The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study

WHO Rabies Modelling Consortium, et al. (2019) The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study. Lancet Infectious Diseases, 19(1), pp. 102-111. (doi: 10.1016/S1473-3099(18)30512-7) (PMID:30472178) (PMCID:PMC6300480)

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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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Hampson, Professor Katie and Steenson, Miss Rachel and Mancy, Dr Rebecca and Ventura, Mr Francesco and Taylor, Dr Louise and Lugelo, Dr Ahmed and Lushasi, Mr Kennedy
Authors: WHO Rabies Modelling Consortium, , Hampson, K., Ventura, F., Steenson, R., Mancy, R., Trotter, C., Cooper, L., Abela-Ridder, B., Knopf, L., Ringenier, M., Tenzin, T., Ly, S., Tarantola, A., Moyengar, R., Oussiguéré, A., Bonfoh, B., Ashwath Narayana, D.H., Sudarshan, M. K., Muturi, M., Mwatondo, A., Wambura, G., Andriamandimby, S. F., Baril, L., Edosoa, G. T., Traoré, A., Jayme, S., Kotzé, J., Gunesekera, A., Chitnis, N., Hattendorf, J., Laager, M., Lechenne, M., Zinsstag, J., Changalucha, J., Mtema, Z., Lugelo, A., Lushasi, K., Yurachai, O., Metcalf, C. J. E., Rajeev, M., Blanton, J., Barbosa Costa, G., Sreenivasan, N., Wallace, R., Briggs, D., Taylor, L., Thumbi, S. M., and Huong, N. T. T.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:Lancet Infectious Diseases
ISSN (Online):1474-4457
Published Online:21 November 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Lancet Infectious Diseases 19(1): 102-111
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3016200The Science of Rabies EliminationKatie HampsonWellcome Trust (WELLCOTR)207569/Z/17/ZInstitute of Biodiversity, Animal Health and Comparative Medicine