Cost-benefit analysis of controlling rabies: placing economics at the heart of rabies control to focus political will

Rabies is an economically important zoonosis. This paper describes the extent of the economic impacts of the disease and some of the types of economic analyses used to understand those impacts, as well as the trade-offs between efforts to manage rabies and efforts to eliminate it. In many cases, the elimination of rabies proves more cost-effective over time than the continual administration of postexposure prophylaxis, animal testing and animal vaccination. Economic analyses are used to inform and drive policy decisions and focus political will, placing economics at the heart of rabies control.

The Economics of a Successful Raccoon Rabies Elimination Program on Long Island, New York

Raccoon rabies is endemic in the eastern U.S.; however, an epizootic had not been confirmed on Long Island, New York until 2004. An oral rabies vaccination (ORV) program was initiated soon after the first rabies-positive raccoon was discovered, and continued until raccoon rabies was eliminated from the vaccination zone. The cost-effectiveness and economic impact of this rabies control program were unknown. A public health surveillance data set was evaluated following the ORV program on Long Island, and is used here as a case study in the health economics of rabies prevention and control efforts. A benefit-cost analysis was performed to determine the cost-effectiveness of the program, and a regional economic model was used to estimate the macroeconomic impacts of raccoon rabies elimination to New York State. The cost of the program, approximately $2.6 million, was recovered within eight years by reducing costs associated with post-exposure prophylaxis (PEP) and veterinary diagnostic testing of rabies suspect animals. By 2019, the State of New York is projected to benefit from the ORV program by almost $27 million. The benefit-cost ratio will reach 1.71 in 2019, meaning that for every dollar spent on the program $1.71 will be saved. Regional economic modeling estimated employment growth of over 100 jobs and a Gross Domestic Product (GDP) increase of $9.2 million through 2019. This analysis suggests that baiting to eliminate rabies in a geographically constrained area can provide positive economic returns.

Raccoon rabies, a type of rabies found most frequently in raccoons, is common in the eastern U.S. Raccoon rabies is at times controlled through oral rabies vaccination (ORV) programs, in which baits containing rabies vaccine are distributed throughout the affected area to be consumed by wildlife, which then develop immunity limiting their ability to spread the disease in the population. A rabies outbreak was not detected in Nassau and Suffolk Counties on Long Island until 2004, when an ORV program was rapidly initiated in response to the discovery of a rabies-positive raccoon. As a result, raccoon rabies was eliminated in January 2009. Some questioned whether the benefits of the ORV program outweighed its costs. To find out, we performed a benefit-cost analysis of the program using avoided medical and animal testing costs to value the benefits. We also used a regional economic model to estimate the effect of the program on the economy of New York State. The results of both analyses indicated that the program had a positive economic impact, increasing employment and income in the region. The ORV program also benefited public health by reducing the need for medical treatment after possible rabies exposures. This study provides insight into the economic value of a program to eliminate rabies from an isolated area.

Defects in ex vivo and in vivo growth and sensitivity to osmotic stress of group A Streptococcus caused by interruption of response regulator gene vicR

The regulator VicR of the two-component regulatory system VicRK is essential in several Gram-positive bacteria. However, the authors were able to generate an unconditional vicR insertional mutant of group A Streptococcus. This mutant grew well in rich media but not in non-immune human blood and serum, had attenuated virulence, and was unstable in mice. Complementation of the mutant with vicR expressed in trans restored its phenotype to wild-type. A vicK deletion mutant had a phenotype similar to that of the vicR mutant. Phagocytosis and killing of the vicR mutant were normal, suggesting that VicRK does not regulate processes involved in evasion of host defence. Microarray analysis showed that vicR inactivation down-regulated the transcription of 13 genes, including putative cell wall hydrolase gene pcsB and spy1058-1060, which encode a putative phosphotransferase system enzyme II for carbohydrate transport, and upregulated the expression of five genes, including spy0183 and spy0184, which encode an osmoprotectant transporter OpuA. Consistent with microarray analysis, the vicR mutant took up more of the osmoprotectants betaine and proline and was sensitive to osmotic stress, indicating that vicR inactivation induced osmotic stress and increased susceptibility to osmotic pressure. Additionally, a spy1060 deletion mutant also displayed attenuated virulence. These results suggest that VicRK regulates processes involved in cell wall metabolism, nutrient uptake, and osmotic protection.