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dc.contributor.authorWHO Rabies Modelling Consortium
dc.date.accessioned2019-01-11T00:32:10Z
dc.date.available2019-01-11T00:32:10Z
dc.date.issued2019-01
dc.identifier.issn1473-3099
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/287847
dc.description.abstractBACKGROUND: 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.
dc.description.sponsorshipWorld Health Organisation Wellcome Trust
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherElsevier BV
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectWHO Rabies Modelling Consortium
dc.subjectAnimals
dc.subjectDogs
dc.subjectHumans
dc.subjectRabies virus
dc.subjectRabies
dc.subjectBites and Stings
dc.subjectDog Diseases
dc.subjectImmunoglobulins
dc.subjectRabies Vaccines
dc.subjectVaccination
dc.subjectIncidence
dc.subjectModels, Economic
dc.subjectEndemic Diseases
dc.subjectQuality-Adjusted Life Years
dc.subjectChild, Preschool
dc.subjectCost-Benefit Analysis
dc.subjectWorld Health Organization
dc.subjectFemale
dc.subjectMale
dc.subjectPost-Exposure Prophylaxis
dc.titleThe potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study.
dc.typeArticle
prism.endingPage111
prism.issueIdentifier1
prism.publicationDate2019
prism.publicationNameLancet Infect Dis
prism.startingPage102
prism.volume19
dc.identifier.doi10.17863/CAM.35162
dcterms.dateAccepted2018-08-08
rioxxterms.versionofrecord10.1016/S1473-3099(18)30512-7
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-01
dc.identifier.eissn1474-4457
rioxxterms.typeJournal Article/Review
pubs.funder-project-idWorld Health Organization (WHO) (2016/679767-0)
cam.issuedOnline2018-11-21


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International