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

作者：Katie Hampson, Francesco Ventura, Rachel Steenson, Rebecca Mancy, Caroline Trotter, Laura Cooper, Bernadette Abela-Ridder, Lea Knopf, Moniek Ringenier, Tenzin Tenzin, Sowath Ly, Arnaud Tarantola, Ronelngar Moyengar, Assandi Oussiguéré, Bassirou Bonfoh, DH Ashwath Narayana, Mysore Kalappa Sudarshan, Matthew Muturi, Athman Mwatondo, Gati Wambura, Soa Fy Andriamandimby, Laurence Baril, Glenn T. Edosoa, Abdallah Traoré, Sarah I. Jayme, Johann Kotzé, Amila Gunesekera, Nakul Chitnis, Jan Hattendorf, Mirjam Laager, Monique Léchenne, Jakob Zinsstag, Joel Changalucha, Zac Mtema, Ahmed Lugelo, Kennedy Lushasi, Onphirul Yurachai, C. Jessica E. Metcalf, Malavika Rajeev, Jesse D. Blanton, Galileu Barbosa Costa, Nandini Sreenivasan, Ryan M. Wallace, Deborah J. Briggs, Louise Taylor, Samuel M. Thumbi, Nguyen Thi Thanh Huong · 发表于：The Lancet Infectious Diseases · 年份：2018 · DOI：10.1016/s1473-3099(18)30512-7 · 被引用次数：135 · 研究领域：Rabies epidemiology and control、Zoonotic diseases and public health、Viral Infections and Outbreaks Research

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 disabili...