Meagan C. Fitzpatrick, MPhil; Katie Hampson, PhD; Sarah Cleaveland, PhD, VetMB; Imam Mzimbiri, BVM; Felix Lankester, DVM; Tiziana Lembo, PhD; Lauren A. Meyers, PhD; A. David Paltiel, PhD; Alison P. Galvani, PhD
Acknowledgments: The authors thank Dr. Jamie Childs for insightful conversation about the rabies system and Mr. Israel Silaa and Mr. Kaneja Ibrahim Mangaru of the Serengeti Health Initiative for informative discussions about campaign logistics. They also thank Angelika Hofmann for editorial assistance. The authors thank the Ministries of Health and Social Welfare, Ministry of Livestock and Fisheries Development in Tanzania, Tanzania National Parks, Tanzania Wildlife Research Institute, Ngorongoro Conservation Area Authority, the Tanzanian Commission for Science and Technology, and National Institute for Medical Research for permissions and collaboration, as well as colleagues from the Serengeti Viral Transmission Dynamics team, medical officers, field officers, paravets, and village officers in Serengeti and Ngorongoro.
Financial Support: By the National Institute of General Medical Sciences (U01 GM087719, Models of Infectious Disease Agent Study) and the Miriam Burnett Trust (Ms. Fitzpatrick and Dr. Galvani). Ms. Fitzpatrick also received support from the National Institute of Allergy and Infectious Diseases, Multidisciplinary Parasitology Training Program (T32AI007404), and Lindsay Fellowship for Research in Africa. Support for Dr. Hampson was provided by the Wellcome Trust. Dr. Paltiel received support from the National Institute on Drug Abuse (R01 DA015612). Vaccination campaigns were conducted and field data were generated with the support of the National Science Foundation and National Institutes of Health (DEB0225453 and DEB0513994), the Wellcome Trust, and Lincoln Park Zoo.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0542.
Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from Dr. Fitzpatrick (e-mail, firstname.lastname@example.org). Data set: Epidemiologic data from Dr. Hampson (e-mail, email@example.com), campaign information from Dr. Lankester (e-mail, firstname.lastname@example.org), and economic data from Dr. Cleaveland (e-mail, email@example.com).
Requests for Single Reprints: Meagan C. Fitzpatrick, MPhil, Yale School of Public Health, 60 College Street, New Haven, CT 06520; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Fitzpatrick and Drs. Paltiel and Galvani: Yale School of Public Health, 60 College Street, New Haven, CT 06520.
Drs. Hampson, Cleaveland, and Lembo: Graham Kerr Building, University of Glasgow, Glasgow G12 8QQ, UK.
Dr. Mzimbiri: PO Box 395, Usa River, Arusha, Tanzania.
Mr. Lankester: Paul G. Allen School for Global Animal Health, PO Box 647090, Washington State University, Pullman, WA 99164.
Dr. Meyers: 1 University Station C0930, Austin, TX 78712.
Author Contributions: Conception and design: M.C. Fitzpatrick, S. Cleaveland, A.D. Paltiel, A.P. Galvani.
Analysis and interpretation of the data: M.C. Fitzpatrick, K. Hampson, S. Cleaveland, F. Lankester, A.D. Paltiel, A.P. Galvani.
Drafting of the article: M.C. Fitzpatrick, K. Hampson, S. Cleaveland, L.A. Meyers, A.P. Galvani.
Critical revision of the article for important intellectual content: S. Cleaveland, F. Lankester, A.D. Paltiel, A.P. Galvani.
Final approval of the article: M.C. Fitzpatrick, K. Hampson, S. Cleaveland, T. Lembo, L.A. Meyers, A.D. Paltiel, A.P. Galvani.
Provision of study materials or patients: F. Lankester.
Statistical expertise: M.C. Fitzpatrick, A.P. Galvani.
Obtaining of funding: K. Hampson, S. Cleaveland, L.A. Meyers, A.D. Paltiel, A.P. Galvani.
Administrative, technical, or logistic support: S. Cleaveland, I. Mzimbiri, T. Lembo, A.P. Galvani.
Collection and assembly of data: M.C. Fitzpatrick, K. Hampson, S. Cleaveland, I. Mzimbiri, F. Lankester, T. Lembo.
Fitzpatrick MC, Hampson K, Cleaveland S, Mzimbiri I, Lankester F, Lembo T, et al. Cost-Effectiveness of Canine Vaccination to Prevent Human Rabies in Rural Tanzania. Ann Intern Med. 2014;160:91-100. doi: 10.7326/M13-0542
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Published: Ann Intern Med. 2014;160(2):91-100.
The annual mortality rate of human rabies in rural Africa is 3.6 deaths per 100 000 persons. Rabies can be prevented with prompt postexposure prophylaxis, but this is costly and often inaccessible in rural Africa. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans.
To evaluate the cost-effectiveness of rabies control through annual canine vaccination campaigns in rural sub-Saharan Africa.
We model transmission dynamics in dogs and wildlife and assess empirical uncertainty in the biological variables to make probability-based evaluations of cost-effectiveness.
Epidemiologic variables from a contact-tracing study and literature and cost data from ongoing vaccination campaigns.
Two districts of rural Tanzania: Ngorongoro and Serengeti.
Vaccination coverage ranging from 0% to 95% in increments of 5%.
Life-years for health outcomes and 2010 U.S. dollars for economic outcomes.
Annual canine vaccination campaigns were very cost-effective in both districts compared with no canine vaccination. In Serengeti, annual campaigns with as much as 70% coverage were cost-saving.
Across a wide range of variable assumptions and levels of societal willingness to pay for life-years, the optimal vaccination coverage for Serengeti was 70%. In Ngorongoro, although optimal coverage depended on willingness to pay, vaccination campaigns were always cost-effective and life-saving and therefore preferred.
Canine vaccination was very cost-effective in both districts, but there was greater uncertainty about the optimal coverage in Ngorongoro.
Annual canine rabies vaccination campaigns conferred extraordinary value and dramatically reduced the health burden of rabies.
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Infectious Disease, Vaccines/Immunization, Prevention/Screening.
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