Katie Hampson University of Glasgow The Impacts of Rabies and - - PowerPoint PPT Presentation

Katie Hampson

University of Glasgow

The Impacts of Rabies and Benefits of Prevention

Maison de la Paix - Geneva, Switzerland - 10 – 11 December 2015

Glasgow: S Cleaveland, D Haydon, T Lembo, R Mancy, S Townsend, I Rysava Tanzania: Ifakara Health Institute, Sokoine University of Agriculture Indonesia AAG Putra, FAO: E Brum, L Schoonman, BAWA: J Giradi, GN Bagus Americas: PAHO - V Del Rio Vilas, M Carvalho, M Vigilato, MEX V Guitierrez Cedillo & co, BRA E Pacheco de Caldas, S Rocha & co. Partners for Rabies Prevention, GARC, Louise Taylor Wellcome Trust, Medical Research Council, Bill & Melinda Gates Foundation UBS Optimus Foundation

Every year: 59,000 deaths, 3.7 million DALYs, $8.6 billion

Official records severely underestimate the burden of rabies

Rabies deaths/ 100,000

Every year: 59,000 deaths, 3.7 million DALYs, $8.6 billion

$$ on dog vaccination/ 100,000

Per capita death rates are highest in the poorest countries Burden reflects lack of investment in dog vaccination

$0.01 $0.014 $0.114 dog vax dog vax dog vax

Africa Asia Latin America

Rabies deaths per million population 20.9 9.3 0.34

Per Capita Expenditure

$0.15 $0.34 $0.24 PEP PEP PEP

Africa Asia Latin America

Rabies deaths per million population 20.9 9.3 0.34

Per Capita Expenditure

Africa Asia Latin America

Rabies deaths per million population 20.9 9.3 0.34 Dog Vaccination 6% 15% 60% Coverage

Dog vaccination is a cost-effective approach to human rabies prevention

From Endemic to Eliminated

Low income High income

Highest death rate Least $ per capita on dog vax Lowest death rate Most $ per capita on dog vax

Pre-control Control Elimination Freedom

From Endemic to Eliminated

Pre-control Control Elimination Freedom

Poorest countries:

• Investing in dog vaccination saves lives of those with poor access to health

services

Incremental Cost-effectiveness Ratio of dog vaccination: $300/ life year saved! ($2000 = WHO very cost effective!) Fitzpatrick et al. 2014

• Wildlife are not an obstacle
• Vast majority of dogs are owned
• Almost all dogs accessible for vaccination

MASS DOG VACCINATION NEEDS TO START!

From Endemic to Eliminated

Pre-control Control Elimination Freedom

Poorest countries:

• Investing in dog vaccination saves lives of those with poor access to health

services

Low-middle income countries:

• Investing in dog vaccination can enable countries to rapidly approach

elimination & save expenditure on PEP

Each year saving >100 lives & $1.5 million on Bali

Annual dog vaccination on Bali, Indonesia has reduced rabies to very low incidence

Mass vaccinations have eliminated rabies locally from several areas of the Philippines

From Endemic to Eliminated

Pre-control Control Elimination Freedom

Countries approaching elimination:

• Investing in neighbouring/ problem areas will result in

disease freedom & massive long-term savings

Poorest countries:

• Investing in dog vaccination saves lives of those with poor access to health

services

Low-middle income countries:

• Investing in dog vaccination can enable countries to rapidly approach

elimination & save expenditure on PEP

• >99% reductions in cases (speed varied by areas, population & wealth!)
• Coordination synchronized dynamics facilitating elimination

LATIN AMERICA & CARIBBEAN

Focus on improving vaccination in poorest/ problematic areas

Mexico Brazil Bolivia Columbia

• >99% reductions in cases (speed varied by areas, population & wealth!)
• Coordination synchronized dynamics facilitating elimination

LATIN AMERICA & CARIBBEAN

Focus on improving vaccination in poorest/ problematic areas

Mexico Brazil Bolivia Columbia

CONCLUSIONS

Poorest countries:

• Investing in dog vaccination saves lives of those with poor

access to health services Low-middle income countries:

• Investing in dog vaccination can enable countries to rapidly

approach elimination & save expenditure on PEP Countries approaching elimination:

• Investing in neighbouring/ problem areas will result in disease

freedom & massive long-term savings

By working together, engaging communities and committing to sustain dog vaccinations, rabies can be eliminated

Thank you

Katie Hampson Katie.Hampson@glasgow.ac.uk University of Glasgow

Bites $$ DALYs deaths Healthy PEP No PEP Alive Rabies Rabid No PEP PEP Vaccination coverage Dogs HDI DALYs $$

Regimens, vaccines, RIG

rabid dog bite receive PEP develop rabies Livestock $$

Population Control

$$

Surveillance

DATA: Questionnaires, literature, cluster extrapolation OUTPUTS