Economic evaluation of vampire bat (Desmodus rotundus) rabies prevention in Mexico.

Vampire bat rabies causes significant impacts within its endemic range in Mexico. These impacts include livestock mortality, animal testing costs, post-exposure prophylaxis costs, and human mortality risk. Mitigation of the impacts can be achieved by vaccinating livestock and controlling vampire bat populations. A benefit-cost analysis was performed to examine the economic efficiency of these methods of mitigation, and Monte Carlo simulations were used to examine the impact that uncertainty has on the analysis. We found that livestock vaccination is efficient, with benefits being over six times higher than costs. However, bat control is inefficient because benefits are very unlikely to exceed costs. It is concluded that when these mitigation methods are judged by the metric of economic efficiency, livestock vaccination is desirable but bat control is not.

Immune response after rabies vaccine in a kidney transplant recipient.

A 48-year-old male kidney-transplant recipient was bitten by a rabid dog. His immunosuppressive treatment consisted of cyclosporine 60 mg b.i.d., mycophenolate mofetil (MMF) 250 mg t.i.d., and prednisone 5 mg. After wound care, he received 5 doses of purified vero cell rabies vaccine on days 0, 3, 7, 14, and 28, and human rabies immunoglobulin, according to international guidelines. Adequate levels of rabies virus neutralizing antibodies were observed after the administration of the third vaccine dose. However, a decrease of antibody titer was detected by day 28. Immunosuppressive medication was minimized, withdrawing MMF and reducing the dose of cyclosporine. Booster doses of the same vaccine were administered on days 38, 41, 45, 52, and 66. Adequate neutralizing antibody response was recovered during the ensuing 12 months, under reduced immunosuppression. Nineteen months after the incident, the patient remains with good graft function and is asymptomatic for rabies. It remains to be determined whether the attained immune response was either the result of the booster vaccinations or the reduction of immunosuppression alone. Nevertheless, such an outcome would have been possible only with the combined management strategy implemented.