Reply to Kapur, V. Is Pre-Exposure Prophylaxis a Cost-Effective Intervention to Avert Rabies Deaths among School-Aged Children in India? Comment on "Royal et al. A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India. Vaccines 2023, 11, 88".

Thank you so much for forwarding the critical analysis the author (VK) conducted on our recently published modelling study 'A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India' in your reputed journal [...].

A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India.

Children contribute to one-half of the total painful rabies mortalities in India. The state-of-the-art rabies mortality averting strategies need exploration for the effective implementation of pre-exposure prophylaxis (PrEP) in India. This study reports on the economic evaluation of various PrEP and post-exposure prophylaxis (PEP) strategies to avert rabies mortalities in school-aged children in India. A decision tree model has been developed for children in the age group of 5-15 years to evaluate various PrEP + PEP and PEP only regimens. The 2-site intradermal regimen administered on day zero and seven was chosen as the intervention [PrEP (I)]. ICER was calculated from the quasi-societal and quasi-health systems' perspectives for the base case analysis, along with one-way sensitivity, and scenario analyses for each regimen. The incremental DALYs averted per million population with the implementation of PrEP (I) ranged between 451 and 85,069 in 2020. The ICER was reported in the range of USD 384-352/DALY averted (non-dominant) in comparison to PEP regimens from a quasi-societal perspective. PrEP (I) is reported to be 'very cost effective' in comparison with PEP regimens from the quasi-societal and quasi-health systems' perspectives and reduce deaths by up to 89.9%. This study concludes that the PrEP (I) regimen is a cost-effective and life-saving strategy to avert painful mortalities due to rabies in school-aged children in India.

Epidemiological, humanistic and economic burden of dog-mediated rabies in India: a systematic review protocol.

Background: Rabies is a neglected zoonotic disease. It is transmitted through the bite of a rabid animal and dog bites are responsible for around 95% of human cases. The disease is almost always fatal after the onset of symptoms. It is an endemic and major public health problem in India with one-third of the global deaths reported from this country. Protocol: This systematic review aims to estimate the epidemiological, humanistic and economic burden of dog-mediated rabies in India. Initially the existence of controlled descriptors in MeSH terms (such as 'Epidemiology', 'Rabies', 'Cost', 'Dog bite', 'Quality of Life', 'India' etc), and their synonyms (key words) was identified in MEDLINE, and were later combined with Boolean operators 'AND' and 'OR' to develop a detailed search strategy. Two independent reviewers will screen the titles and abstracts and select the studies as per the inclusion criteria. The selected studies will be assessed for their quality and risk of bias. Data will be extracted using standardized data extraction tools and will be synthesized for analysis. Disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Discussion: This systematic review will be performed to critically examine relevant literature and report the epidemiological, humanistic and economic burden of dog-mediated rabies in Indian context. The findings will help in estimation of burden of the disease in India and expected to contribute in policy making and planning of the program and interventions in the country. Protocol registration: PROSPERO ID: CRD4202021326.

Expanded principles of ethics and its implementation during COVID-19 vaccine trials: A scoping evidence based research synthesis.

The COVID-19 pandemic will subside only through the emergence and distribution of an efficacious vaccine. The two main aspects that should be maintained in equilibrium: the dire necessity for speedy vaccine research and the need for safeguarding the research subjects, which is of utmost concern in research ethics. This opens up a discussion of what norms to follow during the clinical trials while developing the vaccine. As of now, various companies like Moderna, Pfizer, University of Oxford, Astra-Zeneca and so on have moved beyond the safety, efficacy and immunogenic studies. This narrative review explores and discusses the key principles of ethics: a principle of autonomy, beneficence, non-maleficence, and justice along with its ten general expanded principles. Furthermore, it delves into the different types of vaccines, their mechanisms, side effects, limitations, and advantages.

An altmetric analysis of online news on India's first indigenous COVID-19 vaccine.

BACKGROUND: Covaxin is the first indigenous vaccine developed in India against COVID-19. The purpose of this study was to analyze the news stories on Covaxin published in the online media between two statements issued by Indian Council for Medical Research on 2nd and 4th July for their content, quality of information, and reporting standards. MATERIALS AND METHODS: A systematic search was performed on Google to identify the news stories related to Covaxin in the English language published between these two statements. The selected news stories were subjected to content analysis and reviewed using the screening points developed through a consultation by two independent experts using ten prevalidated criteria for health news review. The data were analyzed in MS Excel and StataMP14. RESULTS: The final analysis included 24 news stories. The mean and median score of the news stories is 10.71 and 12 (out of 20), respectively, with a score ranging from 2 to 17. The stories did not promote disease or vaccine mongering (100%), adequately mentioned the true novelty of the vaccine (95.8%), and source of the information (83.3%). However, they mostly failed to mention the information on costs, research data related to benefits, and harms and quality of the available evidence. CONCLUSION: There is a lack of reporting of detailed analysis about the methodology of development of the vaccine and limitations in its research design by health journalists. It is important to train journalists on proper reporting of health news to improve its quality in Indian media.

Harnessing the potential of the primary healthcare facilities in India to respond COVID-19 pandemic: A scoping evidence-based research synthesis.

COVID-19 has resulted in an unprecedented loss of human lives and sufferings across the world. It has resulted in the collapse of public health systems and economy across the globe. As most of the national health systems lack organized surveillance infrastructure, resources, and expertise to respond to a pandemic, most of the countries failed to mount an effective response to contain the spread of this virus initially. As primary healthcare (PHC) has better access to the community, the settings where PHC services are inadequate or weak, hospitals are overwhelmed with patients, thus overburdening, and wasting meager specialist resources. PHC interventions can manage mild to moderate cases (>80% of total cases) and their contacts, along with addressing the needs of general population while only severe cases may require specialized hospital care. As PHC interventions have huge potential to tackle this pandemic, strengthening and inclusion of PHC in pandemic response could play a significant role in relieving the workload on secondary and tertiary healthcare facilities and minimizing loss of lives and its short and long term socioeconomic consequences. This article explores the scope and importance of strengthening PHC in breaking the chain of the transmission of this infectious disease, building an adequate response to minimize its disastrous consequences and prevent future emerging and reemerging disease outbreaks, if any.