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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study
The Lancet Infectious Diseases, Volume 19, No. 1, Year 2019
Notification
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Description
Background: Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply. Methods: We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs. Findings: We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use. Interpretation: Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies. Funding: World Health Organization. © 2019 World Health Organization
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC6300480/bin/mmc1.pdf
Authors & Co-Authors
Hampson, Katie
Unknown Affiliation
Ventura, Francesco
Unknown Affiliation
Steenson, Rachel
Unknown Affiliation
Mancy, Rebecca
Unknown Affiliation
Trotter, Caroline
Unknown Affiliation
Cooper, Laura V.
Unknown Affiliation
Abela-Ridder, Bernadette
Unknown Affiliation
Knopf, Lea
Unknown Affiliation
Ringenier, Moniek
Unknown Affiliation
Tenzin, Tenzin T.
Unknown Affiliation
Ly, Socheat
Unknown Affiliation
TARANTOLA, A.
Unknown Affiliation
Moyengar, Ronelngar
Unknown Affiliation
Oussiguéré, Assandi
Unknown Affiliation
Bonfoh, Bassirou
Unknown Affiliation
Sudarshan, Mysore Kalappa
Unknown Affiliation
Muturi, Mathew K.
Unknown Affiliation
Mwatondo, Athman Juma
Unknown Affiliation
Wambura, Gati
Unknown Affiliation
Andriamandimby, Soa Fy
Unknown Affiliation
Baril, Laurence
Unknown Affiliation
Edosoa, Glenn Torrencelli
Unknown Affiliation
Traoré, Abdallah N.
Unknown Affiliation
Jayme, Sarah I.
Unknown Affiliation
Kotzé, Johann L.
Unknown Affiliation
Chitnis, Nakul
Unknown Affiliation
Hattendorf, Jan
Unknown Affiliation
Laager, Mirjam
Unknown Affiliation
Léchenne, Monique Sarah
Unknown Affiliation
Zinsstag, Jakob B.
Unknown Affiliation
Changalucha, Joel Jackson
Unknown Affiliation
Mtema, Zacharia J.
Unknown Affiliation
Lugelo, Ahmed
Unknown Affiliation
Lushasi, Kennedy Selestin
Unknown Affiliation
Metcalf, Charlotte Jessica Eland
Unknown Affiliation
Rajeev, Malavika
Unknown Affiliation
Blanton, Jesse D.
Unknown Affiliation
Costa, Galileu Barbosa
Unknown Affiliation
Sreenivasan, Nandini
Unknown Affiliation
Wallace, Ryan Mac Laren
Unknown Affiliation
Briggs, Deborah J.
Unknown Affiliation
Taylor, Louise H.
Unknown Affiliation
Thumbi, S. M.
Unknown Affiliation
Statistics
Citations: 49
Authors: 43
Identifiers
Doi:
10.1016/S1473-3099(18)30512-7
ISSN:
14733099
Research Areas
Disability
Health System And Policy
Study Design
Randomised Control Trial