Elly Hiby

Estimating the global burden of endemic canine rabies.

Background Rabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries. Methodology/Principal Findings We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%). Conclusions/Significance This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

Behavioural and physiological responses of dogs entering re-homing kennels

Behaviour and urinary cortisol/creatinine ratios (C/C) were monitored in twenty-six dogs, on days 1, 2, 3, 5, 7 and 10 following their admission to a rehoming kennel. Half had been relinquished from homes, and half were either strays or returns to the shelter. Drinking and grooming increased with time, while panting and paw-lifting decreased, but only drinking was linked with C/C; dogs observed drinking on the first day had significantly lower C/C than dogs not observed drinking. Mean molar C/C (40 x 10(-6)+/-16 x 10(-6)) tended to decrease with time in the strays and returns, and to increase in dogs relinquished from homes, although C/C on the first day was highly variable and not distinguishable between these two groups. This implies that these populations differed in their long-term, but possibly not their short-term, responses to kennelling. Dogs with rising C/C were more active on average than those with falling C/C, but the opposite trend was detected when making comparisons within-dog. The relationship between C/C and exercise is therefore complex and warrants further investigation before C/C can be considered as a reliable indicator of welfare in this species.

Designing programs for eliminating canine rabies from islands: Bali, Indonesia as a case study.

Background Canine rabies is one of the most important and feared zoonotic diseases in the world. In some regions rabies elimination is being successfully coordinated, whereas in others rabies is endemic and continues to spread to uninfected areas. As epidemics emerge, both accepted and contentious control methods are used, as questions remain over the most effective strategy to eliminate rabies. The Indonesian island of Bali was rabies-free until 2008 when an epidemic in domestic dogs began, resulting in the deaths of over 100 people. Here we analyze data from the epidemic and compare the effectiveness of control methods at eliminating rabies. Methodology/Principal Findings Using data from Bali, we estimated the basic reproductive number, R 0, of rabies in dogs, to be ∼1·2, almost identical to that obtained in ten–fold less dense dog populations and suggesting rabies will not be effectively controlled by reducing dog density. We then developed a model to compare options for mass dog vaccination. Comprehensive high coverage was the single most important factor for achieving elimination, with omission of even small areas (<0.5% of the dog population) jeopardizing success. Parameterizing the model with data from the 2010 and 2011 vaccination campaigns, we show that a comprehensive high coverage campaign in 2012 would likely result in elimination, saving ∼550 human lives and ∼

Response to a rabies epidemic, Bali, Indonesia, 2008-2011.

15 million in prophylaxis costs over the next ten years. Conclusions/Significance The elimination of rabies from Bali will not be achieved through achievable reductions in dog density. To ensure elimination, concerted high coverage, repeated, mass dog vaccination campaigns are necessary and the cooperation of all regions of the island is critical. Momentum is building towards development of a strategy for the global elimination of canine rabies, and this study offers valuable new insights about the dynamics and control of this disease, with immediate practical relevance.

Renewed Global Partnerships and Redesigned Roadmaps for Rabies Prevention and Control

Emergency vaccinations and culling failed to contain an outbreak of rabies in Bali, Indonesia, during 2008–2009. Subsequent island-wide mass vaccination (reaching 70% coverage, >200,000 dogs) led to substantial declines in rabies incidence and spread. However, the incidence of dog bites remains high, and repeat campaigns are necessary to eliminate rabies in Bali.

Fecundity and longevity of roaming dogs in Jaipur, India

Canine rabies, responsible for most human rabies deaths, is a serious global public health concern. This zoonosis is entirely preventable, but by focusing solely upon rabies prevention in humans, this “incurable wound” persists at high costs. Although preventing human deaths through canine rabies elimination is feasible, dog rabies control is often neglected, because dogs are not considered typical economic commodities by the animal health sector. Here, we demonstrate that the responsibility of managing rabies falls upon multiple sectors, that a truly integrated approach is the key to rabies elimination, and that considerable progress has been made to this effect. Achievements include the construction of global rabies networks and organizational partnerships; development of road maps, operational toolkits, and a blueprint for rabies prevention and control; and opportunities for scaling up and replication of successful programs. Progress must continue towards overcoming the remaining challenges preventing the ultimate goal of rabies elimination.

Correction: Estimating the global burden of endemic canine rabies.

BackgroundEstimates of demographic parameters, such as age-specific survival and fecundity, age at first pregnancy and litter size, are required for roaming dogs (i.e. dogs that are neither confined nor restricted) to assess the likely effect of proposed methods of population control. Data resulting from individual identification of dogs spayed as part of an Animal Birth Control (ABC) programme in Jaipur, India, are used to derive such parameters for the roaming dog population of that city.ResultsThe percentage of females becoming pregnant in any given year was estimated by inspection of over 25,000 females caught for spaying from 1995 to 2006. The point estimate is 47.5% with a 95% confidence interval from 44% to 51%. Adult annual survival of spayed females was estimated by recapture of 62 spayed females from 2002 to 2006. The point estimate is 0.70 (95% confidence interval from 0.62 to 0.78), corresponding to an expected total lifespan of 3.8 years for a spayed female at one year old.ConclusionRecording the pregnancy status of dogs collected for spaying and individual marking of dogs released following spaying can provide estimates of some of the demographic parameters essential for predicting the future effectiveness of an ABC programme. Further, we suggest that recording the number and location of spayed and unspayed dogs encountered by the catching teams could be the most effective way to monitor the size and composition of the roaming dog population.

A mark-resight survey method to estimate the roaming dog population in three cities in Rajasthan, India

There are a number of errors in Table 3. The table legend should read: Breakdown of economic costs of rabies by cluster in millions of USD. The headings for columns six, seven, and eight are incorrect. They should be in the following order: Dog vaccination, Dog population management, Livestock losses. Please see the correct Table 3 below. Table 3 Breakdown of economic costs of rabies by cluster in millions of USD.

A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka

1. AbstractBackgroundDog population management is required in many locations to minimise the risks dog populations may pose to human health and to alleviate animal welfare problems. In many cities in India, Animal Birth Control (ABC) projects have been adopted to provide population management. Measuring the impact of such projects requires assessment of dog population size among other relevant indicators.MethodsThis paper describes a simple mark-resight survey methodology that can be used with little investment of resources to monitor the number of roaming dogs in areas that are currently subject to ABC, provided the numbers, dates and locations of the dogs released following the intervention are reliably recorded. We illustrate the method by estimating roaming dog numbers in three cities in Rajasthan, India: Jaipur, Jodhpur and Jaisalmer. In each city the dog populations were either currently subject to ABC or had been very recently subject to such an intervention and hence a known number of dogs had been permanently marked with an ear-notch to identify them as having been operated. We conducted street surveys to record the current percentage of dogs in each city that are ear-notched and used an estimate for the annual survival of ear-notched dogs to calculate the current size of each marked population.ResultsDividing the size of the marked population by the fraction of the dogs that are ear-notched we estimated the number of roaming dogs to be 36,580 in Jaipur, 24,853 in Jodhpur and 2,962 in Jaisalmer.ConclusionsThe mark-resight survey methodology described here is a simple way of providing population estimates for cities with current or recent ABC programmes that include visible marking of dogs. Repeating such surveys on a regular basis will further allow for evaluation of ABC programme impact on population size and reproduction in the remaining unsterilised dog population.

Incidence of dog bites and public attitudes towards dog care and management in Samoa

Background One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management. Methodology/Principal Findings A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US