GARC’s applied research publications

Two papers resulting from GARC’s applied research have recently been published.

The first, by Shwiff, Hatch et al. and published in Transboundary and Emerging Diseases comprises an economic analysis of the KwaZulu Natal (KZN)rabies control programme in South Africa.  Dog vaccination campaigns in KZN were intensified in 2007 and again in 2009 when the project became a demonstration site supported by the Bill and Melinda Gates Foundation.  The economic assessment work sought to compile the recent economic costs of the project, to estimate the total cost per dog vaccinated, cost per PEP administered, and cost per human life saved. The comprehensive figures include all the costs of project implementation (eg. salaries, transport, consumables, etc.) to assess cost-effectiveness and can guide management decisions for KZN and other countries considering investments in rabies control.

The study concluded that dog vaccination cost $5.41/dog where a local campaign could be used, but $6.61/dog where the remote population required a mass campaign strategy. The cost of providing PEP was found to be approximately $64.50 on average per patient, but as high as $333 on average for the 9% of patients who receive RIG. Estimating the cost per life saved depends on the percentage of patients receiving PEP who would otherwise have contracted rabies. Data on this is very hard to find, but two estimates were used. The authors concluded that the cost per human life saved  ranged from around  $2565 to $427  (assuming either 2% or 12% would have developed rabies from the bites sustained.

The second, by Taylor, Knopf et al. published in Zoonoses and Public Health, is the results of a global survey on the surveillance of human rabies. Many of GARC’s colleagues, especially those in the Rabies Expert networks helped by answering this questionnaire, and we are glad to be able to share the findings with the global rabies community. The survey asked questions about whether rabies was a notifiable disease in the country, if so how the surveillance system operated, and importantly whether the system was considered to be operating effectively.

This was the first attempt to collect data of this nature and data from 121 different respondents in 91 countries (covering 88% of the world’s population) were analysed. Although most countries reported that human rabies was a notifiable disease, surveillance systems were very variable, and many were judged to be ineffective. The respondents identified several reasons (such as rabies not being a health priority, to poor training of key medical staff, and a lack of resources to implement a reporting structure) where increased investment and training could have a big impact. However, other reasons, such as the fact that many rabies victims die without any contact with health systems, are less easily overcome.

Globally, people in 27 of the countries surveyed (totalling 2.5 billion people) are living where there is no, or ineffective, surveillance for human rabies, often in African and Asian countries where canine rabies is a high risk. If countries not covered by this survey actually had less emphasis on rabies reporting, as seems plausible, this figure could be much higher. The study concludes that the initiation of regional databases for rabies surveillance Africa, Asia and elsewhere should be strongly encouraged.

GARC is very grateful for the support of the UBS Optimus foundation whose financial support allowed us to undertake both of these projects, and especially to the participants who helped gather the data. The paper details are:  Shwiff, Hatch et al. (2014). Towards Canine Rabies Elimination in KwaZulu-Natal, South Africa: Assessment of Health Economic Data. Transbound. Emerg. Dis. Nov 21. doi: 10.1111/tbed.12283, and Taylor, Knopf et al. (2015). Surveillance of Human Rabies by National Authorities  - A Global Survey. Zoonoses Public Health