Survey of animal bite injuries and their management for an estimate of human rabies deaths in N'Djaména, Chad.

OBJECTIVE: To estimate the annual human rabies incidence as a baseline prior to mass dog vaccination campaigns in N'Djaména, Chad. METHODS: Survey of animal bites, involving 50% of all healthcare providers in N'Djaména, from September 2008 to April 2009. Of 86 people exposed to a suspected rabid animal, 50% received post-exposure vaccination and a further 8% had their wound cleaned. We estimated annual incidence of bites from suspected rabid animals of 12.9/100,000 and an incidence of 0.7 human rabies deaths/100,000, resulting in 7 estimated deaths (95% confidence interval 4-10 deaths) per year in N'Djaména. 14% of bite victims sought help from veterinarians. CONCLUSIONS: Closer cooperation between physicians and veterinarians warrants more effective rabies control. The high proportion (42%) of potentially exposed people without post-exposure vaccination or wound treatment necessitates urgent attention.

[Transmission dynamics and cost-effectiveness of rabies control in dogs and humans in an African city]. / Dynamique de transmission et coût de la lutte contre la rage chez les chiens et les hommes dans une ville Africaine.

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.

Transmission dynamics and economics of rabies control in dogs and humans in an African city.

Human rabies in developing countries can be prevented through interventions directed at dogs. Potential cost-savings for the public health sector of interventions aimed at animal-host reservoirs should be assessed. Available deterministic models of rabies transmission between dogs were extended to include dog-to-human rabies transmission. Model parameters were fitted to routine weekly rabid-dog and exposed-human cases reported in N'Djaména, the capital of Chad. The estimated transmission rates between dogs (beta(d)) were 0.0807 km2/(dogs x week) and between dogs and humans (beta(dh)) 0.0002 km2/(dogs x week). The effective reproductive ratio (R(e)) at the onset of our observations was estimated at 1.01, indicating low-level endemic stability of rabies transmission. Human rabies incidence depended critically on dog-related transmission parameters. We simulated the effects of mass dog vaccination and the culling of a percentage of the dog population on human rabies incidence. A single parenteral dog rabies-mass vaccination campaign achieving a coverage of least 70% appears to be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to postexposure prophylaxis (PEP), which is the current practice in Chad. PEP does not reduce future human exposure. Its cost-effectiveness is estimated at US $46 per disability adjusted life-years averted. Cost-effectiveness for PEP, together with a dog-vaccination campaign, breaks even with cost-effectiveness of PEP alone after almost 5 years. Beyond a time-frame of 7 years, it appears to be more cost-effective to combine parenteral dog-vaccination campaigns with human PEP compared to human PEP alone.

Incidence of canine rabies in N'Djaména, Chad.

This work describes for the first time the incidence risk of passively reported canine rabies, and quantifies reported human exposure in N'Djaména (the capital of Chad). To diagnose rabies, we used a direct immunofluorescent-antibody test (IFAT). From January 2001 to March 2002, we were brought 34 rabies cases in dogs and three cases in cats. Canine cases were geographically clustered. The annual incidence risk of canine rabies was 1.4 (95% CI: 1.2, 1.7) per 1000 unvaccinated dogs. Most of the rabid dogs were owned-although free-roaming and not vaccinated against rabies. Most showed increased aggressiveness and attacked people without being provoked. Eighty-one persons were exposed to rabid dogs and four persons to rabid cats (mostly children<15 years old). Most of the exposed persons were neighbours or family members of the animal owner. Most exposures were transdermal bites, but nearly half of all exposed persons did not apply any first wound care or only applied a traditional treatment. In N'Djaména, humans are often exposed to canine rabies but do not use the full-course post-exposure treatment and wound care is insufficient. Most rabid dogs would be accessible to parenteral vaccination. Pilot vaccination campaigns are needed to determine the success of dog mass vaccination in N'Djaména as a way to prevent animal and human rabies.