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 Djamé na, the capital of Chad. The estimated transmission rates between dogs ( d) were 0.0807 km 2 /(dogs⅐week) and between dogs and humans ( dh ) 0.0002 km 2 /(dogs⅐week). 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 dogvaccination campaigns with human PEP compared to human PEP alone.M ost human deaths from rabies occur in tropical resourcelimited countries (1). In Africa and Asia, an estimated 24,000 to 70,000 people die of rabies each year (2). The domestic dog is the main source of exposure and a primary vector for human rabies (3). Rabies in humans can be prevented by appropriate postexposure prophylaxis (PEP), a treatment not always available and affordable in resource-limited countries. Human rabies can also be prevented through vaccination of the animal vector. Recent work in Africa demonstrates that the intensity of rabies-control efforts seems to depend on the level of perceived prevalence. In the past decades, such efforts have not been able to interrupt cyclical epidemics showing significant synchrony between countries (4). However, evidence of successful and sustained vaccination programs to eliminate dog rabies from South America, Mexico, and the Caribbean provide hope for similar efforts in Africa (5). Unfortunately, human resources, diagnostic capacity, and financial resources of most sub-Saharan African countries are far away from those in South America. Bögel and Meslin show that in areas where the virus continually circulates in the dog population, over a period of 15 years, dog vaccination combined with PEP of dog-bite patients, is more cost-effective than PEP alone (6). In...
Although industrialized countries have been able to contain recent outbreaks of zoonotic diseases, many resource-limited and transitioning countries have not been able to react adequately. The key for controlling zoonoses such as rabies, echinococcosis, and brucellosis is to focus on the animal reservoir. In this respect, ministries of health question whether the public health sector really benefits from interventions for livestock. Cross-sectoral assessments of interventions such as mass vaccination for brucellosis in Mongolia or vaccination of dogs for rabies in Chad consider human and animal health sectors from a societal economic perspective. Combining the total societal benefits, the intervention in the animal sector saves money and provides the economic argument, which opens new approaches for the control of zoonoses in resource-limited countries through contributions from multiple sectors.
Although a "One Health" approach has been successfully implemented for emerging infectious zoonotic diseases with pandemic potential, we still lack a conceptual framework to address enzootic diseases like brucellosis. The vast majority of published brucellosis studies in the developing world rely solely on serology. An important shortcoming of brucellosis serology is the impossibility to infer which (smooth) Brucella spp. induced antibodies in the host. In this respect, mixed farming and especially raising small ruminants along with cattle, a common practice in the developing world, is reported to be a risk factor and a central question that has to be answered is whether cattle are infected with B. melitensis or with B. abortus or with both Brucella species. Therefore the isolation, identification and molecular characterization of Brucella spp. in human and the different livestock species needs to be undertaken to define a sound conceptual framework, identify the source of infection and plan appropriate control measures.
In patients with treatment-induced suppression of blood viral load the likelihood of having detectable HIV in semen is very low (< 4%). In addition, seminal shedding of cell-free and cell-associated HIV is significantly lower than in an untreated population of HIV-infected asymptomatic men. On a population basis, this effect of therapy may help to reduce sexual transmission of HIV. However, individual patients may still be infected as evidenced by continued shedding of cells harbouring the HIV provirus.
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