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The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study
- Source :
- The Lancet Infectious Diseases, The Lancet Infectious Diseases, New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001-, 2019, 19 (1), pp.102-111. ⟨10.1016/S1473-3099(18)30512-7⟩
- Publication Year :
- 2019
- Publisher :
- HAL CCSD, 2019.
-
Abstract
- International audience; 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.
- Subjects :
- MESH: Rabies virus / isolation & purification
MESH: Rabies virus / immunology
MESH: Bites and Stings / virology
MESH: World Health Organization
MESH: Cost-Benefit Analysis / methods
MESH: Dogs
MESH: Rabies / prevention & control
MESH: Rabies / epidemiology
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
MESH: Post-Exposure Prophylaxis / economics
MESH: Rabies / virology
MESH: Animals
MESH: Incidence
MESH: Dog Diseases / prevention & control
MESH: Immunoglobulins / therapeutic use
ComputingMilieux_MISCELLANEOUS
MESH: Models, Economic
MESH: Humans
MESH: Rabies Vaccines / therapeutic use
MESH: Endemic Diseases / prevention & control
MESH: Child, Preschool
MESH: Post-Exposure Prophylaxis / methods
MESH: Rabies / mortality
MESH: Male
MESH: Quality-Adjusted Life Years
MESH: Rabies Vaccines / economics
MESH: Vaccination / economics
MESH: Female
Subjects
Details
- Language :
- English
- ISSN :
- 14733099 and 14744457
- Database :
- OpenAIRE
- Journal :
- The Lancet Infectious Diseases, The Lancet Infectious Diseases, New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001-, 2019, 19 (1), pp.102-111. ⟨10.1016/S1473-3099(18)30512-7⟩
- Accession number :
- edsair.dedup.wf.001..d9b888f55b832bcab6b472540da7b08b