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Proc Natl Acad Sci U S A. 2016 Dec 20;113(51):14574-14581. doi: 10.1073/pnas.1604975113.

One Health approach to cost-effective rabies control in India.

Author information

1
Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.
2
Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201.
3
Research Division, Public Health Foundation of India, Gurgaon, Haryana 122002, India.
4
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115.
5
Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, United Kingdom.
6
Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510.
7
Department of Computational Biology and Bioinformatics, Yale University, New Haven, CT 06511.
8
Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06511.
9
Research Division, Public Health Foundation of India, Gurgaon, Haryana 122002, India; s.abbas@ids.ac.uk alison.galvani@yale.edu.
10
Health & Nutrition Cluster, Institute of Development Studies, Brighton BN1 9RE, United Kingdom.
11
Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510; s.abbas@ids.ac.uk alison.galvani@yale.edu.

Abstract

Over 20,000 rabies deaths occur annually in India, representing one-third of global human rabies. The Indian state of Tamil Nadu has pioneered a "One Health" committee to address the challenge of rabies in dogs and humans. Currently, rabies control in Tamil Nadu involves postexposure vaccination of humans after dog bites, whereas potential supplemental approaches include canine vaccination and sterilization. We developed a data-driven rabies transmission model fit to human rabies autopsy data and human rabies surveillance data from Tamil Nadu. Integrating local estimates for canine demography and costs, we predicted the impact of canine vaccination and sterilization on human health outcomes and evaluated cost-effectiveness according to the WHO criteria for India, which correspond to thresholds of $1,582 and $4,746 per disability-adjusted life-years (DALYs) for very cost-effective and cost-effective strategies, respectively. We found that highly feasible strategies focused on stray dogs, vaccinating as few as 7% of dogs annually, could very cost-effectively reduce human rabies deaths by 70% within 5 y, and a modest expansion to vaccinating 13% of stray dogs could cost-effectively reduce human rabies by almost 90%. Through integration over parameter uncertainty, we find that, for a cost-effectiveness threshold above $1,400 per DALY, canine interventions are at least 95% likely to be optimal. If owners are willing to bring dogs to central point campaigns at double the rate that campaign teams can capture strays, expanded annual targets become cost-effective. This case study of cost-effective canine interventions in Tamil Nadu may have applicability to other settings in India and beyond.

KEYWORDS:

cost-effectiveness; mathematical modeling; rabies; sterilization; vaccination

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