The impact of transmission dynamics of rabies control: Systematic review.

The public health and economic burden of rabies has led to major intersectoral initiatives worldwide to reduce its burden. Over the last decade, the impact of rabies prevention and control programmes in real-world settings has become increasingly evident, especially in countries where most rabies exposures and deaths occur, but they have yet to successfully eradicate rabies due to limited access to health care services. We aimed to systematically review published transmission dynamic modelling studies of rabies in both humans and dogs with a focus on studies which estimated the epidemiological and economic impact of different preventive measures. The findings are intended to inform the World Health Organization's (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) to improve programmatic feasibility and clinical practice in rabies. Medline and Scopus were systematically searched for peer-reviewed articles which were published up to 14th June 2017. In addition, studies identified from a meeting of the WHO Expert Consultation on Rabies on 26-28th April 2017 in Bangkok, Thailand were added, resulting in 19 articles which were included in the review. Results from the disease modelling indicated that the basic reproduction number was low (less than 2 in all but one study). All studies found that rabies control through canine vaccination was likely to be effective in terms of reducing the incidence of rabies in dogs and/or humans, with most studies suggesting 70% annual coverage was adequate. Vaccine coverage, dog density and birth rate were identified as crucial factors influencing the effectiveness of the interventions. In conclusion, the findings from this review suggest that rabies control through canine vaccination is likely to be effective in reducing the incidence of rabies. Vaccine coverage, dog density and canine birth rate were identified as critical factors influencing the effectiveness of vaccination interventions.