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Zeitschrift für Hochschulentwicklung, Zeitschrift für Hochschulentwicklung (Journal for Higher Education Development), Since university students increasingly face the need to reconcile studying and caring for an older person this study explores the lives, challenges and coping strategies of caregiving students in Germany as well as the ways institutions of higher education can (or already do) support them. The situation of such students was investigated with eight in-depth interviews with caregiving students, which were fully transcribed and analysed with a thematic coding strategy. Results show that caregiving students in tertiary education are a group that experiences unique challenges that differ from those faced by caregivers in later life, working life or caregiving children. They tend to live ‘hidden lives’ as caregivers and face exclusion from a ‘normal’ student life. Findings indicate the importance of raising awareness for the topic among university staff as well as flexibility with regards to regulations in the university context.

Dog-mediated rabies continues to kill tens of thousands of people every year in low- and middle-income countries despite being an entirely vaccine-preventable disease. WHO and partners have launched a global campaign to reach zero human deaths from dog-mediated rabies by 2030. The primary tools for reaching this target are mass dog vaccination to interrupt transmission in domestic dog populations that maintain infection, appropriate post-exposure prophylaxis (PEP) for rabies-exposed persons to prevent the fatal onset of disease, together with education to support their effective uptake. Models have been developed to assess the feasibility, impact and cost-effectiveness of these measures. From these models, we argue that the 2030 target of zero human rabies deaths is achievable, but will require concerted effort, engagement and investment. A proposed Gavi investment in human rabies vaccines has potential to drive progress towards the 2030 target; however, concomitant investment is needed to scale up mass dog vaccination or this target will be missed. Predicted economic benefits of mass dog vaccination vary according to national PEP provisioning and healthcare access. Integrated Bite Case Management can enhance surveillance and rationalize PEP use, but needs adapting to and integrating within local health systems and international reporting systems to improve PEP accountability, monitor impacts and support verification of disease freedom. Modelling approaches need refining to project realistic and geographically specific timelines for achieving targets. Model iterations informed by data on the implementation of interventions can be used to evaluate progress and guide future strategies. Critically such models are needed to advocate for investment, since the greatest risk to the ‘Zero by 30’ strategy is the limited long-term cross-sectoral or targeted financing to support countries to deliver and sustain mass dog vaccination.

The Strategic Advisory Group of Experts (SAGE) Working Group on rabies vaccines and immunoglobulins was established in 2016 to develop practical and feasible recommendations for prevention of human rabies. To support the SAGE agenda we developed models to compare the relative costs and potential benefits of rabies prevention strategies. We examined Post-Exposure Prophylaxis (PEP) regimens, protocols for administration of Rabies Immunoglobulin (RIG) and inclusion of rabies Pre-Exposure Prophylaxis (PrEP) within the Expanded Programme on Immunization (EPI). For different PEP regimens, clinic throughputs and consumables for vaccine administration, we evaluated the cost per patient treated, costs to patients and potential to treat more patients given limited vaccine availability. We found that intradermal (ID) vaccination reduces the volume of vaccine used in all settings, is less costly and has potential to mitigate vaccine shortages. Specifically, the abridged 1-week 2-site ID regimen was the most cost-effective PEP regimen, even in settings with low numbers of bite patients presenting to clinics. We found advantages of administering RIG to the wound(s) only, using considerably less product than when the remaining dose is injected intramuscularly distant to the wound(s). We found that PrEP as part of the EPI programme would be substantially more expensive than use of PEP and dog vaccination in prevention of human rabies. These modeling insights inform WHO recommendations for use of human rabies vaccines and biologicals. Specifically, the 1-week 2-site ID regimen is recommended as it is less costly and treats many more patients when vaccine is in short supply. If available, RIG should be administered at the wound only. PrEP is highly unlikely to be an efficient use of resources and should therefore only be considered in extreme circumstances, where the incidence of rabies exposures is extremely high. [Abstract copyright: Copyright © 2018. Published by Elsevier Ltd.]

Background: \ud Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply.\ud \ud Methods: \ud We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs.\ud \ud Findings: \ud We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use.\ud \ud Interpretation: \ud Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies.\ud \ud Funding: \ud World Health Organization.

Background Rabies 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 Findings We 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/Significance This 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., Author Summary Rabies is a fatal viral disease largely transmitted to humans from bites by infected animals—predominantly from domestic dogs. The disease is entirely preventable through prompt administration of post-exposure prophylaxis (PEP) to bite victims and can be controlled through mass vaccination of domestic dogs. Yet, rabies is still very prevalent in developing countries, affecting populations with limited access to health care. The disease is also grossly underreported in these areas because most victims die at home. This leads to insufficient prioritization of rabies prevention in public health agendas. To address this lack of information on the impacts of rabies, in this study, we compiled available data to provide a robust estimate of the health and economic implications of dog rabies globally. The most important impacts included: loss of human lives (approximately 59,000 annually) and productivity due to premature death from rabies, and costs of obtaining PEP once an exposure has occurred. The greatest risk of developing rabies fell upon the poorest regions of the world, where domestic dog vaccination is not widely implemented and access to PEP is most limited. A greater focus on mass dog vaccination could eliminate the disease at source, reducing the need for costly PEP and preventing the large and unnecessary burden of mortality on at-risk communities.

La surveillance a pour but principal de fournir en temps utile des informations pertinentes permettant de déclencher une alerte rapide en cas d'événement sanitaire, et d'informer rapidement les décideurs de façon à limiter la propagation de la maladie et à en atténuer l'impact. Ce guide pratique sur la surveillance est principalement à l'usage des Services vétérinaires ou des autres autorités compétentes, de leur personnel et des experts. Il leur permettra d'améliorer la conception, la mise en oeuvre et l'évaluation des systèmes de surveillance des maladies des animaux terrestres dans leur pays. Ce document reflète la contribution d'experts en méthodologie de la surveillance issus du monde entier. Il prend en compte la dynamique de la santé animale ainsi que la diversité des modes d'élevage et la variété des situations rencontrées dans les Pays membres de l'OIE. Il offre un cadre ouvert destiné à regrouper les approches de surveillance qui correspondent le mieux aux besoins au niveau des pays et au niveau international ; ce cadre devrait rester pertinent au fur et à mesure des évolutions de la surveillance en fonction des défis et des opportunités qui se présenteront. La réalisation des activités de surveillance, qu'elle soit événementielle ou programmée, repose sur des Services vétérinaires qui respectent les normes de l'OIE sur la qualité, ainsi que sur des partenariats public-privé efficaces entre les vétérinaires du secteur public et du secteur privé, les éleveurs, les chasseurs et les gardes des espaces protégés.

El objetivo prioritario de la vigilancia es proporcionar en tiempo oportuno las informaciones necesarias para iniciar una alerta temprana en caso de acontecimiento zoosanitario e informar rápidamente a los responsables políticos de manera a reducir la propagación y mitigar el impacto de la enfermedad. Este manual práctico sobre vigilancia está destinado a ser utilizado principalmente por los Servicios Veterinarios u otras autoridades competentes, su personal y expertos, como herramienta para fortalecer el diseño, implementación y evaluación de los sistemas de vigilancia de las enfermedades de importancia para los animales terrestres en su país.

The purpose of surveillance is to provide timely and relevant information to allow early warning and inform policy makers for rapid response to reduce the spread and mitigate the impact of disease. This practical handbook about surveillance is intended to be used mainly by Veterinary Services or other Competent Authorities, their staff and experts as a tool for strengthening the design, implementation and evaluation of surveillance systems for diseases of relevance for terrestrial animals in their country. The book reflects the contribution of experts in surveillancemethodology from across the world. Recognising the diversityof animal husbandry and other situations in Member Countries and the dynamic nature of animal health, the document presents a flexible framework for integrating surveillance approaches that meet both national and international needs and that should remain relevant as surveillance evolves to embrace new challenges and opportunities. Veterinary Services complying with OIE standards on quality are a cornerstone for effective passive and active surveillance activities, as well as efficient public-private partnerships between official and private veterinarians and animal owners,hunters and rangers in conservation areas.