Rabies Deaths Research Articles

Real-World Cost-Effectiveness of Three-Sessions Compared to Four-Sessions Intradermal Rabies Post-Exposure Prophylaxis in Patients Bitten by Dogs: A Decision Tree Model from the Patients’ Perspective

Background: The annual incidence of rabies deaths has been estimated in Cambodia at nearly 5•8/100,000 person-years. The cost of post exposure prophylaxis (PEP) and travel is potentially a significant barrier for exposed patients and their families, although safety nets are in place to provide the prophylaxis at no cost for low-income families. Method: A decision-tree model compared the costs from the patients’ perspective and the disease outcomes of the Institut Pasteur du Cambodge (IPC) rabies PEP regimen versus the Thai Red Cross (TRC) rabies PEP regimen in patients exposed to WHO category II or III bites by dogs. Derived from the IPC database, data included the trajectory of 203,497 patients, 1,412 called-back patients and economic data on 201 patients. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Findings: Compared to the TRC regimen, the IPC regimen was cheaper and equally effective in patients with category II bites. In patients with category III bites, the IPC regimen was cheaper and its modeled effectiveness (probability of survival) was 0•04% (95% CI: 0 -0•12%) lower than the TRC regimen. Interpretation: Although the equivalence of the IPC regimen is backed by clinical and serological studies, its effectiveness may be lower than TRC’s for category III bites but not for category II bites. Funding: No funding supported this study. Declaration of Interest: None to declare. Ethical Approval: Ethical approval: all patients had approved the use of their personal data for research purposes and we accessed de-identified patient data. The Cambodian National Ethics Committee for Human Research approved the study (approval #046 dated 20 February 2015).

Human rabies: prospects for elimination.

Almost half of all countries in the world are effectively free of human deaths from dog-mediated rabies. But the disease still affects people in low- and middle-income countries, especially the rural poor, and children. Successful regional elimination of human rabies is attributable to advances in significant and sustained investment in dog vaccination, post-exposure vaccination and surveillance, illustrated by productive efforts to reduce human rabies in Latin America over the last 35 years. Nonetheless, countries still facing endemic rabies face significant barriers to elimination. Using the 2017 Global Strategic Plan to end human rabies deaths from dog-mediated rabies by 2030 as a reference point and an organizing framework, we assess progress toward global rabies elimination by examining the characteristics of successful regional control efforts and barriers to elimination. Although substantive barriers exist for countries where rabies remains endemic, advances in knowledge, technology, institutions, and economics provide a basis for optimism.

Animal Bite Management Facilities in aRural Area Near Bangalore

Background Rabies is almost always fatal but being a 100 preventable disease treatment for the prevention of rabies in humans exposed to rabies should begin promptly after the exposure. The vast majority of rabies deaths 84 occur in rural areas. There are various reasons contributing to it and non-availability of health care facilities for animal bite management in these areas is one among them.Methodology The study was conducted in the villages near Bangalore over a period of six months. All the health care facilities in the study area were visited and data was collected regarding the availability and storage of rabies biological by personal interview of the health personnel in charge of these health centres using a check list and also by observation of the storage of rabies biologicals in these health care facilities.Results Both government and private health care facilities in the study area lacked adequate resources for animal bite management.Conclusion The study showed that the health care facilities lacked training and resources for animal bite management in the rural area near Bangalore.

Rabies control in Liberia: Joint efforts towards zero by 30

Despite declaration as a national priority disease, dog rabies remains endemic in Liberia, with surveillance systems and disease control activities still developing. The objective of these initial efforts was to establish animal rabies diagnostics, foster collaboration between all rabies control stakeholders, and develop a short-term action plan with estimated costs for rabies control and elimination in Liberia. Four rabies diagnostic tests, the direct fluorescent antibody (DFA) test, the direct immunohistochemical test (dRIT), the reverse transcriptase polymerase chain reaction (RT-PCR) assay and the rapid immunochromatographic diagnostic test (RIDT), were implemented at the Central Veterinary Laboratory (CVL) in Monrovia between July 2017 and February 2018. Seven samples (n=7) out of eight suspected animals were confirmed positive for rabies lyssavirus, and molecular analyses revealed that all isolates belonged to the Africa 2 lineage, subgroup H. During a comprehensive in-country One Health rabies stakeholder meeting in 2018, a practical workplan, a short-term action plan and an accurately costed mass dog vaccination strategy were developed. Liberia is currently at stage 1.5/5 of the Stepwise Approach towards Rabies Elimination (SARE) tool, which corresponds with countries that are scaling up local-level interventions (e.g. dog vaccination campaigns) to the national level. Overall an estimated 5.3 – 8 million USD invested over 13 years is needed to eliminate rabies in Liberia by 2030. Liberia still has a long road to become free from dog-rabies. However, the dialogue between all relevant stakeholders took place, and disease surveillance considerably improved through implementing rabies diagnosis at the CVL. The joint efforts of diverse national and international stakeholders laid important foundations to achieve the goal of zero dog-mediated human rabies deaths by 2030.

Human rabies exposure outbreak investigation in Tembaro district, Ethiopia, 2018

Background: Rabies is a fatal viral infection that can infect all mammals. It poses a significant health problem in most of African countries including Ethiopia, where the majority of the cases result from dog bites. This study was conducted to assess the extent of the outbreak, to identify the exposing animals and risk factors for the transmission and to give technical support in the control and prevention measures. Methods and materials: Cross-sectional descriptive study design was used to conduct the study from April 28 to May 16, 2018. Line list of human exposure to rabies cases were collected from health facility. Case detection was actively done in the community. Structured questionnaire was used to assess awareness of the victims regarding rabies. Results: A total of 125 suspected rabies exposures and 9 suspected human rabies deaths were found. The rabies exposure crude attack rate (AR) was 90 per 100000 populations at risk. Age groups 15 to 45 were the most affected with age specific AR of 124 per 100000 populations. The highest AR occurred in Keleta kebele with AR of 85/10,000 population. Dogs, cats, donkeys, foxes, hyena and bat were found the responsible exposing animals. However; dogs were the most common, being responsible for 62 (50%) of the exposures. Among the dogs, 45/62 (72.5%) of them were stray dogs. Among the owned dogs, 54(88%) were not vaccinated. Brain tissue from two dogs was tested and became positive for rabies by Fluorescent Antibody Test (FAT). Among 95 victims interviewed about rabies, only 33 (37%) of them know the symptoms, transmission, and prevention methods of rabies. Conclusion: There was high number of human rabies exposure due to animal bites in Tembaro district. Wild lives escaped from the forests around the Gibe river basin and high prevalence of free roaming and unvaccinated dogs were the likely risk factors for the increment of the rabies exposure. Inter-sectoral collaboration is needed among the district health office, wild life and environmental protection office and the livestock and fishery resource office. Mass dog vaccination and awareness creation in the community about rabies exposure are recommended.

Role of Oral Rabies Vaccines in the Elimination of Dog-Mediated Human Rabies Deaths.

Domestic dogs are responsible for nearly all the »59,000 global human rabies deaths that occur annually. Numerous control measures have been successful at eliminating dog-mediated human rabies deaths in upper-income countries, including dog population management, parenteral dog vaccination programs, access to human rabies vaccines, and education programs for bite prevention and wound treatment. Implementing these techniques in resource-poor settings can be challenging; perhaps the greatest challenge is maintaining adequate herd immunity in free-roaming dog populations. Oral rabies vaccines have been a cornerstone in rabies virus elimination from wildlife populations; however, oral vaccines have never been effectively used to control dog-mediated rabies. Here, we convey the perspectives of the World Organisation for Animal Health Rabies Reference Laboratory Directors, the World Organisation for Animal Health expert committee on dog rabies control, and World Health Organization regarding the role of oral vaccines for dogs. We also issue recommendations for overcoming hesitations to expedited field use of appropriate oral vaccines.

Human rabies exposure outbreak investigation in Tembaro district, Ethiopia, 2018

Background: Rabies is a fatal viral infection that can infect all mammals. It poses a significant health problem in most of African countries including Ethiopia, where the majority of the cases result from dog bites. This study was conducted to assess the extent of the outbreak, to identify the exposing animals and risk factors for the transmission and to give technical support in the control and prevention measures. Methods and materials: Cross-sectional descriptive study design was used to conduct the study from April 28 to May 16, 2018. Line list of human exposure to rabies cases were collected from health facility. Case detection was actively done in the community. Structured questionnaire was used to assess awareness of the victims regarding rabies. Results: A total of 125 suspected rabies exposures and 9 suspected human rabies deaths were found. The rabies exposure crude attack rate (AR) was 90 per 100,000 populations at risk. Age groups 15–45 were the most affected with age specific AR of 124 per 100,000 populations. The highest AR occurred in Keleta kebele with AR of 85/10,000 population. Dogs, cats, donkeys, foxes, hyena and bat were found the responsible exposing animals. However; dogs were the most common, being responsible for 62 (50%) of the exposures. Among the dogs, 45/62 (72.5%) of them were stray dogs. Among the owned dogs, 54(88%) were not vaccinated. Brain tissue from two dogs was tested and became positive for rabies by Fluorescent Antibody Test (FAT). Among 95 victims interviewed about rabies, only 33 (37%) of them know the symptoms, transmission, and prevention methods of rabies. Conclusion: There was high number of human rabies exposure due to animal bites in Tembaro district. Wild lives escaped from the forests around the Gibe river basin and high prevalence of free roaming and unvaccinated dogs were the likely risk factors for the increment of the rabies exposure. Inter-sectoral collaboration is needed among the district health office, wild life and environmental protection office and the livestock and fishery resource office. Mass dog vaccination and awareness creation in the community about rabies exposure are recommended.

Portable Rabies Virus Sequencing in Canine Rabies Endemic Countries Using the Oxford Nanopore MinION.

As countries with endemic canine rabies progress towards elimination by 2030, it will become necessary to employ techniques to help plan, monitor, and confirm canine rabies elimination. Sequencing can provide critical information to inform control and vaccination strategies by identifying genetically distinct virus variants that may have different host reservoir species or geographic distributions. However, many rabies testing laboratories lack the resources or expertise for sequencing, especially in remote or rural areas where human rabies deaths are highest. We developed a low-cost, high throughput rabies virus sequencing method using the Oxford Nanopore MinION portable sequencer. A total of 259 sequences were generated from diverse rabies virus isolates in public health laboratories lacking rabies virus sequencing capacity in Guatemala, India, Kenya, and Vietnam. Phylogenetic analysis provided valuable insight into rabies virus diversity and distribution in these countries and identified a new rabies virus lineage in Kenya, the first published canine rabies virus sequence from Guatemala, evidence of rabies spread across an international border in Vietnam, and importation of a rabid dog into a state working to become rabies-free in India. Taken together, our evaluation highlights the MinION’s potential for low-cost, high volume sequencing of pathogens in locations with limited resources.

Epidemiological study of human rabies cases in Bangladesh through verbal autopsy

Identification of risk factors is crucial to find ways to reduce rabies deaths. We investigated the hospital records of rabies deceased through contact tracing of the relatives of the victims using enhanced verbal autopsies (VA) to identify why the people had to die from rabies in recent years in Bangladesh. Patients whose deaths were confirmed by physicians based on the history of animal exposure and clinical signs were taken into account for VA. Socio-demographic profile of the deceased, animal exposure, nature of the wound, and history of post-exposure prophylaxis (PEP) data were obtained and analysed. The study found 256 cases in which the cause of death was attributed to rabies, most of the victims were male (71.88%), resided in the rural community (80.47%), dependent (49.22%), and children below the age of 15 years (47.27%). Dogs were the single most responsible (81.64%); however, cats (12.11%), jackals (3.91%) and mongoose (2.34%) were also found accountable for rabies incidence (P < 0.05). Significantly, limbs were the most common (67.97%) site of exposure, and the shortest incubation period was identified in the case of bites to head and face (P < 0.05). The majority (86.72%) of the deceased did not receive any PEP; whereas, 66.80% sought treatment from traditional healers. Among the deceased (13.28%, n = 34) who had received PEP, only 8.82% of them completed the full course of the vaccination regimen (P < 0.01); however, none of them had history of taking rabies immunoglobulin (RIG). The study recommends extensive public health awareness programs in the rural community and establishing methods to improve healthcare-seeking behaviours, including receiving PEP instead of visiting traditional healers. Moreover, the availability and accessibility of PEP in the government hospital facilities are desirable, and laboratory-based surveillance with compatible rapid data reporting may be incorporated in the existing policy.

Rabies as a Public Health Concern in India-A Historical Perspective.

India bears the highest burden of global dog-mediated human rabies deaths. Despite this, rabies is not notifiable in India and continues to be underprioritised in public health discussions. This review examines the historical treatment of rabies in British India, a disease which has received relatively less attention in the literature on Indian medical history. Human and animal rabies was widespread in British India, and treatment of bite victims imposed a major financial burden on the colonial Government of India. It subsequently became a driver of Pasteurism in India and globally and a key component of British colonial scientific enterprise. Efforts to combat rabies led to the establishment of a wide network of research institutes in India and important breakthroughs in development of rabies vaccines. As a result of these efforts, rabies no longer posed a significant threat to the British, and it declined in administrative and public health priorities in India towards the end of colonial rule—a decline that has yet to be reversed in modern-day India. The review also highlights features of the administrative, scientific and societal approaches to dealing with this disease in British India that persist to this day.

Epidemiological pattern of dog bites and the occurrence of rabies in humans within Srinagar district of Kashmir Valley, India

Men’s dominant ally, best defense defendant, therefore, the pre-eminent peril detector, dogs became a threat for the humanity inflicting a fatal disease of rabies. Dog bites and open garbage dumps became additional and apparent and are serious and sometimes underestimated public health dilemma in the Kashmir region. The aesthetic, primarily health care and psycho-sociological consequences of trauma caused by a dog bites repeatedly burden the standard of lifetime pertaining to the affected persons and their family. The present study was carried in Srinagar district. Diverse sampling plan / data collection strategies were formulated to fulfill the set of objectives. To assess the epidemiological pattern, secondary source of information viz. Shri Maharaja Hari Singh hospital, which shouldered the relevant cases, was utilized. Further, people perception of the subject was assessed using a predesigned interview schedule from respondents selected by appropriate methods. West zone had recorded the highest number of cases (28.95 %), then the south zone, followed by the north zone and the east zone. Majority victims were males (74.27 %) followed by females (25.72 %) [χ2 = 4.442, p = 0.219). Most of them belonged to 30−40 (26.88 %) year old groups, followed by 20−30 (22.36 %), 10−20 (16.03 %) and so on. The time of exposure of victims was evening (62.90 %) [χ2 = 30.342, p = 0.001]. The bulk number of cases had bite on legs (56.60 %). Majority had category 3 bites (70.16 %) and the majority had received immunoglobin (82.85 %) [χ2 = 29.56, p = 0.001]. The summer season (29.30 %) had also recorded the highest number of cases followed by autumn season (27.82 %) irrespective of each determinant. The Anti rabies clinic of SMHS has also recorded two rabies deaths during this period. The majority people (72.50 %) were illiterate and belonging to lower sections of society. About all those diseases that attack humans, rabies is an example of the best known in Srinagar. Its notoriety is peculiar when assessed on its influence medially, on humans who are belonging to the susceptible divisions of the society due to lack of discernment. The lack of complete perception might decipher into higher mortality linked to rabies.

Trends and Clinico-Epidemiological Features of Human Rabies Cases in Bangladesh, 2006–2018

Background: Vaccinating dogs against rabies is an effective means of reducing human rabies. Methods: We analyzed 1,327 clinically diagnosed human rabies deaths and mass dog vaccination (MDV) data during 2006–2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (n = 422) for clinico-epidemiological analysis. Results: We found a positive and increasing trend of dog population vaccination (P = .01 and τ = 0.71) and a negative and declining trend (P &lt; .001 and τ = −0.88) of human rabies cases (correlation coefficient, −0.82). Among 422 human rabies death cases, most victims (78%) sought treatment from traditional healers, and 12% received postexposure prophylaxis (PEP). The mean incubation period of rabies cases with exposure sites on the head and neck (35 days) was shorter than the upper limb (mean, 64 days; P = .02) and lower limb (mean, 89 days; P &lt; .01). MDV is effective for reducing human rabies cases in Bangladesh. Conclusions: Creating awareness among the animal bite victims to stop relying on traditional healers rather seeking PEP, addressing the role of traditional healers through an awareness education program in respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV can help prevent human rabies deaths.Funding: NoneDisclosures: None

Risk factors for rabies in Côte d'Ivoire

Rabies affects more than 150 countries worldwide. Côte d'Ivoire is one of the rabies-endemic countries that has recorded deaths every year since 2006. The evolution of these deaths is almost constant with an average of 18 annual deaths (annual incidence = 0.06-0.08 per 100,000). Children predominate among these victims. However, prevention measures exist in anti-rabies centers distributed throughout the country.The objective of this study was to determine the factors related to rabies risk in Côte d'Ivoire through Gavi rabies project entitled ‘Impact of rabies and immunization in Central and West Africa’.The implementation was conducted from 2016 to 2018 in two departments of Côte d'Ivoire (Bouake and San Pedro). The study population was dog-bite victims vaccinated in anti-rabies centers of project sites from January to December 2016. Two non-free rabies immunization protocols are used in the country (Essen and Zagreb). Information was collected from bites victims for an adequate follow-up. It was to apprciate the risk of developing rabies through access to care, the immunization status of biting animal, the category of exposure and the result of rabies post exposure prophylaxis (compliance). Local program implementers responsible for these bite-management activities and veterinary staff had receved training and the necessary material. The public health education and information dissemination activities were carried out in support of promoting a wide spread of rabies prevention messages. Household surveys were conducted by sociology students in 4002 households each in urban and in rural areas. This activity helped to find people exposed by dogs and who did not receive any Post Exposure Prophylaxis (PEP). The study registered 1,263 bite victims in pilot anti-rabies centers in 2016, 51% of them were children. People living in urban areas were strongly represented (87%) because of anti-rabies centers proximity. Dog was the most animal associated to exposure (94%). Seventy-two percent (72%) of them had owners, but only 14% were vaccinated against rabies. More than half of dog bite victims had category III of exposure (58%). PEP compliance record was very low (37%), which means that 63% of bite victims have not completed the protocol. This study conducted in Bouaké and San Pedro showed somes factors responsible for rabies deaths evolution in Côte d'Ivoire. Main issues identified are the geographical accessibility of anti-rabies centers, frequent bites caused by unvaccinated dogs, often category III of exposure and many non-completions of rabies PEP in ignorance context. The establishment of national comprehensive and integrated rabies control program is needed in Côte d'Ivoire. It must take into account all these factors by focusing on public awareness, dog vaccination and adoption of modern intradermal vaccination regimens to better manage rabies situation in Côte d'Ivoire.

Eliminating human rabies deaths: rabies as a disease and a global burden

Eliminating human rabies deaths: rabies as a disease and a global burden

Eliminating human rabies deaths: targeting the elimination of rabies

Eliminating human rabies deaths: targeting the elimination of rabies

An economic case study of the control of dog-mediated rabies by an animal welfare organisation in Jaipur, India

A global strategic plan for the elimination of dog-mediated human rabies deaths by 2030 was announced in 2018. The cost-effectiveness of annual mass dog vaccination programmes, as a control and elimination method, has been advocated on many occasions. Complementary methods, such as animal birth control (ABC) activities, have received less attention. This paper provides a case-study of a programme operated by Help in Suffering (HIS) in Jaipur, India from 1994/95 until 2016/17 comprising both ABC and additional vaccination-only activities. The availability of cost data alongside information on dog numbers, dog bites and human rabies cases provided an exceptionally detailed and unique retrospective dataset recording actual events and expenditures. Updated to 2016/17 prices, the total cost of the programme was 658,744 USD. Since 2007/2008, activity costs have been separated and returned costs of 10.78 USD per dog, both sterilised and vaccinated, and 1.86 USD per dog, vaccinated only. Over the course of the programme, the number of disability-adjusted life years (DALYs) due to premature death and the distress associated with dog bites was estimated to be 36,246 fewer than would have been expected if HIS had not been operating, based on a counterfactual scenario using pre-intervention values. Linking the DALY figure to the cost of the activities undertaken by HIS yields a cost of 26 USD per DALY averted. Discounted at 3%, the DALYs averted equate to 16,587 at a cost of 40 USD per DALY averted. Both cases make it a very cost-effective intervention, in relation to the threshold of investing one year’s gross domestic product (GDP) per DALY averted (1981 USD in 2016/17). The monetary benefit from fewer dog bites and clinical human rabies cases requiring treatment amounted to 5.62 million USD after discounting, which, if attributed to Help in Suffering, yields a monetary benefit-cost ratio of 8.5. Thus, the potential monetary benefits greatly outweigh the programme costs, even without considering the DALYs averted. If a modest notional monetary value of one year’s GDP is assigned to represent the human capital or production value of DALYs averted, the discounted societal economic benefit reaches 38.48 million USD and implies a benefit-cost ratio of 58.4. These economic analyses demonstrate that ABC activities in combination with additional vaccination efforts can be a cost-effective control measure for dog-mediated human rabies.

Evaluation of Online Risk Assessment To Identify Rabies Exposures Among Health Care Workers — Utah, 2019

On November 7, 2018, the Utah Department of Health (UDOH) reported the first confirmed human rabies death in the state since 1944 (1). The case occurred in a person who had been treated over a period of 19 days at four health care facilities and an emergency medical transport service across three counties and two states. Human rabies is preventable through preexposure or postexposure vaccination but is invariably fatal upon symptom onset. Timely identification of persons who might have been exposed to rabies virus is therefore crucial to administer postexposure prophylaxis (PEP). Because of the large number of health care workers who had been involved in the patient's care, a standardized online risk assessment survey was developed by UDOH based on Advisory Committee on Immunization Practices recommendations (2). This online tool was evaluated for accuracy, acceptability, and administrative obligation by reviewing the results from the tool and conducting focus group discussions and a follow-up survey. Among 90 health care workers initially identified by the online risk assessment as being potentially exposed to infectious material, 74 were classified as exposed. All 74 health care workers received PEP following consultation with occupational health staff members, indicating a positive predictive value of the assessment tool of 82%. In a follow-up survey, 42 (76%) of the 55 respondents reported that they were satisfied with the assessment process. In focus group discussions, participants suggested that the survey could be improved by providing additional information about rabies exposures because many of them were unfamiliar with human-to-human rabies transmission. This evaluation highlighted the importance of adopting clear communication strategies, demonstrated the benefits of using an online risk assessment during a mass rabies exposure, and provided specific feedback for CDC to improve resources available for states and health care facilities after mass rabies exposures.

RABIES IMMUNOGLOBULIN: Brief history and recent experiences in Côte d'Ivoire

BackgroundRabies is a fatal viral zoonosis mainly transmitted via dog bites. The estimated 59′000 annual deaths caused by the disease are preventable through correct and timely administration of post-exposure prophylaxis (PEP). PEP should be initiated as soon as possible after an exposure to a rabies suspected animal and consists of a course of active vaccinations and administration of rabies immunoglobulin (RIG) in case of severe exposure. However, RIG is not accessible in most rabies endemic countries and its impact on survival in combination with modern vaccines and its cost-effectiveness is unclear. We examined the effect of equine RIG (eRIG) in a field-trial in Côte d'Ivoire, a developing country with low but chronic rabies burden and persistent lack of RIG, similar to a majority of rabies endemic countries attempting elimination of the disease. MethodsData from 3367 patients attending anti-rabies centers (Centres Anti-Rabiques, CARs) of the National Institute for Public Hygiene (Institut National d'Hygiène Publique, INHP) in the departments of Bouaké and San Pédro in Côte d'Ivoire was prospectively collected between April 2016 and March 2018. We identified 1594 patients at risk of rabies infection as eligible for RIG administration. Depending on local availability of eRIG and vaccination protocol applied, PEP consisted of active immunization only (non-eRIG group, n = 1145) or active and passive immunization (eRIG group, n = 449). Patients were followed-up by phone interviews at least 15 months after their exposure to assess for rabies suspected deaths. ResultsFollow-up data was available for 641 patients in the non-eRIG group (56%) and 242 in the eRIG group (54%). Three suspected or possible rabies deaths occurred in each of the two groups, corresponding to a possible rabies mortality of 1.2% (95% CI 0.3–3.6%) in the eRIG group and 0.5% (95% CI 0.1–1.4%) in the non-eRIG group. The difference in proportions was small and not statistically significant (0.7%, p = 0.21). Deaths in both groups were associated with treatment delay after exposure and non-compliance to PEP protocol. No death occurred after correct and timely active immunization independent of eRIG administration. ConclusionThe provision of eRIG did not lead to a measurable reduction of rabies burden in our study population. This underlines that improved access to active vaccines will be effective in reducing rabies deaths even if access to eRIG remains difficult in developing countries. A possible benefit of eRIG administration for severely exposed patients cannot be excluded based on these results.

Costs and effectiveness of alternative dog vaccination strategies to improve dog population coverage in rural and urban settings during a rabies outbreak

Dog-rabies elimination programs have typically relied upon parenteral vaccination at central-point locations; however, dog-ownership practices, accessibility to hard-to-reach sub-populations, resource limitations, and logistics may impact a country’s ability to reach the 70% coverage goal recommended by the World Organization for Animal Health (OIE) and World Health Organization (WHO). Here we report the cost-effectiveness of different dog-vaccination strategies during a dog-rabies outbreak in urban and peri-urban sections of Croix-des-Bouquets commune of the West Department, Haiti, in 2016. Three strategies, mobile static point (MSP), mobile static point with capture-vaccinate-release (MSP + CVR), and door-to-door vaccination with oral vaccination (DDV + ORV), were applied at five randomly assigned sites and assessed for free-roaming dog vaccination coverage and total population coverage. A total of 7065 dogs were vaccinated against rabies during the vaccination campaign. Overall, free-roaming dog vaccination coverage was estimated at 52% (47%-56%) for MSP, 53% (47%-60%) for DDV + ORV, and 65% (61%-69%) for MSP + CVR (differences with MSP and DDV + ORV significant at p < 0.01). Total dog vaccination coverage was 33% (95% CI: 26%-43%) for MSP, 49% (95% CI: 40%-61%) for MSP + CVR and 78% (77%-80%) for DDV + ORV (differences significant at p < 0.001). Overall, the least expensive campaign was MSP, with an estimated cost of about $2039 per day ($4078 total), and the most expensive was DDV + ORV with a cost of $3246 per day ($6492 total). Despite the relative high cost of an ORV bait, combining DDV and ORV was the most cost-effective strategy in our study ($1.97 per vaccinated dog), largely due to increased efficiency of the vaccinators to target less accessible dogs. Costs per vaccinated dog were $2.20 for MSP and $2.28 for MSP + CVR. We hope the results from this study will support the design and implementation of effective dog vaccination campaigns to achieve the goal of eliminating dog-mediated human rabies deaths by 2030.

A Scoping Review of the Effectiveness of Control Interventions of Human and Canine Rabies in an Effort to Rationalise the One Health Approach

&#x0D; According to the World Health Organization (WHO), rabies is one of the 18 neglected tropical diseases, together with dengue, leprosy, and trachoma, among others. Despite being a vaccine-preventable disease, the latest estimate of annual human rabies mortality from a 2015 study is as high as 59,000 throughout 150 countries. In human rabies, more than 95% of the cases are due to dog bites, making the elimination of canine rabies a global priority by fighting the disease at its animal source. World Health Organization (WHO), World Organization for Animal Health (OIE), Food and Agriculture Organization (FAO) of the United Nations, and the Global Alliance for Rabies Control (GARC) have warranted the One Health framework with the objective of complete eradication of dog-related human rabies by the year 2030. In an effort to rationalise the One Health approach, this scoping review found 17 studies on assessing the effectiveness of control interventions of human and canine rabies. Different strategies were implemented based on the endemicity of rabies in a particular country. Overall, the combined strategies using the One Health approach, which allows effective participation and communication between different agencies, have shown promising results in reducing rabies cases. These strategies will hopefully realise the goal in the Global Strategic Plan to achieve zero canine-mediated human rabies death by the year 2030.