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Livestock losses due to rabies and health and the corresponding benefits of controlling the disease are not often considered when the cost-effectiveness of rabies control is evaluated. In this research, assessed the benefits of applying a One Health perspective that includes these losses to the case of canine rabies vaccination in Ethiopia. We constructed a dynamic epidemiological model of rabies transmission. The model was fit to district-specific data on human rabies exposures and canine demography for two districts with distinct agro-ecologies. The epidemiological model was coupled with human and livestock economic outcomes to predict the health and economic impacts under a range of vaccination scenarios. The model indicates that human exposures, human deaths, and rabies-related livestock losses would decrease monotonically with increasing vaccination coverage. In the rural district, all vaccination scenarios were found to be cost-saving compared to the status quo of no vaccination, as more money could be saved by preventing livestock losses than would be required to fund the vaccination campaigns. Vaccination coverages of 70% and 80% were identified as most likely to provide the greatest net health benefits at the WHO cost-effectiveness threshold over a period of 5 years, in urban and rural districts respectively. Shorter time frames led to recommendations for higher coverage in both districts, as did even a minor threat of rabies re-introduction. Exclusion of rabies-related livestock losses reduced the optimal vaccination coverage for the rural district to 50%. This study demonstrated the importance of including all economic consequences of zoonotic disease into control decisions. Analyses that include cattle and other rabies-susceptible livestock are likely better suited to many rural communities in Africa wishing to maximize the benefits of canine vaccination., Competing Interests: No conflict of interest.

The cost-effectiveness of different mass dog rabies vaccination strategies, defined as the costs per year of life lost (YLL) averted was evaluated for a period of 10 years by means of a dynamic simulation study for a typical village on Flores Island. In the base strategy (no dog vaccination and no post-exposure treatment (PET) of human bite cases), the model showed that the introduction of the virus by one infectious dog into an isolated village with 1500 inhabitants and 400 dogs resulted in 881 YLLs during a 10-year simulation period, which is equivalent to 30 human rabies cases. An annual dog vaccination campaign with a coverage of 70% using a short-acting vaccine saved 832 YLLs, while the cumulative costs for the public sector were US$3646 or US$4.38 per YLL averted. Switching to a long-acting vaccine, the annual vaccination strategies with a coverage of 50% (AV_156_50) or 70% (AV_156_70) reduced the baseline YLLs from 881 to respectively 78 and 26 YLLs with cumulative costs of US$3716 and US$2264 or US$4.63 and US$2.65 per YLL averted, respectively. In general, dog vaccination was more cost-effective than PET alone (US$2.65-4.63 per YLL averted versus US$23.29 per YLL averted). Although a combination of PET with AV_156_70 was less cost-effective compared to AV_156_70 alone, this strategy was able to prevent all human deaths due to rabies. A combination of PET with annual vaccination using a short-acting vaccine at a coverage of 50% was far from being cost-effective, suggesting that the currently applied rabies control in Flores Island is not an efficient investment in reducing human rabies burden. An increased investment in either an increase in the current coverage or in a switch from the short-acting vaccine to the long-acting vaccine type would certainly pay off., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Rabies is a viral disease that can cause fatal encephalomyelitis both in animals and humans. Although incidences of the disease in cattle have been reported, insight in the economic impact of the disease in livestock remains limited. By affecting cattle in subsistence systems, rabies may have extensive economic impacts at household and country levels, in addition to the effects on human health. This study presents estimates of the direct economic impact of rabies at herd level in two representative subsistence cattle-farming systems in Ethiopia, the mixed crop-livestock and pastoral production systems. The economic impacts were assessed by a structured questionnaire administered to 532 cattle-owning households. These households were selected from four districts within two administrative zones; each zone representing a cattle production system. Rabies incidence rates of 21% and 11% at herd level were calculated for the mixed crop-livestock and pastoral production systems, respectively. The incidence rate at cattle level was the same in both systems., i.e. 2%. Herd-level incidence rates were higher in the mixed crop-livestock system than in the pastoral system (P<0.05). Average economic losses per herd due to rabies were estimated at 49 USD per year for the mixed-crop livestock system, and at 52 USD per year for the pastoral system; whereas in affected herds the average losses per year were 228 USD (range 48-1016 USD) in the mixed crop-livestock system, and 477 USD (range 173-1140 USD) in the pastoral system. The average herd-level economic losses were not significantly different between the farming systems; however once the herd was affected, the losses were significantly higher for the pastoral system than for the mixed crop-livestock system (P<0.01). The losses due to rabies in cattle are relatively high for pastoral households, due to their complete dependency on livestock for their livelihoods. Although the current estimates only account for the direct losses resulting from cattle mortality, the estimates already indicate the potential economic gains from a rabies intervention in the dog population, of which the benefits can be shared by the public health sector., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The success of a rabies control strategy depends on the commitment and collaboration of dog owners. In this study the theory of planned behaviour (TPB) was used to identify the factors, which are associated with the intention of dog owners to participate in rabies control measures in the Manggarai and Sikka regencies of Flores Island, Indonesia. Questionnaires were administered to 450 dog owners from 44 randomly selected villages in the two regencies. Ninety-six percent of the dog owners intended to participate in a free-of-charge vaccination campaign. The intention decreased to 24% when dog owners were asked to pay a vaccination fee equal to the market price of the vaccine (Rp 18.000 per dose=US$2). Approximately 81% of the dog owners intended to keep their dogs inside their house or to leash them day and night during a period of at least three months in case of an incidence of rabies in the dog population within their village. Only 40% intended to cull their dogs in case of a rabies incident within their village. Using multivariable logistic regression analysis, the attitude item 'vaccinating dogs reduces rabies cases in humans', and the perceived behavioural control items 'availability of time' and 'ability to confine dogs' were shown to be significantly associated with the intention to participate in a free-of-charge vaccination campaign. The attitude item 'culling dogs reduces rabies cases in humans' was significantly associated with the intention to participate in a culling measure. The attitude item 'leashing of dogs reduces human rabies cases' and perceived behavioural controls 'availability of time' and 'money to buy a leash' were associated with the intention to leash dogs during a rabies outbreak. As the attitude variables were often significantly associated with intention to participate in a rabies control measure, an educational rabies campaign focusing on the benefit of rabies control measures is expected to increase the intention of dog owners to participate in future rabies control measures. The significant association between perceived behavioural controls and intention to participate points to other relevant policy interventions. Providing dog owners with a skill to confine dogs and creating a subsidy program for the vaccine and leash costs, by involving non-governmental organisations or charitable organisations, may be useful policy interventions. Moreover appropriate time management, such as implementing vaccination campaigns during the weekend, could increase the intention to participate in vaccination campaigns, by relaxing the constraints on the availability of dog owners' time., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Most studies on control strategies for contagious diseases such as foot-and-mouth disease (FMD) evaluate pre-defined control strategies and imply static decision-making during epidemic control. Such a static approach contradicts the dynamic nature of the decision-making process during epidemic control. This paper presents an integrated epidemic-economic modelling approach to support dynamic decision-making in controlling FMD epidemics. This new modelling approach reflects ongoing uncertainty about epidemic growth during epidemic control and provides information required by a dynamic decision process. As demonstrated for a Dutch FMD-case, the modelling approach outperforms static evaluation of pre-fixed control strategies by: (1) providing guidance to decision-making during the entire control process; and (2) generating more realistic estimation of the costs of overreacting or underreacting in choosing control options., (Copyright (c) 2010 Elsevier B.V. All rights reserved.)