Zinsstag J, Dürr S, Penny M A, Mindekem R, Roth F, Menendez Gonzalez S, Naissengar S, Hattendorf J
Institut Tropical et de Santé Publique Suisse, Bâle, Suisse.
Med Trop (Mars). 2011 Dec;71(6):596-604.
Control of human rabies in developing countries depends on prevention in dogs. The purpose of this study was to evaluate the cost-saving potential for the public health sector of intervention to control rabies in animal-host reservoirs. An existing deterministic model was adapted to allow study of dog-to-human rabies transmission. Model parameters were fitted to data from routine weekly reports on the number of rabid dogs and human rabies exposures in N'Djamena, Chad. At the onset of study, the estimated effective reproductive ratio (Re) was 1.01 indicating stable low-level endemic rabies transmission. Simulations were performed to determine what effects mass vaccination and culling of dogs would have on the incidence of human rabies. Findings showed that a mass campaign allowing single parenteral vaccination of at least 70% of the canine population would be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to that of "postexposure prophylaxis" (PEP) which would not reduce future human exposure. Results showed that a sustained 5-year PEP program together with a dog-vaccination campaign would be as cost-effective as PEP alone. Beyond a time-frame of 7 years, combining parenteral dog vaccination campaigns with human PEP appeared to be more cost-effective than human PEP alone.
发展中国家人类狂犬病的防控依赖于对犬类的预防措施。本研究的目的是评估在动物宿主中控制狂犬病的干预措施对公共卫生部门的潜在成本节约效益。对现有的确定性模型进行了调整，以研究犬传人狂犬病的传播情况。模型参数根据乍得恩贾梅纳关于狂犬病犬数量和人类狂犬病暴露情况的每周常规报告数据进行拟合。在研究开始时，估计的有效繁殖率（Re）为1.01，表明狂犬病呈稳定的低水平地方性传播。进行了模拟，以确定犬类大规模疫苗接种和扑杀对人类狂犬病发病率的影响。研究结果表明，开展一次大规模活动，对至少70%的犬类进行单剂量皮下接种，足以在至少6年内阻断狂犬病向人类的传播。将犬类大规模疫苗接种的成本效益与不会减少未来人类暴露风险的“暴露后预防”（PEP）进行了比较。结果显示，持续5年的PEP计划与犬类疫苗接种活动相结合，其成本效益与单纯的PEP相同。在7年以上的时间范围内，将皮下犬类疫苗接种活动与人类PEP相结合，似乎比单纯的人类PEP更具成本效益。
