Estimating the global burden of endemic canine rabies

• Published in: PLoS neglected tropical diseases Vol. 9; no. 4; p. e0003709
• Main Authors: Hampson, Katie, Coudeville, Laurent, Lembo, Tiziana, Sambo, Maganga, Kieffer, Alexia, Attlan, Michaël, Barrat, Jacques, Blanton, Jesse D, Briggs, Deborah J, Cleaveland, Sarah, Costa, Peter, Freuling, Conrad M, Hiby, Elly, Knopf, Lea, Leanes, Fernando, Meslin, François-Xavier, Metlin, Artem, Miranda, Mary Elizabeth, Müller, Thomas, Nel, Louis H, Recuenco, Sergio, Rupprecht, Charles E, Schumacher, Carolin, Taylor, Louise, Vigilato, Marco Antonio Natal, Zinsstag, Jakob, Dushoff, Jonathan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.04.2015; Public Library of Science (PLoS)
• Subjects: Animals; Confidence intervals; Costs; Distribution; Dog diseases; Dog Diseases - epidemiology; Dog Diseases - prevention & control; Dog Diseases - virology; Dogs; Endemic Diseases - veterinary; Estimates; Global Health; Health surveillance; Humans; Medical geography; Medical research; Mortality; Polls & surveys; Post-Exposure Prophylaxis - economics; Public health; Public Health - economics; Rabies; Rabies - economics; Rabies - epidemiology; Rabies - prevention & control; Rabies - veterinary; Rabies Vaccines - economics; Rabies Vaccines - immunology; Vaccination - economics; Viral infections
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0003709

Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries. We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%). This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.