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Eliminating human rabies: impact of enhanced vaccination coverage

Award Number: R01AI141712
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 11/20/2018
PERIOD OF PERFORMANCE END DATE: 10/31/2024

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Eliminating human rabies: impact of enhanced vaccination coverage - PROJECT SUMMARY Rabies has the highest case fatality rate of any known human infectious disease and kills around 59,000 people annually. Nearly all of these deaths (99%) occur in Africa and Asia and are due to canine rabies. While human rabies can be prevented with post-exposure prophylaxis (PEP), the intervention is costly and often not available in remote communities where it is needed. Targeting control efforts at the reservoir host through mass dog vaccination (MDV) is a socially equitable and effective approach. However, implementing MDV across the rural landscapes where rabies remains endemic is logistically challenging and, consequently, expensive. Moreover, there has only been limited empirical evidence to demonstrate the cost-effectiveness of MDV in achieving public health outcomes. As a result many countries spend substantial resources on provision of PEP with only limited investment in MDV. The goal of the proposed study is the elimination of dog-mediated human rabies, whilst the long term objective is the provision of cost-effective control strategies across the remote landscapes where rabies remains endemic. To achieve this a randomized controlled trial (RCT) will be carried out to compare vaccination coverage under two delivery strategies: the standard centralized team-led delivery (which is logistically challenging and results in irregular coverage, at cost) and a decentralized community-led approach (made possible through the recent determination that rabies vaccines are thermotolerant and can be stored for extended periods outside of refrigeration units) (Aim 1). The hypothesis is that community-led delivery will result in more consistent coverage at lower cost per dose. Second, an enhanced rabies surveillance network will be used to quantify the public health impact following the introduction of MDV in Aim 1 (Aim 2). Rabies incidence in the dog population is predicted to decline rapidly and public health impacts to accrue (fewer people bitten, less PEP required and fewer human deaths). Third, the outputs from Aims 1 and 2 will be used to model the impact that delivery strategy has on public health outcomes (Aim 3). The hypothesis is that community-led MDV delivery will result in improved public health outcomes and achieve elimination more rapidly than standard team-led MDV. Fourth, the outputs from Aims 1 – 3 will be used to carry out a suite of cost-effectiveness and benefit-cost analyses to understand the cost-effectiveness and net benefits derived from the two MDV strategies. In quantifying the reduction in the human rabies burden that MDV provides and the comparative effectiveness and cost effectiveness of the delivery strategies, this study will provide much needed data that will inform international policy on the best approaches to eliminate rabies at scale. With a date of 2030 set by WHO/OIE/FAO for the global elimination of dog- mediated human rabies, the study’s outputs will provide a critical and timely contribution to guide elimination in canine- rabies endemic countries.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$2,088 )
2025	2023	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	000	5	4/16/2025	NON-COMPETING CONTINUATION	-$2,088
														Subtotal = -$2,088

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2023	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	000	5	10/26/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $319,527 )
2023	2023	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	000	5	10/18/2022	NON-COMPETING CONTINUATION	$319,527
														Subtotal = $319,527

Issue Date FY: 2022 ( Subtotal = $314,455 )
2022	2022	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	000	4	10/21/2021	NON-COMPETING CONTINUATION	$314,455
														Subtotal = $314,455

Issue Date FY: 2021 ( Subtotal = $562,971 )
2021	2021	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	000	3	10/16/2020	NON-COMPETING CONTINUATION	$562,971
														Subtotal = $562,971

Issue Date FY: 2020 ( Subtotal = $553,431 )
2020	2020	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	001	2	4/14/2020	NON-COMPETING CONTINUATION	$0
2020	2020	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	000	2	11/7/2019	NON-COMPETING CONTINUATION	$553,431
														Subtotal = $553,431

Issue Date FY: 2019 ( Subtotal = $590,274 )
2019	2019	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	000	1	11/19/2018	NEW	$590,274
2019	2019	WASHINGTON STATE UNIVERSITY	240 FRENCH ADMINISTRATION BLDG	PULLMAN	WA	99164	WHITMAN	USA	Allergy and Infectious Diseases Research	001	1	12/17/2018	NEW	$0
														Subtotal = $590,274

Grand Total All Awards = $2,338,570

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Eliminating human rabies: impact of enhanced vaccination coverage

Award Number: R01AI141712

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 11/20/2018

PERIOD OF PERFORMANCE END DATE: 10/31/2024

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