katie hampson - world organisation for animal health · rabies deaths/ 100,000 every year: 59,000...

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