The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Hampson, Katie; Ventura, Francesco; Steenson, Rachel; Mancy, Rebecca; Trotter, Caroline; Cooper, Laura; Abela-Ridder, Bernadette; Knopf, Lea; Ringenier, Moniek; Tenzin, Tenzin; Ly, Sowath; Tarantola, Arnaud; Moyengar, Ronelngar; Oussiguéré, Assandi; Bonfoh, Bassirou; Narayana, DH Ashwath; Sudarshan, Mysore Kalappa; Muturi, Matthew; Mwatondo, Athman; Wambura, Gati; Andriamandimby, Soa Fy; Baril, Laurence; Edosoa, Glenn T; Traoré, Abdallah; Jayme, Sarah; Kotzé, Johann; Gunesekera, Amila; Chitnis, Nakul; Hattendorf, Jan; Laager, Mirjam; Lechenne, Monique; Zinsstag, Jakob; Changalucha, Joel; Mtema, Zac; Lugelo, Ahmed; Lushasi, Kennedy; Yurachai, Onphirul; Metcalf, Charlotte Jessica E.; Rajeev, Malavika; Blanton, Jesse; Costa, Galileu Barbosa; Sreenivasan, Nandini; Wallace, Ryan; Briggs, Deborah; Taylor, Louise; Thumbi, Samuel M.; Huong, Nguyen Thi Thanh;
• Is Part Of: Lancet infectious diseases. Volume 19:Issue 1(2019)
• Page Start: 102
• Page End: 111
• Publication Date: 2019-01
• Subjects: Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases -- Periodicals; Infection -- Periodicals; Maladies infectieuses -- Périodiques; Infection -- Périodiques; Communicable diseases; Infection; Periodicals; 616.905
• DOI: 10.1016/S1473-3099(18)30512-7
• Languages: English
• ISSNs: 1473-3099

Abstract

Summary: 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.