Sultanov Akmetzhan A, Abdrakhmanov Sarsenbay K, Abdybekova Aida M, Karatayev Bolat S, Torgerson Paul R
Kazakh Research - Scientific Veterinary Institute LLP, Almaty, Kazakhstan.
Kazakh Agrotechnical University named after S. Seifullin JSC, Astana, Kazakhstan.
PLoS Negl Trop Dis. 2016 Aug 3;10(8):e0004889. doi: 10.1371/journal.pntd.0004889. eCollection 2016 Aug.
Rabies is a neglected zoonotic disease. There is a sparsity of data on this disease with regard to the incidence of human and animal disease in many low and middle income countries. Furthermore, rabies results in a large economic impact and a high human burden of disease. Kazakhstan is a large landlocked middle income country that gained independence from the Soviet Union in 1991 and is endemic for rabies.
METHODOLOGY/PRINCIPAL FINDINGS: We used detailed public health and veterinary surveillance data from 2003 to 2015 to map where livestock rabies is occurring. We also estimate the economic impact and human burden of rabies. Livestock and canine rabies occurred over most of Kazakhstan, but there were regional variations in disease distribution. There were a mean of 7.1 officially recorded human fatalities due to rabies per year resulting in approximately 457 Disability Adjusted Life Years (DALYs). A mean of 64,289 individuals per annum underwent post exposure prophylaxis (PEP) which may have resulted in an additional 1140 DALYs annually. PEP is preventing at least 118 cases of human rabies each year or possibly as many as 1184 at an estimated cost of $1193 or $119 per DALY averted respectively. The estimated economic impact of rabies in Kazakhstan is $20.9 million per annum, with nearly half of this cost being attributed to the cost of PEP and the loss of income whilst being treated. A further $5.4 million per annum was estimated to be the life time loss of income for fatal cases. Animal vaccination programmes and animal control programmes also contributed substantially to the economic losses. The direct costs due to rabies fatalities of agricultural animals was relatively low.
CONCLUSIONS/SIGNIFICANCE: This study demonstrates that in Kazakhstan there is a substantial economic cost and health impact of rabies. These costs could be reduced by modifying the vaccination programme that is now practised. The study also fills some data gaps on the epidemiology and economic effects of rabies in respect to Kazakhstan.
狂犬病是一种被忽视的人畜共患疾病。在许多低收入和中等收入国家，关于人类和动物狂犬病发病率的数据稀少。此外，狂犬病会造成巨大的经济影响和沉重的人类疾病负担。哈萨克斯坦是一个幅员辽阔的内陆中等收入国家，1991年从苏联独立出来，是狂犬病的地方流行区。
方法/主要发现：我们使用了2003年至2015年详细的公共卫生和兽医监测数据来绘制家畜狂犬病的发病地点。我们还估计了狂犬病的经济影响和人类负担。家畜和犬类狂犬病在哈萨克斯坦的大部分地区都有发生，但疾病分布存在区域差异。每年平均有7.1例官方记录的人类狂犬病死亡病例，导致约457个伤残调整生命年（DALYs）。每年平均有64,289人接受暴露后预防（PEP），这可能每年额外导致1140个DALYs。PEP每年至少预防118例人类狂犬病病例，或者可能多达1184例，估计成本分别为1193美元或每避免一个DALY 119美元。据估计，哈萨克斯坦狂犬病的经济影响为每年2090万美元，其中近一半的成本归因于PEP的费用和治疗期间的收入损失。估计每年还有540万美元是死亡病例的终身收入损失。动物疫苗接种计划和动物控制计划也对经济损失有很大影响。农业动物狂犬病死亡造成的直接成本相对较低。
结论/意义：本研究表明，在哈萨克斯坦，狂犬病造成了巨大的经济成本和健康影响。通过修改目前实施的疫苗接种计划，可以降低这些成本。该研究还填补了哈萨克斯坦狂犬病流行病学和经济影响方面的一些数据空白。
