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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
Abstract : 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.
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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, New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001-, 2019, 19 (1), pp.102-111. ⟨10.1016/S1473-3099(18)30512-7⟩. ⟨hal-02868805⟩

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