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

J. Zinsstag, S. Dürr, M. A. Penny, R. Mindekem, F. Roth, S. Menendez Gonzalez, S. Naissengar, J. Hattendorf

Research output: Contribution to journalArticlepeer-review

225 Citations (Scopus)

Abstract

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 (βd) were 0.0807 km2/(dogs·week) and between dogs and humans (βdh) 0.0002 km2/(dogs·week). The effective reproductive ratio (Re) 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.

Original languageEnglish
Pages (from-to)14996-15001
Number of pages6
JournalProceedings of the National Academy of Sciences of the United States of America
Volume106
Issue number35
DOIs
Publication statusPublished - 1 Sept 2009
Externally publishedYes

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