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

Every year: 59,000 deaths, 3.7 million DALYs, $8.6 billion Official records severely underestimate the burden of rabies

Every year: 59,000 deaths, 3.7 million DALYs, $8.6 billion $$ on dog Rabies vaccination/ deaths/ 100,000 100,000 Per capita death rates are highest in the poorest countries Burden reflects lack of investment in dog vaccination

Africa Asia Latin America Rabies deaths per million 20.9 9.3 0.34 population Per Capita Expenditure $0.01 $0.014 $0.114 dog vax dog vax dog vax

Africa Asia Latin America Rabies deaths per million 20.9 9.3 0.34 population Per Capita Expenditure $0.15 $0.34 $0.24 PEP PEP PEP

Africa Asia Latin America Rabies deaths per million 20.9 9.3 0.34 population Dog Vaccination 6% 15% 60% Coverage Dog vaccination is a cost-effective approach to human rabies prevention

From Endemic to Eliminated Pre-control Control Elimination Freedom High income Low income Highest death rate Lowest death rate Least $ per capita on dog vax Most $ per capita on dog vax

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

Annual dog vaccination on Each year saving >100 lives & Bali, Indonesia has reduced $1.5 million on Bali 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 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

LATIN AMERICA & CARIBBEAN • >99% reductions in cases (speed varied by areas, population & wealth!) • Coordination synchronized dynamics facilitating elimination Mexico Brazil Columbia Bolivia Focus on improving vaccination in poorest/ problematic areas

LATIN AMERICA & CARIBBEAN • >99% reductions in cases (speed varied by areas, population & wealth!) • Coordination synchronized dynamics facilitating elimination Mexico Brazil Columbia Bolivia Focus on improving vaccination in poorest/ problematic areas

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

Population Control Dogs Bites Vaccination $$ Livestock rabid dog bite $$ coverage Surveillance Rabid Healthy receive PEP HDI No PEP PEP PEP No PEP Regimens, develop $$ vaccines, rabies DALYs RIG $$ DALYs Alive Rabies deaths DATA: Questionnaires, literature, cluster extrapolation OUTPUTS