitten by suspected rabid animals was 25.6 × 100,000 inhabitants. Simple bivariate correlation analysis shows that the departments with the highest CI of bites caused by cats, wild animals, and bites on the neck (R 2 = 0.99 P < 0.05) are mostly associated with dropping out of the PEP. In El Salvador, the abandonment CI of PEP is lower than other countries, however, bites by rabid suspected animal are frequent, this represents a public health problem due to the presence of the rabies virus in wild animals and the high lethality of the disease. Municipalities where head bites are common are the most related to the abandonment of PEP.

Description of human anti-rabies post-exposure prophylaxis care notifications in Brazil, 2014-2019.

To analyze human anti-rabies post-exposure prophylaxis notifications in Brazil. This was a descriptive study using data from the Notifiable Diseases Information System in Brazil, from 2014 to 2019. A total of 4,033,098 anti-rabies medical consultations were notified, averaging 672,183 a year. Percentage care was higher among males (n = 2,111,369; 52.4%), those under 19 years old (n = 1,423,433; 35.3%), living in urban areas (n = 3,386,589; 88.1%), attacked by dogs (n = 3,281,190; 81.5%) and bitten (n = 3,575,717; 81.9%), mainly on the hands and feet (n = 1,541,201; 35.3%). The most frequent prophylactic procedure was observation plus vaccination (n = 1,736,036; 44.2%). Prophylactic procedure was appropriate in 57.8% (n = 2,169,689) of cases and inappropriate in 42.2% (n = 1,582,411) of cases. Although there were appropriate prophylactic procedures, we also found procedures that were inappropriate and which, when insufficient, can result in cases of human rabies and, when unnecessary, can result in waste, including shortage of immunobiological products.

A broad-spectrum and highly potent human monoclonal antibody cocktail for rabies prophylaxis.

Post-exposure prophylaxis (PEP) is highly effective in preventing disease progression of rabies when used in timely and appropriate manner. The key treatment for PEP is infiltration of rabies immune globulin (RIG) into lesion site after bite exposure, besides wound care and vaccination. Unfortunately, however, RIG is expensive and its supply is limited. Currently, several anti-rabies virus monoclonal antibody (mAb) products are under development as alternatives to RIG, and two recently received regulatory approval in India. In this study, fully human mAbs that recognize different rabies virus glycoprotein conformational antigenic site (II and III) were created from peripheral blood mononuclear cells of heathy vaccinated subjects. These mAbs neutralized a diverse range of lyssavirus types. As at least two anti-rabies virus mAbs are recommended for use in human PEP to ensure broad coverage against diverse lyssaviruses and to minimize possible escape variants, two most potent mAbs, NP-19-9 and 11B6, were selected to be used as cocktail treatment. These two mAbs were broadly reactive to different types of lyssaviruses isolates, and were shown to have no interference with each other. These results suggest that NP-19-9 and 11B6 are potent candidates to be used for PEP, suggesting further studies involving clinical studies in human.

The urgency of resuming disrupted dog rabies vaccination campaigns: a modeling and cost-effectiveness analysis

Dog vaccination is a cost-effective approach to preventing human rabies deaths. In Haiti, the last nation-wide dog vaccination campaign occurred in 2018. We estimated the number of human lives that could be saved by resuming dog vaccination in 2021 compared to 2022 and compared the cost-effectiveness of these two scenarios. We modified a previously published rabies transmission and economic model to estimate trends in dog and human rabies cases in Haiti from 2005 to 2025, with varying assumptions about when dog vaccinations resume. We compared model outputs to surveillance data on human rabies deaths from 2005 to 2020 and animal rabies cases from 2018 to 2020. Model predictions and surveillance data both suggest a 5- to 8-fold increase in animal rabies cases occurred in Haiti’s capital city between Fall 2019 and Fall 2020. Restarting dog vaccination in Haiti in 2021 compared to 2022 could save 285 human lives and prevent 6541 human rabies exposures over a five-year period. It may also decrease program costs due to reduced need for human post-exposure prophylaxis. These results show that interruptions in dog vaccination campaigns before elimination is achieved can lead to significant human rabies epidemics if not promptly resumed.

Feline and Canine Rabies in New York State, USA.

In New York State, domestic animals are no longer considered rabies vector species, but given their ubiquity with humans, rabies cases in dogs and cats often result in multiple individuals requiring post-exposure prophylaxis. For over a decade, the New York State rabies laboratory has variant-typed these domestic animals to aid in epidemiological investigations, determine exposures, and generate demographic data. We produced a data set that outlined vaccination status, ownership, and rabies results. Our data demonstrate that a large percentage of felines submitted for rabies testing were not vaccinated or did not have a current rabies vaccination, while canines were largely vaccinated. Despite massive vaccination campaigns, free clinics, and education, these companion animals still occasionally contract rabies. Barring translocation events, we note that rabies-positive cats and dogs in New York State have exclusively contracted a raccoon variant. While the United States has made tremendous strides in reducing its rabies burden, we hope these data will encourage responsible pet ownership including rabies vaccinations to reduce unnecessary animal mortality, long quarantines, and post-exposure prophylaxis in humans.

Epidemiological Characteristics of Post-exposure Prophylaxis of Rabies in Varna Region for the Period 2014-2018

Rabies is a viral zoonosis still posing a significant threat to public health worldwide, especially in developing countries. The disease can be controlled by animal vaccination and appropriate post-exposure prophylaxis in humans administered in the earliest possible time. To study and analyze animal-related injuries and post-exposure prophylaxis for rabies.Materials and methods: Between 2014 and 2018, a retrospective epidemiological study was conducted in Varna region, which in-cluded 1462 persons who suffered injuries from animals. The study was based on the official data in the annual analysis of the Regional Health Inspectorate (RHI) in Varna. The information was summarized, analyzed, and graphically illustrated. The results were statisti-cally analysed using SPSS v. 20 employing variational and comparative (χ2) analyses. The statistical significance level was set at p.

Public health significance of human immunodeficiency virus pre-exposure and post-exposure prophylaxis.

Public health significance of human immunodeficiency virus pre-exposure and post-exposure prophylaxis.

Investigating Possible Etiologies of Post-Exposure Prophylaxis Failure and Deaths From Rabies Infection: Case Reports

Rabies virus, as a neurotropic agent, is transmitted to humans usually after animal biting. Rabies is endemic in most Middle Eastern countries. Pre-exposure Prophylaxis (PrEP) program is recommended for high-risk populations in endemic areas. The present study reported 7 deaths from rabies infection despite human Post-Exposure Prophylaxis (PEP) and the evolution of their possible etiologies from 2014 to 2018 in Iran. In this study, 29 rabid human deaths were evaluated despite PEP in 2014-2018. Seven people deceased despite receiving PEP. The most damaged organs were hands and face (71.43%). Injecting anti-Rabies Immunoglobulin (RIG) around the wound, improper cleansing, and delayed PEP were the main causes of PEP failure. In addition, immunodeficiency in a patient was another cause of failure. Our obtained data suggested that immediate precise measures after exposure based on the World Health Organization (WHO) recommendation, maintaining the temperature integrity (cold chain) of vaccines, and RIGs during transportation, and performing detailed injection schedule could prevent PEP failure in most cases. Furthermore, society’s awareness plays a key role in controlling the disease, especially in endemic areas.

Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic.

A canine rabies epidemic started in early 2015 in Arequipa, Peru and the rabies virus continues to circulate in the dog population. Some city residents who suffer dog bites do not seek care or do not complete indicated post-exposure prophylaxis (PEP) regimens, increasing the risk of human rabies. The objectives of our study are to qualitatively assess knowledge about rabies, and preventive practices, such as rabies vaccine administration, following a dog bite. We conduct eight focus group discussions in peri-urban and urban communities with 70 total participants. In our results, we observe low awareness of rabies severity and fatality, and different practices following a dog bite, depending on the community type: for example, whereas participants in the urban communities report cleaning the wound with hydrogen peroxide rather than soap and water, participants in peri-urban areas cover the wound with herbs and hair from the dog that bit them. Misconceptions about rabies vaccines and mistreatment at health centers also commonly prevent initiating or completing PEP. We identify important behavioral and structural barriers and knowledge gaps that limit evidence-based preventive strategies against rabies and may threaten successful prevention of dog-mediated human rabies in this setting.

Attitudes about community pharmacy access to HIV prevention medications in California

ObjectiveIncreasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP. MethodsWe conducted a qualitative case study with key pharmacy stakeholders. Semistructured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences. ResultsWe launched the study in October 2018 and interviewed pharmacists (n = 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n = 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n = 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: community pharmacists are widely accessible, PrEP and PEP protocols are similar to other preventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to diagnose and treat other health conditions. ConclusionThis study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This information may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists.

Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan

BackgroundRabies is endemic in southern Bhutan, associated with 1–2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians’ management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023.MethodsA cross-sectional survey of 50 clinicians’ management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February–March 2016.ResultsData were collected on clinicians’ management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years’ experience. There was poor agreement between clinicians’ rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals.ConclusionsThis study highlights important discrepancies between clinicians’ management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician’s management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians’ practices.

Healthcare demand in response to rabies elimination campaigns in Latin America.

The World Health Organization, the World Organization for Animal Health, and the Food and Agriculture Organization have resolved to eliminate human rabies deaths due to dog bites by 2030, and the Vaccine Alliance (Gavi) has added human rabies vaccines to their investments for 2021–2025. Implementing these goals cost-effectively and sustainably requires understanding the complex connections between dog rabies vaccination and human risk and response. The objective of this paper is to estimate how dog rabies vaccinations affect human rabies deaths, mediated through dog rabies cases, dog bite reporting, and post-exposure human rabies vaccination. To approach this objective, we apply multivariate regression analysis over five rabies-related outcomes: (a) dog vaccinations, (b) dog rabies cases, (c) reported human exposures, (d) human post-exposure prophylaxis (PEP) use, and (e) human rabies cases. Analysis uses aggregate annual data over 1995–2005 for seven Latin American countries that experienced dramatic declines in canine and human rabies. Among other results, we estimate the following. (i) A 10% increase in dog vaccinations decreases dog rabies cases by 2.3%. (ii) Reported exposures decline as concurrent dog rabies cases decline, but these declines are more than offset by increases in reported exposures per dog rabies case, which may result from higher rabies awareness due to anti-rabies campaigns. (iii) A 10% increase in PEP use decreases human deaths by 7%, but a 10% increase in dog vaccination induces a 2.8% decrease in PEP use. The net effect is that a 10% increase in dog vaccination reduces human deaths by 12.4% overall, although marginal effectiveness declines as dog rabies incidence declines. (iv) Increases in income and public health expenditures increase PEP demand. The findings highlight the importance of mass dog vaccination, heightened awareness, treatment access, and clinical algorithms to reduce both false negatives leading to death and false positives leading to costly unnecessary PEP prescriptions.