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.
Amid ongoing devastation due to Serve-Acute-Respiratory-Coronavirus2 (SARS-CoV-2), the global spatial and temporal variation in the pandemic spread has strongly anticipated the requirement of designing area-specific preventive strategies based on geographic and meteorological state-of-affairs. Epidemiological and regression models have strongly projected particulate matter (PM) as leading environmental-risk factor for the COVID-19 outbreak. Understanding the role of secondary environmental-factors like ammonia (NH3) and relative humidity (RH), latency of missing data structuring, monotonous correlation remains obstacles to scheme conclusive outcomes. We mapped hotspots of airborne PM2.5, PM10, NH3, and RH concentrations, and COVID-19 cases and mortalities for January, 2021-July,2021 from combined data of 17 ground-monitoring stations across Delhi. Spearmen and Pearson coefficient correlation show strong association (p-value < 0.001) of COVID-19 cases and mortalities with PM2.5 (r > 0.60) and PM10 (r > 0.40), respectively. Interestingly, the COVID-19 spread shows significant dependence on RH (r > 0.5) and NH3 (r = 0.4), anticipating their potential role in SARS-CoV-2 outbreak. We found systematic lockdown as a successful measure in combatting SARS-CoV-2 outbreak. These outcomes strongly demonstrate regional and temporal differences in COVID-19 severity with environmental-risk factors. The study lays the groundwork for designing and implementing regulatory strategies, and proper urban and transportation planning based on area-specific environmental conditions to control future infectious public health emergencies.
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