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Appears in Collections:Biological and Environmental Sciences Journal Articles
Peer Review Status: Refereed
Title: The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study
Author(s): 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
Issue Date: Jan-2019
Date Deposited: 20-Nov-2020
Citation: 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 (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.
Abstract: 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.
DOI Link: 10.1016/s1473-3099(18)30512-7
Rights: © This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.
Notes: Additional co-authors: D. H. Ashwath Narayana, M. K. Sudarshan, Athman Mwatondo, Matthew Muturi, Gati Wambura, Glenn T Edosoa, Soa Fy Andriamandimby, Laurence Baril, Abdallah Traoré, Sarah Jayme, Johann Kotzé, Amila Gunesekera, Nakul Chitnis, Jan Hattendorf, Mirjam Laager, Monique Lechenne, Jakob Zinsstag, Joel Changalucha, Zac Mtema, Ahmed Lugelo, Kennedy Lushasi, Onphirul Yurachai, Charlotte Jessica E. Metcalf, Malavika Rajeev, Jesse Blanton, Galileu Barbosa Costa, Nandini Sreenivasan, Ryan Wallace, Deborah Briggs, Louise Taylor, Samuel M Thumbi, Nguyen Thi Thanh Huong
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