One Health approach to cost-effective rabies control in India.

Over 20,000 rabies deaths occur annually in India, representing one-third of global human rabies. The Indian state of Tamil Nadu has pioneered a "One Health" committee to address the challenge of rabies in dogs and humans. Currently, rabies control in Tamil Nadu involves postexposure vaccination of humans after dog bites, whereas potential supplemental approaches include canine vaccination and sterilization. We developed a data-driven rabies transmission model fit to human rabies autopsy data and human rabies surveillance data from Tamil Nadu. Integrating local estimates for canine demography and costs, we predicted the impact of canine vaccination and sterilization on human health outcomes and evaluated cost-effectiveness according to the WHO criteria for India, which correspond to thresholds of $1,582 and $4,746 per disability-adjusted life-years (DALYs) for very cost-effective and cost-effective strategies, respectively. We found that highly feasible strategies focused on stray dogs, vaccinating as few as 7% of dogs annually, could very cost-effectively reduce human rabies deaths by 70% within 5 y, and a modest expansion to vaccinating 13% of stray dogs could cost-effectively reduce human rabies by almost 90%. Through integration over parameter uncertainty, we find that, for a cost-effectiveness threshold above $1,400 per DALY, canine interventions are at least 95% likely to be optimal. If owners are willing to bring dogs to central point campaigns at double the rate that campaign teams can capture strays, expanded annual targets become cost-effective. This case study of cost-effective canine interventions in Tamil Nadu may have applicability to other settings in India and beyond.

Demographics of animal bite victims & management practices in a tertiary care institute in Mumbai, Maharashtra, India.

BACKGROUND & OBJECTIVES: Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. METHODS: Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients' perspective was calculated using both direct and indirect costs. RESULTS: The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%).Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound care. Of the Category III bites, only 21 of 783 (2.7%) patients were prescribed human rabies immunoglobulin (HRIG) which was primarily for severe bites or bites close to or on the face. A total of 318 patients did not complete the full Essen regime of the vaccine. The median cost to the patient per bite was Rs. 220 (3.5 USD). INTERPRETATION & CONCLUSIONS: Our findings showed that the use of HRIG was low with less than 2 per cent of the Category III patients being prescribed it. As vaccine and HRIG continue to remain expensive, the intradermal vaccine, shorter regimes like the Zagreb regime and monoclonal antibodies may offer safer and cost-effective options in the future. Further studies need to be done in different parts of the country.

AN APPRAISAL OF RABIES OCCURRENCE AND CONTROL IN KISUMU MUNICIPALITY, KENYA.

BACKGROUND: Rabies is a serious neglected disease which occurs worldwide. In urban areas, the control of the diseaseis expected to be hampered by several unique constraints. OBJECTIVE: To appraise the occurrence and control of rabies. STUDY DESIGN: The tools used in the study included key informant interviews with senior veterinary and medical officers and a questionnaire survey on 15 veterinary officers and 9 human physicians. The occurrence of animal bites and costs involved in treatment was also investigated using retrospective hospital data for the year 2007. SETTING: Kisumu Municipality, Kenya. RESULTS: The control of rabies was under the Veterinary Department through dog vaccinations and baiting, and also under the Department of Public Health (DPH) through people vaccinations and post exposure treatments. The constraints observed were poor coordination in rabies control efforts, understaffing and limited resources. Animal bites were common with 1270 cases reported during 2007. The post-bite rabies vaccines were mainly purchased from local chemists at KES 7,500 per full dose. This amounted to an annual total cost of KES 9,525,000 (136,071 USD). The bites were mainly from domestic dogs (89%) and occurred commonly in highly populated areas. The mean age of people with bites was 21 (2.5 - 78) years, showing that young people had a higher risk. Males (59%) were at higher risk of bites than females (41%). CONCLUSIONS: It would be important for the relevant departments to harmonise their rabies control strategies and also address the prevalent constraints by using local networks. The incidence of rabies and the associated epidemiology needs proper updated documentation with a view of carrying out mass vaccination of dogs at times free of cost to the economically disadvantaged owners.

English hospital episode data analysis (1998-2018) reveal that the rise in dog bite hospital admissions is driven by adult cases.

Dog bites are a global health issue that can lead to severe health outcomes. This study aims to describe the incidence and sociodemographics of patients admitted to English National Health Service (NHS) hospitals for dog bites (1998-2018), and to estimate their annual direct health care costs. An analysis of patient level data utilising hospital episode statistics for NHS England, including: temporal trends in annual incidence of admission, Poisson models of the sociodemographic characteristics of admitted patients, and direct health care cost estimates. The incidence of dog bite admissions rose from 6.34 (95%CI 6.12-6.56) in 1998 to 14.99 (95%CI 14.67-15.31) admissions per 100,000 population in 2018, with large geographic variation. The increase was driven by a tripling of incidence in adults. Males had the highest rates of admission in childhood. Females had two peaks in admission, childhood and 35-64 years old. Two percent (2.05%, 95%CI 0.93-3.17) of emergency department attendances resulted in admission. Direct health care costs increased and peaked in the financial year 2017/2018 (admission costs: £25.1 million, emergency attendance costs: £45.7million). Dog bite related hospital admissions have increased solely in adults. Further work exploring human-dog interactions, stratified by demographic factors, is urgently needed to enable the development of appropriate risk reduction intervention strategies.

A new look at horse-related sport and recreational injury in New Zealand.

Although equestrian injury studies to date have provided useful information for injury prevention, these studies have not been detailed enough or inclusive enough, to identify and characterise all sub-populations that may be at risk. One study has reported injury rates for the population-at-risk. The present study was carried out to determine, more precisely, who is injured in horse-related activities in New Zealand, what sorts of injuries they sustain, the circumstances of injury and the cost of treatment. A novel search of linked hospital discharge and compensation claim data for 2002 and 2003 was carried out. Of 716 newly hospitalised cases, 29% were in the 5-19-year and 28% in the 35-49-year age groups. Incidence rates for regular riders peaked at 13-15 years (900/100000) and 50+ years (880/100000). Where the 'place of occurrence' was specified only 12% of cases sustained injury in a 'sports and athletics area'. This new study has highlighted injuries occurring in farm and other 'open' locations such as mountains and forest, injuries to older riders and injuries to bystanders/handlers during non-organised recreational activity. Attention was drawn to the high in-patient cost of hospitalised injuries in persons >40 years and the need for injury information relating to specific riding activities. Current equestrian injury prevention tends to target young females and organised riding; in focusing on these, other significant population groups and injury mechanisms may be overlooked and opportunities for injury prevention missed.

Investigating Clinical and Cost Burdens of Law Enforcement-Related K9 Injuries: The Impact of "the Bite" on a Community Hospital.

The decision to introduce canines (K9s) to a law enforcement (LE) agency does not typically involve the evaluation of the fiscal or clinical impact on local hospitals. This study compared injury, cost, and care associated with K9s to a common nonlethal force method, the Thomas A Swift Electrical Rifle (TASER), to highlight the cost and resources required to treat both patient types. Patients treated for LE-related K9 and TASER injuries at a Level I community-based trauma center (2011-2016) were evaluated for level of care required (e.g., surgeon/specialist), clinical interventions, proxy medical costs, and length of stay (LOS). Nearly one-third of K9 patients required tertiary-level medical care. The cost of treating the K9-inflicted injuries (n = 75) was almost twice as costly as care for patients subdued with a TASER (n = 80); the K9 patients had significantly (one-tailed t tests) higher medical costs (P = 0.036), required more medical procedures (P = 0.014), and had longer LOS (P = 0.0046) than the TASER patients. Patients with K9 injuries had higher acuity and were significantly more expensive to treat with longer LOS than TASER injuries. LE agencies considering establishing and operating a K9 unit should initiate discussions with their local medical first responders and health-care facilities regarding the capabilities to treat severe K9 injuries to ensure adequate resource allocation.

[Loss of risk perception to zoonoses and the figure of community dog]. / La pérdida de la percepción al riesgo de zoonosis y la figura del perro comunitario.

Dogs may cause zoonoses and damages; especially when we accept as normal some dangerous behavior, losing the perception of disease risk. The purpose of this review was to demonstrate that the presence of stray dogs as well as community dogs, are public health hazard. Through sustainable epidemiological information, we believe this measure could prevent it from spreading. Dog's aggressiveness regulates its social relationships through submission or dominance; those characteristics are difficult to be recognized by human population. In Chile, 327.150 people were bitten by dogs, between years 2003 and 2012 with a cost of USD$22.7 to USD$177,9 million in addition to the USD$3,13 million for the surgical intervention of 767 human subjects of Hydatidosis during 2012. However zoonosis more dangerous is Rabies with death results. As a conclusion we state that the presence of stray and community dogs in the streets cannot be tolerated. This measure must have a sustainable technical of Health and Public safety because population have lost its ability of recognize the risk of contracting zoonotic diseases, with high costs for the health care system, besides the economical decline and psychological damage to the affected individuals.

The evaluation of operating Animal Bite Treatment Centers in the Philippines from a health provider perspective.

BACKGROUND: The Philippine government has an extensive network of 513 Animal Bite Treatment Centers (ABTCs) to supply rabies post exposure prophylaxis (PEP), reaching over 1 million bite victims in 2016. The network was evaluated using a review of existing national and provincial data, key informant interviews and surveys in sample ABTCs to determine the cost-effectiveness of this network in preventing human rabies deaths. METHODOLOGY AND PRINCIPAL FINDINGS: One urban and one rural ABTC in each of three selected provinces were studied in more detail. PEP delivery generally followed national guidance based on best practices, but there was evidence of operational challenges in supplying all ABTCs with adequate biologics and recently trained staff. Funding was contributed by different levels of government and in some clinics, patients paid for a significant fraction of the total cost. From a health provider perspective including both fixed and variable costs, the average PEP course delivered cost USD 32.91 /patient across urban ABTCs (with higher patient throughput) and USD 57.21 /patient across rural ABTCs. These costs suggests that PEP provision in the Philippines cost USD 37.6 million in 2016, with a cost per life saved of USD 8,290. An analysis of the 2,239 suspected rabies deaths from 2008 to 2016 showed no significant decline, and from 2014-16 an average of 8,534 years of life were lost annually. The incidence of rabies deaths from 2014-16 was not clearly related to the provision of ABTCs (per 100,000 population) or human population density, but deaths were more common in higher income provinces. CONCLUSIONS/SIGNIFICANCE: In the context of comprehensive rabies control (including dog vaccination and public awareness) ways to reduce this high expenditure on PEP should be explored, to most cost-effectively reach the elimination of human rabies deaths. This paper is accompanied by another containing data on the operation of ABTCs network from a patient perspective.

Dog-bites, rabies and One Health: Towards improved coordination in research, policy and practice.

Dog-bites and rabies are neglected problems worldwide, notwithstanding recent efforts to raise awareness and to consolidate preventive action. As problems, dog-bites and rabies are entangled with one another, and both align with the concept of One Health. This concept emphasizes interdependence between humans and non-human species in complex socio-ecological systems. Despite intuitive appeal, One Health applications and critiques remain under-developed with respect to social science and social justice. In this article, we report on an ethnographic case-study of policies on dog bites and rabies, with a focus on Calgary, Alberta, Canada, which is widely recognized as a leader in animal-control policies. The fieldwork took place between 2013 and 2016. Our analysis suggests that current policies on rabies prevention may come at the expense of a 'bigger picture' for One Health. In that 'bigger picture,' support is needed to enhance coordination between animal-control and public-health policies. Such coordination has direct relevance for the well-being of children, not least Indigenous children.

Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014-2015.

AbstractHaiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area (N = 2,289) in 2014-2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568-$80,290) than the no-bite-case-management (NBCM) scenario ($15,988-$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891-$4,735, NBCM: $5,980-$8,453; 2015, HARSP: $3,534-$7,171, NBCM: $7,298-$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination.

Burden of Bites by Dogs and Other Animals in Los Angeles County, California, 2009-2011.

OBJECTIVES: The objective of this study was to analyze all animal-to-human bite reports during a 3-year period from a regional surveillance database. Results helped to inform local efforts to reduce and prevent animal-to-human bites. METHODS: We reviewed all cases of animal-to-human bites occurring from 2009 through 2011 that were reported to the Los Angeles County Department of Public Health's Animal Bites Database. We collected data on the bite victim's date of birth, age, and address; bite circumstances (ie, date, time, location, how bite occurred); anatomic site and treatment of bite; type of reporting facility; and breed and management of biting animal. RESULTS: From 2009 through 2011, 26   169 animal-to-human bites were reported, of which 23   103 (88%) were dog bites. Most animal-to-human bites (n = 7673, 29%) occurred between 4 pm and 8 pm and peaked during the month of July (n = 2663, 10%). Most animal-to-human bites occurred outdoors (n = 8772, 34%) and while victims engaged in recreational activities (n = 4353, 17%). The hands were the most common injury site (n = 9130, 35%), and only 1% of animal bites (n = 267) resulted in hospitalization. A total of 4115 bite victims (16%) received tetanus vaccinations. Of all animal-to-human bite cases, medical organizations reported 13   451 (51%), and animal control agencies reported 10   682 (41%). CONCLUSIONS: Animal-to-human bites can often lead to medical complications. Surveillance is essential in helping to identify, manage, and reduce these highly preventable injuries and direct public health actions and policies on animal bite risk and prevention.

Frequency of tail lesions and risk factors for tail biting in heavy pig production from weaning to 170 kg live weight.

Tail biting lesions have a negative effect on both the welfare of pigs and on the revenue of the pig farm. Due to the multifactorial nature of this abnormal behaviour and its sporadic onset, an epidemiological approach was adopted to identify the management and housing factors influencing the occurrence of tail biting and the frequency of bitten pigs in the weaning and fattening phases up to 170 kg live weight in heavy pig production. Data were collected from a sample of 67 commercial pig farms via an on-farm visit and a questionnaire to the farmer. Data collected included general farm information, hygiene and herd health, prevention, management, climate control, feeding and production traits. In the weaning phase, the occurrence of tail biting was increased by a factor of 16.64 for tipped vs. short-docked tails, by a factor of 68.09 when the observer detected poor air quality, and by a factor of 14.44 when the feeding time was variable. In fattening pigs, a high stocking density increased the risk of tail biting by a factor of 18.00. The frequency of lesions in weaners was greater in pigs with tipped tails (0.29 vs. 0.03%; P = 0.034), whereas in fatteners the frequency of lesions was greater when drinkers were not present in the lying area (0.71 vs. 0.05%; P = 0.009) and when air turnover was not detected in the barn (0.70 vs. 0.07%; P = 0.005). There was also a trend for increased tail biting when the stocking density was high (1.06 vs. 0.33%; P = 0.057). Many of the risk factors that emerged for heavy pigs in the present study could be easily managed to reduce the risk of tail biting and the frequency of tail lesions through the systematic evaluation and control of stocking density, climate, and feed and water management.

Incidence and impact of dog attacks on guide dogs in the UK: an update.

Data on dog attacks on Guide Dogs' stock were reviewed to investigate the characteristics of the attacks. An average of 11.2 attacks occurred each month. Nearly all of the attacks occurred in public areas, 68.4 per cent of victim dogs were qualified guide dogs and 55.5 per cent of victim dogs were working in harness when they were attacked. Guide Dogs' stock were injured in 43.2 per cent of attacks and veterinary costs for attacks were estimated at £34,514.30. Over 40 per cent of qualified guide dogs' working ability was affected and >20 per cent of qualified guide dogs required some time off from working after a dog attack. Twenty dogs were permanently withdrawn from the Guide Dogs' programme as a result of dog attacks, 13 of which were qualified and working with guide dog owners at the time of the withdrawal; this resulted in a financial cost of >£600,000 to the charity. More importantly perhaps, temporary and permanent withdrawals have a significant impact upon the mobility and independence of guide dog owners and in many cases significantly impacted their emotional well-being.

Dog-bite injuries at a Bangkok teaching hospital.

Thailand has a large domestic and stray dog population and Buddhist cultural beliefs encourage feeding and protection of stray animals. Dog bites are common injuries encountered in emergency rooms throughout the country. A prospective study of such bites seen at a teaching hospital in Bangkok revealed that: (1) dog bites represent 5.3% of injuries seen in the emergency room; (2) the majority occur on the street, are inflicated by stray dogs and are interpreted by the victim as unprovoked. Children and teenagers account for 55% of the victims. The lower extremities (54%) and upper extremities (20%) were the most common sites for bites. 9% of patients were bitten on the face or head. In addition to pain, risk of infection (approximately 13%) and the significant cost of caring for these injuries, victims often experienced prolonged anxiety because of to the generally known risk of rabies in Thailand. Due to the high cost of imported immune globulins and vaccines, rabies exposures are not always managed optimally in Asia.

The impact of zoonotic diseases transmitted by pets on human health and the economy.

In the context of all causes of human morbidity and mortality, or even within the context of all infectious diseases affecting the public health, pet-associated zoonotic infections are of moderate importance. The data documented in Table 1, however, indicate that they do exact significant human health and economic costs. If complete data were available for all of the infections shown in Table 1, the costs would be considerably higher. Moreover, most of these diseases are preventable through educating the public, particularly pet owners, of the zoonotic potential of these diseases, so that they may take precautions to minimize the risks leading to infection. These measures include appropriate health care of pets to eliminate infectious agents, reducing the number of uncontrolled, ownerless pets as well as unwanted or poorly supervised pets, preventing pets from soiling public places with their feces, excluding animals from areas where children play, enforcing leash laws, and promoting responsible pet ownership. Veterinarians, physicians, and public health agencies can aid in these efforts; ultimately, however, the responsibility lies with the pet owner.

[Infected animal bite injuries of the extremities]. / Infizierte Tierbissverletzungen an den Extremitäten.

The appearance of animal bite injuries varies in regard to location and extent. Injuries with puncture wounds involving the extremities carry great risk of infection. Managing the complications often requires substantial medical treatment and increased costs. The aim of this study is the evaluation of the course of disease, medical care, and treatment costs in patients with infected bite injuries. In the year 2000, 16 patients were treated for infection after bite injuries of the extremities. Fourteen patients received substandard therapy because of incorrect assessment of the extent of the bite wound. Because of infection, the average time needed for treatment before returning to work was 3 months, including 12 days of hospitalization and 16 days of out-patient treatment. The average treatment costs exceeded 6,100 Euro for the health insurance companies. Because of its increasing prevalence and inadequate treatment, this type of injury has become a serious public health problem.

[Survey of personal injuries caused by dogs and cats in Umeå. Walking the dog was the activity most often related to injury]. / Kartläggning av personskador orsakade av hund och katt i Umeå. "Gå ut med hunden" den aktivitet som oftast var relaterad till skada.

Injuries due to interaction with dogs and cats are not uncommon, and constituted 1.4% of all injuries in an unselected policlinical and inpatient material. This material was collected from a population of 135,000 people in Northern Sweden, and during 2 years 280 patients with injuries related to these domestic animals were found (Ndogs = 212, Ncats = 68). The injuries were in most cases caused by bites and by falls. The former were more common among men, the latter more common among women and related to fractures and dislocations. In contrast to many previous investigations, bite injuries were more common among adults than among children, possibly related to national differences in the keeping of dogs. Most dog related injuries were caused by the owner's dog. Walking the dog was the activity most often related to personal injury. The cost for inpatient cases (treated at the University Hospital, Umeå) caused by dogs and cats is of the same magnitude as the cost due to motorcycling in traffic, but less than the cost for injuries sustained during horseback riding and other horse related activities, for soccer, snowmobiling and for assaults.