scholarly journals New Rabies Vaccines for Use in Humans

Vaccines ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 54 ◽  
Author(s):  
Hildegund C. J. Ertl
Keyword(s):  
Cost Effective ◽  
Central American ◽  
Human Rabies ◽  
Clinical Testing ◽  
Vaccination Programs ◽  
Rabies Control ◽  
Surveillance Programs ◽  
Vaccination Campaigns ◽  
Animal Vaccination ◽  
Rabid Animal

Although vaccines are available, rabies still claims more than 55,000 human lives each year. In most cases, rabies vaccines are given to humans after their exposure to a rabid animal; pre-exposure vaccination is largely reserved for humans at high risk for contacts with the virus. Most cases of human rabies are transmitted by dogs. Dog rabies control by mass canine vaccination campaigns combined with intensive surveillance programs has led to a decline of human rabies in many countries but has been unsuccessful in others. Animal vaccination programs are also not suited to control human rabies caused by bat transmission, which is common in some Central American countries. Alternatively, or in addition, more widespread pre-exposure vaccination, especially in highly endemic remote areas, could be implemented. With the multiple dose regimens of current vaccines, pre-exposure vaccination is not cost effective for most countries and this warrants the development of new rabies vaccines, which are as safe as current vaccines, but achieve protective immunity after a single dose, and most importantly, are less costly. This chapter discusses novel rabies vaccines that are in late stage pre-clinical testing or have undergone clinical testing and their potential for replacing current vaccines.

scholarly journals Human Rabies in the WHO Southeast Asia Region: Forward Steps for Elimination

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Gyanendra Gongal ◽  
Alice E. Wright
Keyword(s):  
Southeast Asia ◽  
Cost Effective ◽  
Human Rabies ◽  
Regional Office ◽  
Technical Leadership ◽  
Intersectoral Cooperation ◽  
Health Authorities ◽  
Rabies Control ◽  
Major Stakeholder ◽  
Elimination Programme

There are eleven Member States in the WHO southeast Asia region (Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste) of which eight are endemic for rabies. More than 1.4 billion people in the Region are at risk of rabies infection, and approximately 45% of worldwide rabies deaths occur in Asia. Dog bites account for 96% of human rabies cases. Progress in preventing human rabies through control of the disease in dogs has been slow due to various factors. Innovative control tools and techniques have been developed and standardized in recent years. The introduction of cost-effective intradermal rabies vaccination regimens in Asian countries has increased the availability and affordability of postexposure prophylaxis. Elimination of rabies is not possible without regional and intersectoral cooperation. Considering the importance of consolidating achievements in rabies control in Member countries, the WHO Regional Office for southeast Asia has developed a regional strategy for elimination of human rabies transmitted by dogs in the Region. They have committed to provide technical leadership, to advocate national health authorities to develop major stakeholder consensus for a comprehensive rabies elimination programme, and to implement national strategies for elimination of human rabies.

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amber Kunkel ◽  
Seonghye Jeon ◽  
Haim C. Joseph ◽  
Pierre Dilius ◽  
Kelly Crowdis ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vaccination Campaign ◽  
Cost Effective ◽  
Fold Increase ◽  
Surveillance Data ◽  
Capital City ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Program Costs ◽  
Vaccination Campaigns

AbstractDog 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.

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

2021 ◽  
Author(s):  
Amber Kunkel ◽  
Seonghye Jeon ◽  
Haim C Joseph ◽  
Pierre Dilius ◽  
Kelly Crowdis ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vaccination Campaign ◽  
Fold Increase ◽  
Surveillance Data ◽  
Capital City ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Vaccination Programs ◽  
Program Costs ◽  
Vaccination Campaigns

OBJECTIVE: Dog vaccination is a cost-effective approach to preventing human rabies deaths. In Haiti, the 2019 dog vaccination campaign did not include the capital city, and the 2020 campaign was cancelled because of COVID-19 lockdown restrictions and redirection of funds. 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. METHODS: We modified a previously published rabies transmission and economic model to estimate trends in dog and human rabies cases in Haiti from 2005-2025. We compared model outputs to surveillance data on human rabies deaths from 2005-2020 and animal rabies cases from 2018-2020. We then estimated the human health and cost implications of restarting dog vaccination programs in either 2021 or 2022. FINDINGS: Model predictions and animal surveillance data from Haiti both suggest a 5- to 8-fold increase in animal rabies cases has occurred in the capital city between Fall 2019 and Fall 2020. We estimate that restarting dog vaccination in Haiti in 2021 compared to 2022 could save 285 human lives and prevent 6,541 human rabies exposures over a five-year period and may decrease program costs due to reduced need for human post-exposure prophylaxis. CONCLUSIONS: A one-year delay in resuming dog vaccination in Haiti, from 2021 to 2022, could cost hundreds of lives over the next 5 years. Interruptions in dog vaccination campaigns before elimination is achieved can lead to significant human rabies epidemics if not promptly resumed.

scholarly journals Human exposure to rabies in Yemen: Incidence, trend, and mortality 2011-2017 (Preprint)

2021 ◽  
Author(s):  
Rihana Abdulmoghni ◽  
Ahmed Alward ◽  
Khaled Almoayed ◽  
Mohammed Abdullah AL-Amad ◽  
Yousef Khader
Keyword(s):  
Control Unit ◽  
Control Program ◽  
Electronic System ◽  
Annual Incidence ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Information Campaigns ◽  
Rabies Control ◽  
Exposure Prophylaxis ◽  
Rabid Animal

BACKGROUND Rabies remains a neglected disease and poorly controlled throughout the developing world, particularly Africa and Asia, where most human rabies deaths occur. OBJECTIVE This study aimed to describe the epidemiology of rabies, its trend, and its geographical distribution in Yemen METHODS Cumulative data from Rabies surveillance system for the period 2011 to 2017 was obtained from the National Rabies Control Program. The data included the number of persons bitten by a suspected animal, their gender and age, and the result of animal’s lab-test. Cases were defined as human victims bitten or injured by animals confirmed to be infected with rabies and received post exposure prophylaxis at any rabies control unit during 2011-2017 RESULTS During the period 2011-2017, a total of 76049 persons were bitten or injured by a suspected rabid animal. Of those, 21,927 (29%) were exposed to positively confirmed rabid animal and had PEP. Of all cases 68% were males and 32% were females. About 15% of cases were under five years, 41% aged 5-14 years, 28% aged 15-40 years, and 16% aged > 40 years. One third (36.8%) of reported cases were from Amanat Al Asimah followed by 32% from Ibb governorates, 12% from Dhamar, 8% from Al Hudaydah, 5% from Taizz, and 4% from Amran. The annual mean number of the cases exposed to positively confirmed rabid animal and had PEP was 3132. The annual incidence rate of exposure to positively confirmed rabid animal was 14 per 100,000 population. The annual mean number of deaths was 42 and the annual mean mortality rate was 2 per 1000,000 populations. CONCLUSIONS Rabies is still a worrying health problem in Yemen with a higher percentage among children and males. The annual incidence of exposure was 14 per 100,000 population. An electronic system should be introduced to improve reporting. It is important to have sufficient supply of vaccines and immunoglobulins in control units especially in the affected governorates. Education, communication and information campaigns about preventive measures targeting school-age populations are strongly recommended. Moreover, vaccination campaigns in the canine population to avoid animal-to-human transmission is necessary.

scholarly journals Cost-effectiveness of the national dog rabies prevention and control program in Mexico, 1990–2015

2021 ◽  
Vol 15 (3) ◽  
pp. e0009130
Author(s):  
Jesús Felipe González-Roldán ◽  
Eduardo A. Undurraga ◽  
Martin I. Meltzer ◽  
Charisma Atkins ◽  
Fernando Vargas-Pino ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
World Health Organization ◽  
Public Health Problem ◽  
World Health ◽  
Human Rabies ◽  
National Program ◽  
Rabies Control ◽  
Health Organization ◽  
Vaccination Campaigns ◽  
Rabies Vaccination

Background Rabies is a viral zoonosis that imposes a substantial disease and economic burden in many developing countries. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. Through mass annual dog rabies vaccination campaigns, the national program of rabies control in Mexico progressively reduced rabies cases in dogs and humans since 1990. In 2019, the World Health Organization validated Mexico for eliminating rabies as a public health problem. Using a governmental perspective, we retrospectively assessed the economic costs, effectiveness, and cost-effectiveness of the national program of rabies control in Mexico, 1990–2015. Methodology Combining various data sources, including administrative records, national statistics, and scientific literature, we retrospectively compared the current scenario of annual dog vaccination campaigns and post-exposure prophylaxis (PEP) with a counterfactual scenario without an annual dog vaccination campaign but including PEP. The counterfactual scenario was estimated using a mathematical model of dog rabies transmission (RabiesEcon). We performed a thorough sensitivity analysis of the main results. Principal findings Results suggest that in 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an incremental cost (MXN 2015) of $4,700 million (USD 300 million). We estimated an average cost of $360,000 (USD 23,000) per human rabies death averted, $6,500 (USD 410) per additional year-of-life, and $3,000 (USD 190) per dog rabies death averted. Results were robust to several counterfactual scenarios, including high and low rabies transmission scenarios and various assumptions about potential costs without mass dog rabies vaccination campaigns. Conclusions Annual dog rabies vaccination campaigns have eliminated the transmission of dog-to-dog rabies and dog-mediated human rabies deaths in Mexico. According to World Health Organization standards, our results show that the national program of rabies control in Mexico has been highly cost-effective.

scholarly journals Estimating the effectiveness of vaccine programs in dog populations

2019 ◽  
Vol 147 ◽  
Author(s):  
R.M. Wallace ◽  
E.A. Undurraga ◽  
A. Gibson ◽  
J. Boone ◽  
E.G. Pieracci ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Field Data ◽  
Vaccination Strategy ◽  
Cost Effective ◽  
Limited Resources ◽  
Average Difference ◽  
Vaccination Programs ◽  
Vaccination Strategies ◽  
Main Factors ◽  
Vaccination Campaigns

Abstract Dogs harbor numerous zoonotic pathogens, many of which are controlled through vaccination programs. The delivery of these programs can be difficult where resources are limited. We developed a dynamic model to estimate vaccination coverage and cost-per-dog vaccinated. The model considers the main factors that affect vaccination programs: dog demographics, effectiveness of strategies, efficacy of interventions and cost. The model was evaluated on data from 18 vaccination programs representing eight countries. Sensitivity analysis was performed for dog confinement and vaccination strategies. The average difference between modelled vaccination coverage and field data was 3.8% (2.3%–5.3%). Central point vaccination was the most cost-effective vaccination strategy when >88% of the dog population was confined. More active methods of vaccination, such as door-to-door or capture-vaccinate-release, achieved higher vaccination coverage in free-roaming dog populations but were more costly. This open-access tool can aid in planning more efficient vaccination campaigns in countries with limited resources.

scholarly journals Modelling the factors affecting the probability for local rabies elimination by strategic control

2021 ◽  
Vol 15 (3) ◽  
pp. e0009236
Author(s):  
Johann L. Kotzé ◽  
John Duncan Grewar ◽  
Aaron Anderson
Keyword(s):  
Herd Immunity ◽  
Transmission Model ◽  
Human Rabies ◽  
Vaccination Programs ◽  
Factors Affecting ◽  
Control Programs ◽  
Rabies Control ◽  
Population Turnover ◽  
Local Program ◽  
Ancient Times

Dog rabies has been recognized from ancient times and remains widespread across the developing world with an estimated 59,000 people dying annually from the disease. In 2011 a tri-partite alliance consisting of the OIE, the WHO and the FAO committed to globally eliminating dog-mediated human rabies by 2030. Regardless of global support, the responsibility remains with local program managers to implement successful elimination programs. It is well known that vaccination programs have a high probability of successful elimination if they achieve a population-coverage of 70%. It is often quoted that reducing population turnover (typically through sterilizations) raises the probability for local elimination by maintaining herd immunity for longer. Besides this, other factors that affect rabies elimination are rarely mentioned. This paper investigates the probability for local elimination as it relates to immunity, fecundity, dog population size, infectivity (bite rates), in-migration of immune-naïve dogs, and the initial incidence. To achieve this, an individual-based, stochastic, transmission model was manipulated to create a dataset covering combinations of factors that may affect elimination. The results thereof were analysed using a logistic regression model with elimination as the dependent variable. Our results suggest that smaller dog populations, lower infectivity and lower incidence (such as when epidemics start with single introductions) strongly increased the probability for elimination at wide ranges of vaccination levels. Lower fecundity and lower in-migration had weak effects. We discuss the importance of these findings in terms of their impact and their practical application in the design of dog-mediated rabies control programs.

scholarly journals Qualitative Study of Stakeholder Perceptions Related to Requirements for Elimination of Dog Rabies in Sri Lanka by 2025

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Kamalika Harshini Ubeyratne Janrabelge ◽  
Lertrak Srikitjakarn ◽  
Dirk Udo Pfeiffer ◽  
Sunil-Chandra Narapity Pathirannehalage ◽  
Lisa Kohnle ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Government Officials ◽  
Disease Reporting ◽  
Weakest Link ◽  
Rabies Control ◽  
Disease Risks ◽  
Exposure Prophylaxis ◽  
Vaccination Campaigns

Rabies has been eliminated in some Asian countries including Japan, Singapore, Maldives, and Hong Kong. Sri Lanka is close to joining that group:  human rabies cases declined from 288 in 1975 to 23 in 2017, due largely to intradermal post-exposure prophylaxis. The weakest link in rabies elimination in Sri Lanka is inconsistent prevention at the source due in part to insufficient institutional capacity to achieve the goal of 70% dog vaccination coverage.Obstacles to rabies control identified through focus groups and in-depth interviews with stakeholders, government officials, non-government agents, and community residents include  insufficient motivation for disease reporting and development of a clear protocol for disease reporting by the public, lack of awareness in some areas of the importance of disease reporting exacerbated by logistical issues, uneven vaccination coverage due to insufficient communication regarding government vaccination campaigns, and incomplete implementation of government policies. Other issues included a need for more responsible dog ownership and better understanding of rabies disease risks amongst dog owners. Dog-associated factors included the need for improved understanding of drivers of variation in dog population size, for lower sterilization cost to owners, and for monitoring of post-surgical complications.An integrated national dog rabies monitoring and reporting system based on effective partnerships among relevant institutions plus additional decentralized dog rabies diagnosis laboratories plus additional local veterinary and medical government staff are needed.

scholarly journals Management tool to guide rabies elimination programmes

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Kristyna Rysava ◽  
Tamara Mancero ◽  
Eduardo Caldas ◽  
Mary Carvalho ◽  
Veronica Gutierrez ◽  
...  
Keyword(s):  
State Level ◽  
Cost Effective ◽  
Management Tool ◽  
Human Rabies ◽  
Socioeconomic Indicators ◽  
Classification Framework ◽  
Level Data ◽  
High Prevalence ◽  
Vaccination Campaigns ◽  
Risk Investment

ObjectiveTo provide surveillance tools to support policymakers andpractitioners to identify epidemiological situations and inform theprogressive implementation of rabies elimination programmes.IntroductionGlobal targets for elimination of human rabies mediated by dogshave been set for 2030. In the Americas countries are progressingtowards interruption of transmission and declaration of rabiesfreedom1. Guidance for managing elimination programmes toensure continued progress during the endgame is critical, yet oftenlimited and lacking in specific recommendations. Characteristicspatiotemporal incidence patterns are indicative of progress, andthrough their identification, tailored guidance can be provided.MethodsUsing SIRVERA, a surveillance database for rabies in theAmericas2, we developed a classification framework for identificationof epidemiological situations at subnational level. Each situationexhibits a characteristic pattern identified via a set of objective criteriaincluding trends in case detection, assessment of virus variants, caselocations and measures of incursion risk.We refined our framework through application to Mexico inconsultation with stakeholders. To understand factors predictingincursions we analysed state-level data on vaccination campaigns,populations and socioeconomic indicators employing multivariateregression models.ResultsWe were able to classify all states in Mexico and providecorrespondingly tailored guidance. Control efforts have resultedin progress towards elimination; however rabies still circulatesendemically in one state Chiapas, putting its neighbours at risk ofre-emergence.Epidemiological and socioeconomic factors associated withincursions were primarily geographic proximity to endemic and high-prevalence states, and inconsistent vaccination campaigns associatedwith a low human development index.ConclusionsOur management tool can support rabies programme managersat subnational levels to identify their epidemiological situation,develop tailored plans to meet targets, and sustainably maintainrabies freedom, as demonstrated for Mexico. Effective surveillanceis critical for disease elimination. Control options differ dependingon whether disease circulates intermittently through reintroductionsor persists focally, but with poor detection these situations mightbe indistinguishable. Our analysis enables identification of at-riskareas and methods to reduce risk. Investment in remaining endemicareas, through improved implementation and monitoring of mass dogvaccinations, is expected to provide the most cost-effective approachto elimination whilst preventing re-emergence elsewhere.Decision-tree framework.Rabies incursions in Mexico, 2005-2015. Blue circles indicate incursionlocations, and resulting outbreak sizes, with darker shading for more recentincursions. Red shading indicates the duration of endemic circulation over theten-year period.

scholarly journals One Health approach to cost-effective rabies control in India

2016 ◽  
Vol 113 (51) ◽  
pp. 14574-14581 ◽  
Author(s):  
Meagan C. Fitzpatrick ◽  
Hiral A. Shah ◽  
Abhishek Pandey ◽  
Alyssa M. Bilinski ◽  
Manish Kakkar ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Tamil Nadu ◽  
One Health ◽  
Cost Effective ◽  
Transmission Model ◽  
Human Rabies ◽  
Stray Dogs ◽  
Rabies Control ◽  
Life Years ◽  
The Impact

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.

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