The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study

Katie Hampson (1) , Francesco Ventura (2) , Rachel Steenson (2) , Rebecca Mancy (2) , Caroline Trotter (3) , Laura Cooper (3) , Bernadette Abela-Ridder (4) , Lea Knopf (4) , Moniek Ringenier (5) , Tenzin Tenzin (6) , Sowath Ly (7) , Arnaud Tarantola (7) , Ronelngar Moyengar (8) , Assandi Oussiguéré (9) , Bassirou Bonfoh (10) , Dh Ashwath Narayana , Mysore Kalappa Sudarshan , Matthew Muturi , Athman Mwatondo , Gati Wambura , Soa Fy Andriamandimby (11) , Laurence Baril (11) , Glenn Edosoa (12) , Abdallah Traore (13) , Sarah Jayme , Johann Kotzé , Amila Gunesekera , Nakul Chitnis (14) , Jan Hattendorf (14) , Mirjam Laager , Monique Léchenne (14) , Jakob Zinsstag (14) , Joel Changalucha , Zac Mtema , Ahmed Lugelo , Kennedy Lushasi , Onphirul Yurachai , Charlotte Jessica E. Metcalf (15) , Malavika Rajeev (15) , Jesse Blanton (16) , Galileu Barbosa Costa (17) , Nandini Sreenivasan (16) , Ryan Wallace (16) , Deborah Briggs (18) , Louise Taylor (19) , Samuel Thumbi (20) , Nguyen Thi Thanh Huong (21)

1 Institute of Biodiversity, Animal Health & Comparative Medicine
2 University of Glasgow
3 CAM - University of Cambridge [UK]
4 OMS / WHO - Organisation Mondiale de la Santé / World Health Organization Office
5 UGENT - Universiteit Gent = Ghent University
6 NCAH - National Centre for Animal Health [Bhoutan]
7 Unité d'Épidémiologie et de Santé Publique [Phnom Penh]
8 CSSI - Centre de Support en Santé Internationale [N'Djamena, Tchad]
9 IRED - Institut de Recherche en Elevage pour le Developpement [N'Djamena, Tchad]
10 CSRS-CI - Centre Suisse de Recherches Scientifiques en Cote d'Ivoire [Abidjan]
11 Institut Pasteur de Madagascar
12 Ministère de la Santé Publique - Ministry of Public Health [Antananarivo, Madagascar]
13 Laboratoire Central Vétérinaire [Bamako, Mali]
14 Swiss Tropical and Public Health Institute [Basel]
15 Princeton University
16 Centers for Disease Control and Prevention
17 UFMG - Universidade Federal de Minas Gerais = Federal University of Minas Gerais [Belo Horizonte, Brazil]
18 Kansas State University
19 Global Alliance for Rabies Control [Manhattan, Kansas]
20 WSU - Washington State University
21 NIHE - National Institute of Hygiene and Epidemiology [Hanoi, Vietnam]

Background: Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply. Methods: We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs. Findings: We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use. Interpretation: Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies. Funding: World Health Organization.

Domaines: Maladies infectieuses

Katie Hampson, Francesco Ventura, Rachel Steenson, Rebecca Mancy, Caroline Trotter, et al.. The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study. The Lancet Infectious Diseases, 2019, 19 (1), pp.102-111. ⟨10.1016/S1473-3099(18)30512-7⟩. ⟨hal-02868805⟩