Eliminating human rabies: impact of enhanced vaccination coverage

项目总结 狂犬病是已知人类传染病中病死率最高的，每年导致约5.9万人死亡。 几乎所有这些死亡(99%)都发生在非洲和亚洲，都是由犬狂犬病引起的。虽然人类狂犬病是可以预防的 通过暴露后预防(PEP)，干预成本高昂，而且在所在的偏远社区往往无法获得 需要的。通过大规模接种犬类疫苗(MDV)来控制宿主的目标是一种社会公平和 有效的方法。然而，在狂犬病仍然流行的农村地区实施MDV在后勤上是可行的。 具有挑战性，因此也很昂贵。此外，只有有限的经验证据可以证明 MDV在实现公共卫生成果方面的成本效益。因此，许多国家在以下方面花费大量资源 提供PEP，但对MDV的投资有限。这项拟议的研究的目标是消除以狗为媒介的 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战略 狂犬病仍然流行的地方。为了实现这一点，将进行随机对照试验(RCT)来比较 两种交付战略下的疫苗接种覆盖面：标准的集中团队领导的交付(在后勤上 具有挑战性并导致非正常覆盖(按成本计算)和分散的社区主导的方法(通过 最近确定的狂犬病疫苗是耐热的，可以在户外长时间储存 (目标1)。其假设是，社区主导的分娩将在较低的水平上产生更一致的覆盖 每剂的成本。第二，加强狂犬病监测网络，以量化下列对公众健康的影响 在目标1(目标2)中引入MDV。狂犬病在狗的种群中的发病率预计将迅速下降，并公开 对健康造成的影响(被咬的人更少，所需的PEP更少，死亡人数更少)。第三，AIMS 1的产出 和2将用于模拟交付战略对公共卫生结果的影响(目标3)。假设是这样的 社区主导的MDV传播将带来更好的公共卫生结果，并比 标准的团队领导的MDV。第四，目标1-3的产出将用于实施一套成本效益和 效益-成本分析，以了解两种MDV战略的成本效益和净效益。在……里面 量化MDV提供的人类狂犬病负担的减少以及相对有效性和成本 为了确保交付战略的有效性，这项研究将提供亟需的数据，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/世界动物卫生组织/粮农组织设定的2030年全球消灭狗- 这项研究的结果将为指导消除犬只狂犬病提供关键和及时的贡献。 狂犬病流行国家。

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.