Eliminating human rabies: impact of enhanced vaccination coverage

消除人类狂犬病：加强疫苗接种覆盖率的影响

• 批准号: 10287488
• 负责人: Felix Lankester
• 金额: $ 31.45万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-11-20 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10287488
• 关键词: Africa; Asia; Canis familiaris; Case Fatality Rates; Cessation of life; Clinic; Cold Chains; Communicable Diseases; Communities; Cost-Benefit Analysis; Country; Data; Decentralization; Dose; Drops; Economics; Goals; Health; Human; Improve Access; Incidence; International; Intervention; Investments; Location; Logistics; Mass Vaccinations; Measures; Mediating; Methods; Modeling; Onchocerciasis; Outcome; Output; Persons; Policies; Population; Power Sources; Prevention; Prophylactic treatment; Public Health; Rabies; Rabies Vaccines; Randomized Controlled Trials; Refrigeration; Resources; Rural; Rural Community; Socioeconomic Status; Source; Temperature; Testing; Time; Vaccinated; Vaccination; Vaccines; base; burden of illness; comparative; comparative effectiveness; cost; cost effective; cost effectiveness; disorder control; effectiveness testing; health data; immunogenicity; implementation barriers; improved; improved outcome; neglected tropical diseases; novel; pharyngeal critical pressure; prevent; remote communities; social; surveillance network; thermostability; transmission process; vaccination outcome; vaccination strategy; vaccine delivery

PROJECT SUMMARY Rabies has the highest case fatality rate of any known human infectious disease and kills around 59,000 people annually. Nearly all of these deaths (99%) occur in Africa and Asia and are due to canine rabies. While human rabies can be prevented with post-exposure prophylaxis (PEP), the intervention is costly and often not available in remote communities where it is needed. Targeting control efforts at the reservoir host through mass dog vaccination (MDV) is a socially equitable and effective approach. However, implementing MDV across the rural landscapes where rabies remains endemic is logistically challenging and, consequently, expensive. Moreover, there has only been limited empirical evidence to demonstrate the cost-effectiveness of MDV in achieving public health outcomes. As a result many countries spend substantial resources on provision of PEP with only limited investment in MDV. The goal of the proposed study is the elimination of dog-mediated human rabies, whilst the long term objective is the provision of cost-effective control strategies across the remote landscapes where rabies remains endemic. To achieve this a randomized controlled trial (RCT) will be carried out to compare vaccination coverage under two delivery strategies: the standard centralized team-led delivery (which is logistically challenging and results in irregular coverage, at cost) and a decentralized community-led approach (made possible through the recent determination that rabies vaccines are thermotolerant and can be stored for extended periods outside of refrigeration units) (Aim 1). The hypothesis is that community-led delivery will result in more consistent coverage at lower cost per dose. Second, an enhanced rabies surveillance network will be used to quantify the public health impact following the introduction of MDV in Aim 1 (Aim 2). Rabies incidence in the dog population is predicted to decline rapidly and public health impacts to accrue (fewer people bitten, less PEP required and fewer human deaths). Third, the outputs from Aims 1 and 2 will be used to model the impact that delivery strategy has on public health outcomes (Aim 3). The hypothesis is that community-led MDV delivery will result in improved public health outcomes and achieve elimination more rapidly than standard team-led MDV. Fourth, the outputs from Aims 1 – 3 will be used to carry out a suite of cost-effectiveness and benefit-cost analyses to understand the cost-effectiveness and net benefits derived from the two MDV strategies. In quantifying the reduction in the human rabies burden that MDV provides and the comparative effectiveness and cost effectiveness of the delivery strategies, this study will provide much needed data that will inform international policy on the best approaches to eliminate rabies at scale. With a date of 2030 set by WHO/OIE/FAO for the global elimination of dog- mediated human rabies, the study’s outputs will provide a critical and timely contribution to guide elimination in canine- rabies endemic countries.

项目摘要 狂犬病是任何已知的人类传染病中病死率最高的，每年造成约59，000人死亡。 几乎所有这些死亡（99%）发生在非洲和亚洲，是由于犬狂犬病。虽然人类狂犬病可以预防 对于接触后预防（PEP），干预费用昂贵，而且在偏远社区往往无法获得， needed.通过大规模犬只疫苗接种（MDV）将控制工作的目标锁定在水库宿主， 有效的方法。然而，在狂犬病仍然流行的农村地区实施MDV在逻辑上是不可行的。 具有挑战性，并且因此昂贵。此外，只有有限的经验证据表明， MDV在实现公共卫生成果方面的成本效益。因此，许多国家将大量资源用于 提供PEP，而对MDV的投资有限。拟议研究的目标是消除狗介导的 人类狂犬病，而长期目标是在偏远地区提供具有成本效益的控制策略 狂犬病仍然流行的地方。为了实现这一目标，将进行一项随机对照试验（RCT）， 两种提供战略下的疫苗接种覆盖率：标准的集中式小组领导的提供（后勤上 具有挑战性，导致覆盖面不规则，需要支付费用）和分散的社区主导办法（通过 最近确定狂犬病疫苗是耐热的，可以在 （目标1）。假设是，社区主导的服务提供将在较低的覆盖率下产生更一致的覆盖率。 每剂成本。第二，我们会加强狂犬病监察网络，以量化下列措施对公众健康的影响： 在目标1（目标2）中引入MDV。狂犬病在犬群中的发病率预计将迅速下降， 健康影响的累积（更少的人被咬伤，更少的PEP需要和更少的人类死亡）。第三，目标1的输出 和2将用于模拟实施战略对公共卫生成果的影响（目标3）。前提是 社区主导的MDV提供将导致改善公共卫生结果，并比 标准团队领导的MDV。第四，目标1 - 3的产出将用于执行一套成本效益和 效益-成本分析，以了解两种MDV策略的成本效益和净效益。在 量化MDV对人类狂犬病负担的减少以及相对有效性和成本 这项研究将提供急需的数据，为国际政策提供信息， 大规模消灭狂犬病的最佳方法世卫组织/国际兽疫局/粮农组织将2030年定为全球消除犬只的日期， 介导的人狂犬病，该研究的结果将提供一个关键和及时的贡献，指导消除犬- 狂犬病流行国家。