BackgroundRabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.Methodology/Principal FindingsWe established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%).Conclusions/SignificanceThis study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.

There are a number of errors in Table 3. The table legend should read: Breakdown of economic costs of rabies by cluster in millions of USD. The headings for columns six, seven, and eight are incorrect. They should be in the following order: Dog vaccination, Dog population management, Livestock losses. Please see the correct Table 3 below.

S ince the advent of Pasteur's germ theory and the general acceptance that infectious diseases do not develop spontaneously, humankind has strived to reduce and eliminate pathogens that pose a serious public health threat. Incorporating routine vaccinations to control human diseases such as pneumonia, diarrhea, pertussis, measles, and polio contributed to the prevention of >10 million human deaths during 2010-2015 (1). Intensive global efforts toward disease eradication have focused on only a few diseases, including Guinea worm disease (dracunculiasis) (>99% reduction in human cases), smallpox (eradicated in 1980), rinderpest (eradicated in 2011), polio (99% reduction in human cases), and lymphatic filariasis (73% reduction in human cases) (2-6). Those disease eradication efforts have focused on pathogens that are host-restricted or affect only a single host. In 2015, the world called for action by setting a goal of zero human dog-mediated rabies deaths by 2030 worldwide. In 2018, the World Health Organization (WHO), the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations, and the Global Alliance for Rabies Control launched the Global Strategic Plan for global elimination of dog-mediated human rabies deaths by 2030, which represents the first major effort to eliminate a classical zoonosis and poses

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