Papers by Louise H Taylor
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As canine rabies control in Africa and Asia transitions from research-led proof-of-concept studie... more As canine rabies control in Africa and Asia transitions from research-led proof-of-concept studies to government-led programs for elimination, experience and evidence of their impact and costs must be shared for the benefit of future programs. The Ilocos Norte Communities against Rabies Exposure project was implemented in April 2012 by the provincial veterinary and health offices and supported by many other partners. It delivered a comprehensive dog vaccination program and increased awareness of the need for postexposure prophylaxis (PEP), aiming to eliminate human and animal rabies cases from Ilocos Norte by 2015. Prior to the intervention, confirmed rabies cases in dogs were between 19 and 50 per year (2008–2011). The primary outcome of the project was a reduction in rabies cases in both dogs and humans to 0 in 2014 and 2015, which has subsequently been maintained. Animal bite consultations increased significantly during the project. Economic data for the dog vaccination and PEP components of the project were collated for two sites: Laoag City (an urban setting) and Dingras Municipality (a rural setting) between 2012 and 2014. The average programmatic cost of vaccinating each dog was $4.54 in Laoag City and $8.65 in Dingras, and costs fell as the project reached more dogs. The average costs of providing PEP were $69.72 per patient and $49.02 per patient for the two sites, respectively, again falling as the project reached more people. External donor contributions contributed less than 20% of dog vaccination costs and less than 1% of PEP costs. The project demonstrated that rabies elimination can be achieved in a short period of time, with concerted effort across multiple sectors. A lack of clear dog population estimates hampered interpretation of some aspects of the programme. From 2016, the provincial government has assumed complete responsibility for the programme and must now continue the vaccination and surveillance efforts. Although safeguards are in place, reintroduction from surrounding areas remains a threat, and vigilance must be maintained.
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Rabies, a vaccine preventable neglected tropical disease, still claims an estimated 35,000–60,000... more Rabies, a vaccine preventable neglected tropical disease, still claims an estimated 35,000–60,000 human lives annually. The international community, with more than 100 endemic countries, has set a global target of 0 human deaths from dog-transmitted rabies by 2030. While it has been proven in several countries and regions that elimination of rabies as a public health problem is feasible and tools are available, rabies deaths globally have not yet been prevented effectively. While there has been extensive rabies research, specific areas of implementation for control and elimination have not been sufficiently addressed. This article highlights some of the commonest perceived barriers for countries to implementing rabies control and elimination programs and discusses possible solutions for sociopolitical, organizational, technical, and resource-linked requirements, following the pillars of the global framework for the elimination of dog-mediated human rabies adopted at the global rabies meeting in December 2015.
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Free-roaming dogs and rabies transmission are integrally linked across many low-income countries,... more Free-roaming dogs and rabies transmission are integrally linked across many low-income countries, and large unmanaged dog populations can be daunting to rabies control program planners. Dog population management (DPM) is a multifaceted concept that aims to improve the health and well-being of free-roaming dogs, reduce problems they may cause, and may also aim to reduce dog population size. In theory, DPM can facilitate more effective rabies control. Community engagement focused on promoting responsible dog ownership and better veterinary care could improve the health of individual animals and dog vaccination coverage, thus reducing rabies transmission. Humane DPM tools, such as sterilization, could theoretically reduce dog population turnover and size, allowing rabies vaccination coverage to be maintained more easily. However, it is important to understand local dog populations and community attitudes toward them in order to determine whether and how DPM might contribute to rabies control and which DPM tools would be most successful. In practice, there is very limited evidence of DPM tools achieving reductions in the size or turnover of dog populations in canine rabies-endemic areas. Different DPM tools are frequently used together and combined with rabies vaccinations, but full impact assessments of DPM programs are not usually available, and therefore, evaluation of tools is difficult. Surgical sterilization is the most frequently documented tool and has successfully reduced dog population size and turnover in a few low-income settings. However, DPM programs are mostly conducted in urban settings and are usually not government funded, raising concerns about their applicability in rural settings and sustainability over time. Technical demands, costs, and the time necessary to achieve population-level impacts are major barriers. Given their potential value, we urgently need more evidence of the effectiveness of DPM tools in the context of canine rabies control. Cheaper, less labor-intensive tools for dog sterilization will be extremely valuable in realizing the potential benefits of reduced
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World Rabies Day was set up in 2007 to raise global awareness about rabies, to provide informatio... more World Rabies Day was set up in 2007 to raise global awareness about rabies, to provide information on how to prevent the disease in at-risk communities and support advocacy for increased efforts in rabies control. It is held annually on September 28th, with events, media outreach and other initiatives carried out by individuals, professionals, organisations and governments from the local to the international level. The Global Alliance for Rabies Control coordinates World Rabies Day, amplifying the campaign's reach through the provision of a central event platform and resources to support events across the world, the promotion of messages through key rabies stakeholders, and the implementation of specific activities to highlight particular issues. Over the last decade, more than 1,700 registered events have been held across the world and shared with others in the global rabies community. Events in canine rabies endemic countries, particularly in Africa and Asia, have increased over time. Beyond the individual events, World Rabies Day has gained the support of governments and international agencies that recognise its value in supporting existing rabies control initiatives and advocating for improvements. As the rabies landscape has changed, World Rabies Day remains a general day of awareness but has also become an integral part of national, regional and global rabies elimination strategies. The global adoption of 2030 as the goal for the elimination of rabies as a public health threat has led to even greater opportunities for World Rabies Day to make a sustainable impact on rabies, by bringing the attention of policy makers and donors to the ongoing situation and elimination efforts in rabies-endemic countries.
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Current passive surveillance data for canine rabies, particularly for the regions where the burde... more Current passive surveillance data for canine rabies, particularly for the regions where the burden is highest, are inadequate for appropriate decision making on control efforts. Poor enforcement of existing legislation and poor implementation of international guidance reduce the effectiveness of surveillance systems, but another set of problems relates to the fact that canine rabies is an untreatable condition which affects very poor sectors of society. This results in an unknown, but potentially large proportion of rabies victims dying outside the health system, deaths that are unlikely to be recorded by surveillance systems based on health centre records. This article critically evaluates the potential sources of information on the number of human deaths attributable to canine rabies, and how we might improve the estimates required to move towards the goal of global canine rabies elimination.
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Acta Tropica, 2015
There is a need for innovation to improve control of all Neglected Zoonotic Diseases (NZDs). The ... more There is a need for innovation to improve control of all Neglected Zoonotic Diseases (NZDs). The Global Alliance for Rabies Control was formed to prevent human deaths from rabies and relieve the burden of rabies in other animal populations, especially dogs. It aims to identify reasons for the neglect of rabies in developing countries and to develop strategies to improve rabies control. Through initiatives such as World Rabies Day and the Partners for Rabies Prevention, progress has been made towards increased awareness of the burden of rabies transmitted by dogs at scales from local to international. An evidence base of the feasibility of canine rabies elimination has been built up and now easier access to information and tools enables countries to design and implement rabies elimination strategies in a logical way, utilizing the structures of regional networks for rabies control. The body of evidence has built consensus amongst international stakeholders in rabies control and is now being used to encourage international policy change, attract investment and increase delivery of effective rabies control programmes in canine rabies endemic countries.
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The rabies virus, a public health scourge from ancient times, is currently responsible for an est... more The rabies virus, a public health scourge from ancient times, is currently responsible for an estimated 59,000 human deaths a year, almost all transmitted via dog bites. It causes considerable economic impacts on developing countries, primarily in Africa and Asia, which can least afford these losses. However, despite its almost 100% case fatality rate, canine rabies is a completely preventable disease, and historic examples of canine rabies elimination in the developed world attest to this. Over the last decade, programs based on eliminating the source of the disease from dogs have shown success in reducing the public health burden of canine rabies in developing countries, notably across Latin America, and this has contributed to the growing evidence base necessary to change attitudes toward the feasibility of global canine rabies elimination. More recently, assessments of the current economic burden of canine rabies and the potential cost savings achievable through mass dog vaccinations have been added to this evidence base. Tools and support are available from the international community to help countries move progressively toward canine rabies elimination, and there is optimism that global freedom from canine rabies can be achieved within the next few decades.
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Background
Rabies is a notoriously underreported and neglected disease of low-income countries. T... more 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.
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Effective prevention of deaths due to human rabies is currently hampered by a
lack of understandi... more Effective prevention of deaths due to human rabies is currently hampered by a
lack of understanding of the scale of the problem, and the distribution of both
animal and human cases across countries, regions and continents. Unfortunately,
despite the severity of the disease, accurate data on which to assess these questions
and to prioritize and direct public health interventions are not available for
many parts of the world. This survey sought to understand the current global situation
regarding the surveillance of human rabies. Data were collected from 91
countries across all continents and all categories of human rabies risk, generating
the most complete and representative global data set currently available. Respondents
were asked key questions about whether human rabies was a notifiable disease,
how the surveillance system for human rabies operated and whether the
respondent considered that the surveillance system was working effectively.
Across the 91 countries from which data were collated, human rabies was a notifiable
disease in all but eight. Despite international guidance, surveillance systems
were very varied. Even where rabies is a notifiable disease, many countries had
surveillance system judged to be ineffective, almost all of these being high and
moderate rabies risk countries in Africa and Asia. Overall, 41% of the population
covered by this survey (around 2.5 billion people) live in countries where there is
no or ineffective rabies surveillance. The lack of robust surveillance is hindering
rabies control efforts. However, whilst worldwide rabies surveillance would be
improved if rabies were notifiable in all countries, many other challenges to the
implementation of effective global human rabies surveillance systems remain.
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Canine rabies has been eliminated from industrialized countries, but infected dogs remain the pri... more Canine rabies has been eliminated from industrialized countries, but infected dogs remain the principal source of human infections in the developing world. Despite the availability of effective tools for prevention and post-exposure prophylaxis, canine rabies inflicts a heavy burden on the poorest people of Africa, Asia and Latin America, resulting in more than 60,000 deaths each year. Public-private partnerships offer a new approach to the challenge of eliminating canine rabies in the developing world, by bringing together stakeholders to share responsibilities and reduce costs. The leading partnership for rabies control, the Partners for Rabies Prevention, is an informal international group that includes representatives of major health organizations (WHO, PAHO, FAO, OIE), the European Commission, universities, nongovernmental organizations, the human and animal health industries, and private global health institutions. This article describes how the Partners for Rabies Prevention is working toward the global elimination of canine rabies. It forms part of a symposium in Antiviral Research on the elimination of canine rabies.Copyright © 2013 Elsevier B.V. All rights reserved.
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Current topics in microbiology and immunology, 2007
An emerging pathogen has been defined as the causative agent of an infectious disease whose incid... more An emerging pathogen has been defined as the causative agent of an infectious disease whose incidence is increasing following its appearance in a new host population or whose incidence is increasing in an existing population as a result of long-term changes in its underlying epidemiology (Woolhouse and Dye 2001). Although we appear to be in a period where novel diseases are appearing and old diseases are spreading at an unprecedented rate, disease emergence per se is not a new phenomenon. It is almost certain that disease emergence is a routine event in the evolutionary ecology of pathogens, and part of a ubiquitous response of pathogen populations to shifting arrays of host species. While our knowledge of emerging diseases is, for the most part, limited to the time span of the human lineage, this history provides us with a modern reflection of these deeper evolutionary processes, and it is clear from this record that at many times throughout human history, demographic and behaviour...
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Emerging infectious …, Jan 1, 2002
Many infectious agents, especially those that cause emerging diseases, infect more than one host ... more Many infectious agents, especially those that cause emerging diseases, infect more than one host species. Managing reservoirs of multihost pathogens often plays a crucial role in effective disease control. However, reservoirs remain variously and loosely defined. We propose that reservoirs can only be understood with reference to defined target populations. Therefore, we define a reservoir as one or more epidemiologically connected populations or environments in which the pathogen can be permanently maintained and from which infection is transmitted to the defined target population. Existence of a reservoir is confirmed when infection within the target population cannot be sustained after all transmission between target and nontarget populations has been eliminated. When disease can be controlled solely by interventions within target populations, little knowledge of potentially complex reservoir infection dynamics is necessary for effective control. We discuss the practical value of different approaches that may be used to identify reservoirs in the field.
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Science, Jan 1, 2001
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… of the Royal …, Jan 1, 2001
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Experimental Parasitology, 2002
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Papers by Louise H Taylor
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.
lack of understanding of the scale of the problem, and the distribution of both
animal and human cases across countries, regions and continents. Unfortunately,
despite the severity of the disease, accurate data on which to assess these questions
and to prioritize and direct public health interventions are not available for
many parts of the world. This survey sought to understand the current global situation
regarding the surveillance of human rabies. Data were collected from 91
countries across all continents and all categories of human rabies risk, generating
the most complete and representative global data set currently available. Respondents
were asked key questions about whether human rabies was a notifiable disease,
how the surveillance system for human rabies operated and whether the
respondent considered that the surveillance system was working effectively.
Across the 91 countries from which data were collated, human rabies was a notifiable
disease in all but eight. Despite international guidance, surveillance systems
were very varied. Even where rabies is a notifiable disease, many countries had
surveillance system judged to be ineffective, almost all of these being high and
moderate rabies risk countries in Africa and Asia. Overall, 41% of the population
covered by this survey (around 2.5 billion people) live in countries where there is
no or ineffective rabies surveillance. The lack of robust surveillance is hindering
rabies control efforts. However, whilst worldwide rabies surveillance would be
improved if rabies were notifiable in all countries, many other challenges to the
implementation of effective global human rabies surveillance systems remain.
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.
lack of understanding of the scale of the problem, and the distribution of both
animal and human cases across countries, regions and continents. Unfortunately,
despite the severity of the disease, accurate data on which to assess these questions
and to prioritize and direct public health interventions are not available for
many parts of the world. This survey sought to understand the current global situation
regarding the surveillance of human rabies. Data were collected from 91
countries across all continents and all categories of human rabies risk, generating
the most complete and representative global data set currently available. Respondents
were asked key questions about whether human rabies was a notifiable disease,
how the surveillance system for human rabies operated and whether the
respondent considered that the surveillance system was working effectively.
Across the 91 countries from which data were collated, human rabies was a notifiable
disease in all but eight. Despite international guidance, surveillance systems
were very varied. Even where rabies is a notifiable disease, many countries had
surveillance system judged to be ineffective, almost all of these being high and
moderate rabies risk countries in Africa and Asia. Overall, 41% of the population
covered by this survey (around 2.5 billion people) live in countries where there is
no or ineffective rabies surveillance. The lack of robust surveillance is hindering
rabies control efforts. However, whilst worldwide rabies surveillance would be
improved if rabies were notifiable in all countries, many other challenges to the
implementation of effective global human rabies surveillance systems remain.
Published in Front. Vet. Sci. and collected into this eBook.