Transmission dynamics and economics of rabies control in dogs and humans in an African city

Zinsstag, J.; Dürr, S.; Penny, M. A.; Mindekem, R.; Roth, F.; Menendez Gonzalez, S.; Naissengar, S.; Hattendorf, J. (2009). Transmission dynamics and economics of rabies control in dogs and humans in an African city. Proceedings of the National Academy of Sciences of the United States of America - PNAS, 106(35), pp. 14996-15001. National Academy of Sciences NAS 10.1073/pnas.0904740106

Text Zinsstag, Dürr - 2009 - Transmission dynamics and economics of rabies control in dogs and humans in an African city.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (920kB) | Request a copy

Human rabies in developing countries can be prevented through interventions directed at dogs. Potential cost-savings for the public health sector of interventions aimed at animal-host reservoirs should be assessed. Available deterministic models of rabies transmission between dogs were extended to include dog-to-human rabies transmission. Model parameters were fitted to routine weekly rabid-dog and exposed-human cases reported in N'Djaména, the capital of Chad. The estimated transmission rates between dogs (beta(d)) were 0.0807 km2/(dogs x week) and between dogs and humans (beta(dh)) 0.0002 km2/(dogs x week). The effective reproductive ratio (R(e)) at the onset of our observations was estimated at 1.01, indicating low-level endemic stability of rabies transmission. Human rabies incidence depended critically on dog-related transmission parameters. We simulated the effects of mass dog vaccination and the culling of a percentage of the dog population on human rabies incidence. A single parenteral dog rabies-mass vaccination campaign achieving a coverage of least 70% appears to be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to postexposure prophylaxis (PEP), which is the current practice in Chad. PEP does not reduce future human exposure. Its cost-effectiveness is estimated at US $46 per disability adjusted life-years averted. Cost-effectiveness for PEP, together with a dog-vaccination campaign, breaks even with cost-effectiveness of PEP alone after almost 5 years. Beyond a time-frame of 7 years, it appears to be more cost-effective to combine parenteral dog-vaccination campaigns with human PEP compared to human PEP alone.

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