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Rabies in Kazakhstan

機(jī)譯：哈薩克斯坦的狂犬病

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Background Rabies is a neglected zoonotic disease. There is a sparsity of data on this disease with regard to the incidence of human and animal disease in many low and middle income countries. Furthermore, rabies results in a large economic impact and a high human burden of disease. Kazakhstan is a large landlocked middle income country that gained independence from the Soviet Union in 1991 and is endemic for rabies. Methodology/Principal Findings We used detailed public health and veterinary surveillance data from 2003 to 2015 to map where livestock rabies is occurring. We also estimate the economic impact and human burden of rabies. Livestock and canine rabies occurred over most of Kazakhstan, but there were regional variations in disease distribution. There were a mean of 7.1 officially recorded human fatalities due to rabies per year resulting in approximately 457 Disability Adjusted Life Years (DALYs). A mean of 64,289 individuals per annum underwent post exposure prophylaxis (PEP) which may have resulted in an additional 1140 DALYs annually. PEP is preventing at least 118 cases of human rabies each year or possibly as many as 1184 at an estimated cost of USD 1193 or USD 119 per DALY averted respectively. The estimated economic impact of rabies in Kazakhstan is USD 20.9 million per annum, with nearly half of this cost being attributed to the cost of PEP and the loss of income whilst being treated. A further USD 5.4 million per annum was estimated to be the life time loss of income for fatal cases. Animal vaccination programmes and animal control programmes also contributed substantially to the economic losses. The direct costs due to rabies fatalities of agricultural animals was relatively low. Conclusions/Significance This study demonstrates that in Kazakhstan there is a substantial economic cost and health impact of rabies. These costs could be reduced by modifying the vaccination programme that is now practised. The study also fills some data gaps on the epidemiology and economic effects of rabies in respect to Kazakhstan.
機(jī)譯：背景狂犬病是一種被忽視的人畜共患病。在許多中低收入國家，關(guān)于該疾病的人類和動(dòng)物疾病的發(fā)病率數(shù)據(jù)很少。此外，狂犬病導(dǎo)致巨大的經(jīng)濟(jì)影響和人類疾病的高負(fù)擔(dān)。哈薩克斯坦是一個(gè)內(nèi)陸的中等收入大國，于1991年脫離蘇聯(lián)獨(dú)立，是狂犬病的地方病。方法/主要發(fā)現(xiàn)我們使用了2003年至2015年的詳細(xì)公共衛(wèi)生和獸醫(yī)監(jiān)測(cè)數(shù)據(jù)來繪制家畜狂犬病的發(fā)生地點(diǎn)。我們還估計(jì)了狂犬病的經(jīng)濟(jì)影響和人類負(fù)擔(dān)。哈薩克斯坦大部分地區(qū)都有牲畜和犬狂犬病，但疾病分布存在區(qū)域差異。每年官方記錄的狂犬病造成的平均死亡人數(shù)為7.1，導(dǎo)致大約457殘疾調(diào)整生命年（DALYs）。每年平均有64,289個(gè)人接受暴露后預(yù)防（PEP），這可能每年導(dǎo)致另外1140個(gè)DALY。 PEP每年預(yù)防至少118例狂犬病，或預(yù)防多達(dá)1184例狂犬病，估計(jì)每避免一個(gè)DALY的成本分別為1193美元或119美元。哈薩克斯坦狂犬病的估計(jì)經(jīng)濟(jì)影響為每年2090萬美元，其中近一半的費(fèi)用歸因于PEP的費(fèi)用和在治療期間的收入損失。據(jù)估計(jì)，每年還有540萬美元是致命病例的終身收入損失。動(dòng)物疫苗接種計(jì)劃和動(dòng)物控制計(jì)劃也極大地造成了經(jīng)濟(jì)損失。農(nóng)作物狂犬病致死的直接成本相對(duì)較低。結(jié)論/意義這項(xiàng)研究表明，在哈薩克斯坦，狂犬病具有巨大的經(jīng)濟(jì)成本和健康影響。這些成本可以通過修改現(xiàn)已實(shí)施的疫苗接種計(jì)劃來降低。該研究還填補(bǔ)了狂犬病對(duì)哈薩克斯坦的流行病學(xué)和經(jīng)濟(jì)影響方面的一些數(shù)據(jù)空白。

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