Quantifying the interconnectedness between poverty, health access, and rabies mortality.

The global 2030 goal set by the World Organization for Animal Health (WOAH), the World Health Organization (WHO), and the Food and Agriculture Organization (FAO), to eliminate dog-mediated human rabies deaths, has undeniably been a catalyst for many countries to re-assess existing dog rabies control programmes. Additionally, the 2030 agenda for Sustainable Development includes a blueprint for global targets which will benefit both people and secure the health of the planet. Rabies is acknowledged as a disease of poverty, but the connections between economic development and rabies control and elimination are poorly quantified yet, critical evidence for planning and prioritisation. We have developed multiple generalised linear models, to model the relationship between health care access, poverty, and death rate as a result of rabies, with separate indicators that can be used at country-level; total Gross Domestic Product (GDP), and current health expenditure as a percentage of the total gross domestic product (% GDP) as an indicator of economic growth; and a metric of poverty assessing the extent and intensity of deprivation experienced at the individual level (Multidimensional Poverty Index, MPI). Notably there was no detectable relationship between GDP or current health expenditure (% GDP) and death rate from rabies. However, MPI showed statistically significant relationships with per capita rabies deaths and the probability of receiving lifesaving post exposure prophylaxis. We highlight that those most at risk of not being treated, and dying due to rabies, live in communities experiencing health care inequalities, readily measured through poverty indicators. These data demonstrate that economic growth alone, may not be enough to meet the 2030 goal. Indeed, other strategies such as targeting vulnerable populations and responsible pet ownership are also needed in addition to economic investment.

Grains on the brain: A survey of dog owner purchasing habits related to grain-free dry dog foods.

Grain-free pet food options abound in the pet food market today, representing more than 40% of available dry dog foods in the United States. There is currently a dearth of information about the factors that contribute to a dog owner's choice of a grain-free dry dog food and if those factors are similar among countries. Therefore, the primary objective of the current survey was to identify the variables that are predictive of a dog owner's choice of a grain-free dry food across North America (Canada and the United States) and Europe (France, the United Kingdom and Germany). The survey consisted of 69 questions, took less than 15 minutes to complete and was distributed virtually via Qualtrics (Qualtrics XM, Utah, USA). A total of 3,298 responses were collected, equally distributed between countries. Multinomial logistic regression was performed in SPSS Statistics (Version 26, IBM Corp, North Castle, New York, USA). Male respondents, people from France, people who ranked the importance of ingredients in a pet food in the lower quartiles and people who do not rotate their dog's diet to provide variety were less likely to select 'no grain' when choosing a pet food. In contrast, people who believe that their dog has a food allergy, follow more than 5 specific dietary routines in their own diet, do not try to include grains in their own diet, get their information about pet food from online resources or pet store staff and look for specific claims on pet food (such as 'no fillers'), were all more likely to select 'no grain' when choosing a pet food. This survey provides insight into the similarities and differences in decision making among dog owners in North America and Europe and should be considered when exploring the effects of grain-free dog foods on canine health and well-being.

Canine cruciate ligament ruptures: Implications for financial costs and human health.

The cranial cruciate ligament (CCL) in dogs is homologous to the anterior cruciate ligament (ACL) in humans. Factors that place an individual at-risk for noncontact ruptures are not clearly defined in humans or dogs. Cyclic variation in human females as well as early spay/neuter in canines has frequently implicated hormonal variation, however these factors do not fully explain the human dimorphic or canine breed rupture rates. The present study examined dogs as a proxy model for humans to better understand the covariance. A random clinical data sample from the Oklahoma State University Veterinary Hospital was obtained on (n = 29) CCL surgical cases and nonsurgical (n = 28) controls. A statistical test for association of spay/neuter with CCL rupture was significant (chi-square = 21.7, p < .01). Sex balance between the groups was not significantly (p > .01) different. Data on other variables related to morphometric variability such as the tibial plateau angle was not available on the nonsurgical sample and comparisons could only be made to values from the literature. Though there may have been sample bias, this preliminary study found that more large than small dogs were represented in the surgical sample. Our results also support the claim that spayed/neutered dogs are more likely to rupture their CCL than intact dogs. Given the high costs of surgical repair, both for canines and humans, we argue for multivariate studies that investigate the interaction of variables in a larger subject sample which can provide comparable data on all parameters.

How much does it cost to prevent and control visceral leishmaniasis in Brazil? Comparing different measures in dogs.

Visceral leishmaniasis (VL) is an important zoonosis in Brazil. Dogs are considered the main domestic reservoirs of the disease in the country; hence, control measures are focused on these reservoirs. Despite efforts to prevent and control VL, important reductions in disease prevalence and incidence have not been identified, stimulating the development and application of new strategies. The choice and implementation of new control strategies can benefit from the application of mathematical models that allow the simulation of different strategies in different scenarios. Selecting the best strategy to be implemented is also supported by cost-effectiveness studies. Here we used the results of a mathematical model in which scenarios, including isolated use of the vaccine and insecticide-impregnated collar (IIC), both at different coverage rates, were simulated to conduct a cost-effectiveness study. The costs were calculated for each scenario considering a simulation period of four years. Collar application in both infected and non-infected animals was the most cost-effective strategy. For example, to reduce the prevalence in humans and dogs by approximately 70%, the costs ranged from $250,000 and $550,000 for the IICs and vaccination, respectively. Even in the scenario with 40% loss/replacement of IICs, this measure was more advantageous in terms of cost-effectiveness than vaccination. If the vaccine were applied with culling of seropositive tested dogs, then the measure became more effective with a reduced cost compared with the vaccine alone. The use of the three first consecutive vaccine doses had the greatest impact on the cost of the vaccination strategy. The advantage of using IICs is that there is no need for a prior diagnosis, unlike vaccination, reducing costs and facilitating implementation. The present study aims to contribute to strategies to reduce hosts infected with VL by reducing public expenditure.

A bioeconomic model for the optimization of local canine rabies control.

We present a new modeling tool that can be used to maximize the impact of canine rabies management resources that are available at the local level. The model is accessible through a web-based interface that allows for flexibility in the management strategies that can be investigated. Rabies vaccination, sterilization, chemo-contraception, and euthanasia can be specified and limited to specific demographic groups. Additionally, we allowed for considerable complexity in the specification of management costs. In many areas, the costs of contacting additional dogs increases as management effort increases, and this can have important strategic implications. We illustrated the application of the model by examining several alternative management strategies in an area of Mpumalanga Province, South Africa. Our results based on this dog population suggested that puppies should be vaccinated and sterilization would not be optimal if the spatial extent of management is not large (and perhaps not even then). Furthermore, given a sufficient budget, it was evident that vaccination campaigns should be repeated annually.

Evaluation of a low-dose desoxycorticosterone pivalate treatment protocol for long-term management of dogs with primary hypoadrenocorticism.

BACKGROUND: Lowering the dose of desoxycorticosterone pivalate (DOCP) for the treatment of dogs with primary hypoadrenocorticism (PH) decreases costs and could lead to increased owner motivation to treat their affected dogs. OBJECTIVE: To evaluate the efficacy of a low-dose DOCP treatment protocol in dogs with PH. ANIMALS: Prospective study, 17 client-owned dogs with naturally occurring PH (12 newly diagnosed, 5 previously treated with fludrocortisone acetate [FC]). METHODS: Dogs with newly diagnosed PH were started on 1.5 mg/kg DOCP SC; dogs previously treated with FC were started on 1.0-1.8 mg/kg DOCP SC. Reevaluations took place at regular intervals for a minimum of 3 months and included clinical examination and determination of serum sodium and potassium concentrations. The DOCP dosage was adjusted to obtain an injection interval of 28-30 days and to keep serum electrolyte concentrations within the reference interval. RESULTS: Median (range) follow-up was 16.2 months (4.5-32.3 months). The starting dosage was sufficient in all but 2 dogs and had to be significantly decreased after 2-3 months to a median dosage (range) of 1.1 mg/kg (0.7-1.8). Dogs 3 years of age or younger needed significantly higher dosages compared to older dogs. None of them, however, needed the 2.2 mg/kg DOCP dosage, recommended by the manufacturer. CONCLUSIONS AND CLINICAL IMPORTANCE: A starting dosage of 1.5 mg/kg DOCP is effective in controlling clinical signs and serum electrolyte concentrations in the majority of dogs with PH. An additional dose reduction often is needed to maintain an injection interval of 28-30 days. Young and growing animals seem to need higher dosages.

Evaluation of a structured individualised protocol as a potential cost-effective diagnostic and therapeutic approach to chronic diarrhoea in the dog.

Diagnostic investigation and management of chronic diarrhoea in dogs can be cost-prohibitive to many owners. The objectives of this study were to evaluate evidence-based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget-limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty-two client-owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget-limited step-wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence-based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget-limited protocol were then enrolled for complete, referral-level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow-up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget-limited approach (success rate 72.2%, confidence intervals 46.5-90.3%) and five dogs were moved on to a referral-level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget-limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% (CI 72.7-99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.

The geographic distribution and financial impact of canine parvovirus in Australia.

Canine parvovirus (CPV) is an important cause of serious and often fatal disease in dogs worldwide, however, a national survey of CPV cases in Australia has not been conducted since 1982. For this study we surveyed the entire Australian veterinary clinic population and achieved a response rate of 23.5% (534 unique veterinary clinics). Respondents reported 4,451 CPV cases in 2015 and 4,219 cases in 2016; the estimated total CPV case load across Australia was 20,661 in 2015 and 20,110 in 2016. The overall reported euthanasia rate was 41%. Geospatial analysis revealed large numbers of CPV cases in rural and remote areas of Australia. Where cases occurred in capital city areas, these were found in peri-urban areas, away from the inner city. The median cost to treat CPV cases was $A1,500 per patient. A significant difference in the cost of treating cases was found between Australian states; Western Australia (median $A2,500) was the most expensive state. There was a strong correlation between cost of treatment and rate of euthanasia without treatment reflecting the important role of affordability in disease-related euthanasia. These findings highlight the considerable impact of the evolving CPV situation in Australia, particularly in regional and rural areas. This survey is the most comprehensive epidemiological investigation of canine parvoviral-related disease, to date, globally and provides a process for national disease surveillance.

Intratumoral temozolomide in spontaneous canine gliomas: feasibility of a novel therapy using implanted microcylinders.

Entotherapy an image-guided drug-eluting microcylinder platform, has the potential to bypass the limitations of systemic chemotherapy use in the treatment of canine brain tumours. Gliomas, which are common in dogs and also represent the majority of fatal brain tumours in humans, can be amenable to chemotherapy with temozolomide. Biopolymer microcylinders conjugated with temozolomide and gadolinium were implanted into partially resected tumours of four client-owned dogs with gliomas. All four dogs presented with generalized seizures and had mild to no neurologic deficits at the time of craniotomy. All dogs underwent craniotomy for implantation of the microcylinders into partially resected gliomas (glioblastoma multiforme {n = 1} or oligodendroglioma {n = 3}). All dogs recovered well from the craniotomy and implantation procedure. This novel procedure appears to be feasible and tolerated in tumour-bearing dogs. A future controlled clinical study can now aim to evaluate the microcylinder implantation for long-term efficacy.

Benefit-cost analysis of the policy of mandatory annual rabies vaccination of domestic dogs in rabies-free Japan.

Japan is one of the few rabies-free countries/territories which implement the policy of mandatory vaccination of domestic dogs. In order to assess the economic efficiency of such policy in reducing the economic burden of a future canine rabies outbreak in Japan, a benefit-cost analysis (BCA) was performed using probabilistic decision tree modelling. Input data derived from simulation results of published mathematical model, field investigation conducted by the authors at prefectural governments, literature review, international or Japanese database and empirical data of rabies outbreaks in other countries/territories. The current study revealed that the annual costs of implementing the current vaccination policy would be US$160,472,075 (90% prediction interval [PI]: $149,268,935-171,669,974). The economic burden of a potential single canine rabies outbreak in Japan were estimated to be US$1,682,707 (90% PI: $1,180,289-2,249,283) under the current vaccination policy, while it would be US$5,019,093 (90% PI: $3,986,882-6,133,687) under hypothetical abolition of vaccination policy, which is 3-fold higher. Under a damage-avoided approach, the annual benefits of implementing the current vaccination policy in expected value were estimated to be US$85.75 (90% PI: $55.73-116.89). The benefit-cost ratio (BCR) was estimated to be 5.35 X 10(-7) (90% PI: 3.46 X 10(-7)-7.37 X 10(-7)), indicating that the implementation of the current policy is very economically inefficient for the purpose of reducing the economic burden of a potential canine rabies outbreak. In worse-case scenario analysis, the BCR would become above 1 (indicating economic efficiency) if the risk of rabies introduction increased to 0.04 corresponding to a level of risk where rabies would enter Japan in 26 years while the economic burden of a rabies outbreak under the abolition of vaccination policy increased to $7.53 billion. Best-case analysis further revealed that under relatively extreme circumstances the economic efficiency of the current policy could be improved by decreasing the vaccination price charged to dog owners, relaxing the frequency of vaccination to every two to three years and implementing the policy on a smaller scale, e.g. only in targeted prefectures instead of the whole Japan.

Estimating the economic impact of canine rabies to Viet Nam 2005-2014.

The global economic impact of canine rabies has been estimated by several studies. Asia bears a disproportionate burden of this zoonosis due to high levels of human deaths and rates of post-exposure prophylaxis (PEP), but low investment in preventative dog vaccination. The same factors that cause rabies to burden much of Asia are also present in Viet Nam. This study estimated the economic burden of canine rabies in a societal perspective including direct and indirect cost of rabies in dogs, livestock, and humans. Using data collected from personal interviews, published literature, published and supplementary reports, and primary data collection, we estimated the economic impact of canine rabies in Viet Nam over a ten year period (2005-2014). We incorporated the direct and indirect costs for PEP, dog vaccination efforts, livestock losses, and disability adjusted life years (DALYs) into the analysis. General findings from this analysis indicated that over the 10 year study period, the total economic impact of canine rabies was over $719 million USD. The largest portion of impacts (92%) were made up of PEP-related costs. Canine rabies created between 36,560 and 45,700 DALYs, measured in years of life lost (YLL). A total of 914 human deaths were reported over the study period. Deaths/100,000 people were 0.11, which is lower than the reported level for Asian countries. The cost per dog vaccinated was $1.75 USD. Our results indicate that canine rabies impacts in Viet Nam are consistent with the burden elsewhere reported in Asia, with large expenditures on PEP and very small investments in dog vaccination.

[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.

Cost-effectiveness of dog rabies vaccination programs in East Africa.

BACKGROUND: Dog rabies annually causes 24,000-70,000 deaths globally. We built a spreadsheet tool, RabiesEcon, to aid public health officials to estimate the cost-effectiveness of dog rabies vaccination programs in East Africa. METHODS: RabiesEcon uses a mathematical model of dog-dog and dog-human rabies transmission to estimate dog rabies cases averted, the cost per human rabies death averted and cost per year of life gained (YLG) due to dog vaccination programs (US 2015 dollars). We used an East African human population of 1 million (approximately 2/3 living in urban setting, 1/3 rural). We considered, using data from the literature, three vaccination options; no vaccination, annual vaccination of 50% of dogs and 20% of dogs vaccinated semi-annually. We assessed 2 transmission scenarios: low (1.2 dogs infected per infectious dog) and high (1.7 dogs infected). We also examined the impact of annually vaccinating 70% of all dogs (World Health Organization recommendation for dog rabies elimination). RESULTS: Without dog vaccination, over 10 years there would a total of be approximately 44,000-65,000 rabid dogs and 2,100-2,900 human deaths. Annually vaccinating 50% of dogs results in 10-year reductions of 97% and 75% in rabid dogs (low and high transmissions scenarios, respectively), approximately 2,000-1,600 human deaths averted, and an undiscounted cost-effectiveness of $451-$385 per life saved. Semi-annual vaccination of 20% of dogs results in in 10-year reductions of 94% and 78% in rabid dogs, and approximately 2,000-1,900 human deaths averted, and cost $404-$305 per life saved. In the low transmission scenario, vaccinating either 50% or 70% of dogs eliminated dog rabies. Results were most sensitive to dog birth rate and the initial rate of dog-to-dog transmission (Ro). CONCLUSIONS: Dog rabies vaccination programs can control, and potentially eliminate, dog rabies. The frequency and coverage of vaccination programs, along with the level of dog rabies transmission, can affect the cost-effectiveness of such programs. RabiesEcon can aid both the planning and assessment of dog rabies vaccination programs.

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

Resumen Los perros son causantes de zoonosis y lesiones; en especial, si aceptamos como normales conductas peligrosas; perdiendo la percepción al riesgo a enfermar. El objetivo de este manuscrito fue demostrar, que la presencia de perros vagos y comunitarios, es un peligro para la salud y seguridad pública, a través de información epidemiológica que sustenta la medida de evitar su libre circulación. La agresividad de los perros regula sus relaciones sociales a través de sumisión o dominancia; características de difícil reconocimiento para la población humana. En Chile, 327.150 personas resultaron mordidas por perros, entre los años 2003-2012, con un costo de U$22,7 a U$177,9 millones; además de los U$3,13 millones por intervenir quirúrgicamente 767 sujetos humanos de hidatidosis durante el año 2012. Sin embargo, la zoonosis más temida es la rabia, dado el resultado mortal de ésta. No se debe tolerar la presencia de perros vagos y comunitarios en las calles, medida que debe tener un sustento técnico de salud y seguridad pública; debido a que la población ha perdido la capacidad de percibir el riesgo de contraer enfermedades zoonóticas, de altos costos para el sistema asistencial; sin considerar el desmedro económico al núcleo familiar y el daño psicológico a los afectados.

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.

Pilot study of the financial and practice protocol impacts of canine influenza virus (H3N2) outbreaks in example veterinary practices.

Since March 2015, canine influenza virus (CIV) H3N2 has caused widespread outbreaks in dogs across the USA. The effects of local H3N2 outbreaks on veterinary practices were investigated using an online interface and followed with phone calls to respondents when necessary. An outbreak was defined as confirmed diagnosis of H3N2 by either PCR or serology in at least four dogs. Of 30 practices invited to participate, five met the entry criteria: at least one documented H3N2 outbreak in the previous 12 months, a predominantly (≥70%) small animal caseload, and adequate financial records to complete the survey. Respondents reported 1-3 H3N2 outbreaks/practice over the last 12 months, with 4-8 dogs diagnosed/outbreak. For each participating practice, self-reported direct financial impact data was collected from the single H3N2 outbreak that involved the most dogs. The two most substantial categories of self-reported financial loss occurred due to boarding facility closure (estimated cost per practice: median $5000), and treatment costs borne by the practice (estimated cost per practice: median $2850). Median extra biosecurity costs were $300/practice. Median total direct costs of an H3N2 outbreak were $8945/practice. Lost foot traffic included cancelled appointments, appointments redirected to other veterinary hospitals for the duration of the outbreak, and loss of revenue from ancillary services provided during usual business (calculated cost per practice: median $450). Cost/practice normalized by the number of fulltime veterinarians in each practice was calculated and additional effects, such as interruptions to daily practice routine, reduced productivity, reputation loss and poor staff morale, were also reported. Vaccination against H3N2 was introduced as part of routine practice vaccination protocols or was made mandatory before boarding in three of five practices. In the remaining two practices, a focus on client education about canine infectious disease, especially H3N2, emerged in response to outbreaks. H3N2 outbreaks had substantial impacts on veterinary practice finances, daily routines and staff morale, and was associated with enhancements in vaccination, biosecurity and client education protocols.

Towards canine rabies elimination: Economic comparisons of three project sites.

An appreciation of the costs of implementing canine rabies control in different settings is important for those planning new or expanded interventions. Here we compare the costs of three canine rabies control projects in South Africa, the Philippines and Tanzania to identify factors that influence the overall costs of rabies control efforts. There was considerable variation in the cost of vaccinating each dog, but across the sites these were lower where population density was higher, and later in the projects when dog vaccination coverage was increased. Transportation costs comprised a much higher proportion of total costs in rural areas and where house-to-house vaccination campaigns were necessary. The association between the cost of providing PEP and human population density was less clear. The presence of a pre-existing national rabies management programme had a marked effect on keeping infrastructure and equipment costs for the project low. Finally, the proportion of the total costs of the project provided by the external donor was found to be low for the projects in the Philippines and South Africa, but likely covered close to the complete costs of the project in Tanzania. The detailed economic evaluation of three recent large-scale rabies control pilot projects provides the opportunity to examine economic costs across these different settings and to identify factors influencing rabies control costs that could be applied to future projects.

Cost-benefit analysis of controlling rabies: placing economics at the heart of rabies control to focus political will.

Rabies is an economically important zoonosis. This paper describes the extent of the economic impacts of the disease and some of the types of economic analyses used to understand those impacts, as well as the trade-offs between efforts to manage rabies and efforts to eliminate it. In many cases, the elimination of rabies proves more cost-effective over time than the continual administration of postexposure prophylaxis, animal testing and animal vaccination. Economic analyses are used to inform and drive policy decisions and focus political will, placing economics at the heart of rabies control.

La rage est une zoonose importante au plan économique. Les auteurs décrivent la portée de l'impact économique de la rage et présentent quelques modèles d'analyse économique utilisés pour comprendre ces effets ; ils analysent également les compromis à trouver entre les efforts consacrés à la gestion de la rage et ceux dédiés à son élimination. Dans bien des cas, il est plus rentable sur le long terme d'éliminer la rage que de procéder à la gestion continue de la prophylaxie post-exposition chez l'homme et au dépistage et à la vaccination des animaux. Les analyses économiques servent à documenter et à orienter les décisions concernant les mesures à prendre afin de mobiliser la volonté politique nécessaire, en plaçant l'économie au coeur de la lutte contre la rage.

La rabia es una zoonosis que reviste importancia económica. Los autores exponen la magnitud del impacto económico de la enfermedad y algunas de las modalidades de análisis económico utilizadas para aprehender esas consecuencias, así como el juego de equilibrios entre las medidas de gestión de la rabia y las actividades destinadas a eliminarla. En muchos casos, la eliminación de la enfermedad ofrece a la larga mayor eficacia, en relación con el costo, que la continua labor de administración de profilaxis tras exposición, realización de pruebas en animales y vacunación de estos. Los análisis económicos sirven para fundamentar y encauzar las decisiones de planificación y para aglutinar la voluntad política, haciendo de los aspectos económicos un eje de la lucha contra la rabia.

Retrospective study of intra-anesthetic predictors of prolonged hospitalization, increased cost of care and mortality for canine patients at a veterinary teaching hospital.

OBJECTIVE: To determine the impact of intraoperative anesthetic variables on the length of hospitalization, cost of care and mortality in dogs. STUDY DESIGN: Retrospective, observational study. ANIMALS: A total of 235 dogs undergoing general anesthesia. METHODS: Medical records of dogs undergoing general anesthesia between 2007 and 2014 at the University of Georgia Veterinary Teaching Hospital were reviewed. Data collected included demographic data, American Society of Anesthesiologists (ASA) physical status, type and duration of anesthesia, hemodynamic variables, temperature, ventilation, fluid therapy and adjunctive drugs administered. Outcome variables were length of hospitalization in the intensive care unit (ICU), hospital charges and survival to discharge. RESULTS: The only factor significantly associated with duration of ICU care was higher ASA status (p<0.0001). Factors associated with increased cost of hospitalization were ICU duration (p<0.0001), anesthesia duration (p<0.0001), hemorrhage amount (p<0.0001), colloid use (p=0.0081), increased age (p=0.0253), increased weight (p = 0.0293) and presence of hypertension (p=0.0179). Overall mortality rate was 5.1%. The only factors negatively associated with survival were the administration of colloids (p<0.0008) and ASA status (p=0.0314). CONCLUSIONS AND CLINICAL RELEVANCE: Several intrinsic patient factors and intraoperative hemodynamic variables were significantly associated with postoperative morbidity and mortality in dogs. These factors might have prognostic value in conjunction with preoperative risk assessment, and patient outcome may be improved by stricter intraoperative control of these variables.