Lancet Infect Dis. 2019 Jan;19(1):102-111. doi: 10.1016/S1473-3099(18)30512-7. Epub 2018 Nov 21.
Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply.
We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs.
We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use.
Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies.
World Health Organization.
每年有数万人死于狗介导的狂犬病。通过对被咬伤的人进行暴露后预防，以及通过给狗接种疫苗，可以预防死亡。目前，暴露后预防的使用挽救了许多生命，但由于成本高、获取途径有限和供应不足，在许多狂犬病流行国家，这种方法的可及性仍然很差。
我们开发了流行病学和经济模型，以调查 Gavi（疫苗联盟）对暴露后预防措施的投资的效果。我们根据现状，按照世界卫生组织推荐的皮内疫苗接种、有无狂犬病免疫球蛋白和有无狗疫苗接种，来建模暴露后预防的使用情况。我们从卫生服务提供者的角度出发，只考虑直接成本。
我们预测，在 2020 年至 2035 年期间，在 67 个被认为存在狂犬病的国家中，将有超过 100 万人死亡。目前的暴露后预防措施的使用每年可预防约 56000 人死亡。扩大暴露后预防措施的获取途径并免费提供这种措施，将在 2020 年至 2035 年期间额外预防 489000 人死亡。在这种转向高效的皮内暴露后预防方案的情况下，总计划疫苗需求保持相似（约 7300 万支疫苗），但接种疫苗的人数增加了 1740 万，使其成为一种极具成本效益的方法，每避免 1 人死亡的成本为 635 美元，每避免 1 个残疾调整生命年的成本为 33 美元。在这段时间内，扩大狗疫苗接种计划可以消除狗介导的狂犬病；在这种情况下，改善暴露后预防措施的获取途径仍然具有成本效益，尤其是在结合对患者风险评估以减少不必要的暴露后预防措施使用的情况下。
投资暴露后疫苗将是一种极具成本效益的干预措施，可以大大减轻疾病负担，并促进狗疫苗接种工作，以消除狗介导的狂犬病。
世界卫生组织。
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