|
||||||||||
|
Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The vast majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals like raccoons, skunks, bats, and foxes. Domestic animals account for less than 10% of the reported rabies cases, with cats, cattle, and dogs most often reported rabid. Rabies virus infects the central nervous system, causing encephalopathy and ultimately death. Early symptoms of rabies in humans are nonspecific, consisting of fever, headache, and general malaise. As the disease progresses, neurological symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of symptoms. Public
health importance of rabies Cost
of rabies prevention Accurate estimates of these expenditures are not available. Although the number of PEPs given in the United States each year is unknown, it is estimated to be about 40,000. When rabies becomes epizootic or enzootic in a region, the number of PEPs in that area increases. Although the cost varies, a course of rabies immune globulin and five doses of vaccine given over a 4-week period typically exceeds $1,000. The cost per human life saved from rabies ranges from approximately $10,000 to $100 million, depending on the nature of the exposure and the probability of rabies in a region. The
cost of rabies worldwide Underreporting is a characteristic of almost every infectious disease in developing countries, and increasing the estimated human mortality does not in itself increase the relative public health importance of rabies. There is, however, one often neglected aspect of rabies that does affect perception of its importance. Rabies is not, in the natural sense, a disease of humans. Human infection is incidental to the reservoir of disease in wild and domestic animals; therefore, a more accurate projection of the impact of rabies on public health should include an estimate of the extent to which the animal population is affected and the expense involved in preventing transmission of rabies from animals to humans. An additional figure is needed to complete the global picture of rabies. The best estimates of the impact of rabies on a country and the public health resources available within that country for rabies control are found in data for the number and distribution of cases of rabies in domestic animals. Despite evidence that control of dog rabies through programs of animal vaccination and elimination of stray dogs can reduce the incidence of human rabies, exposure to rabid dogs is still the cause of over 90% of human exposures to rabies and of over 99% of human deaths worldwide. The cost of these programs prohibits their full implementation in much of the developing world, and in even the most prosperous countries the cost of an effective dog rabies control program is a drain on public health resources. The estimated annual expenditure for rabies prevention in the United States is over US$300 million, most of which is spent on dog vaccinations. An annual turnover of approximately 25% in the dog population necessitates revaccination of millions of animals each year, and reintroduction of rabies through transport of infected animals from outside a controlled area is always a possibility should control programs lapse. Reservoirs of wildlife rabies, virtually unknown in Asia and tropical regions, are also potential sources of rabies infection for dogs in Europe and North America. For
more detailed information on the economic effects of rabies, see: Uhaa, I.J., Dato, V.M., Sorhage, F.E., Beckley, J.W., Roscoe, D.E., Gorsky, R.D., & Fishbein, D.B. (1992). Benefits and costs of using an orally absorbed vaccine to control rabies in raccoons. Journal of the American Veterinary Medical Association, 201(12), 1873-1882. Meltzer, M.I. & Rupprecht, C.E. (1998). A review of the economics of the prevention and control of rabies -- Part 1: global impact and rabies in humans. Pharmacoeconomics, 14(4), 365-383. Meltzer, M.I. & Rupprecht, C.E. (1998). A review of the economics of the prevention and control of rabies -- Part 2: rabies in dogs, livestock and wildlife. Pharmacoeconomics, 14(5), 481-498. Meltzer, M.I. (1996). Assessing the costs and benefits of an oral vaccine for raccoon rabies: a possible model. Emerging Infectious Diseases, 2, 343-349. |
This page last reviewed December 1, 2003 All
information presented in these pages and all items available for download
are for public use. US Department of Health and Human Services Privacy Policy | Accessibility |