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      Quantifying the burden of vampire bat rabies in Peruvian livestock

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          Abstract

          Background

          Knowledge of infectious disease burden is necessary to appropriately allocate resources for prevention and control. In Latin America, rabies is among the most important zoonoses for human health and agriculture, but the burden of disease attributed to its main reservoir, the common vampire bat ( Desmodus rotundus), remains uncertain.

          Methodology/Principal findings

          We used questionnaires to quantify under-reporting of livestock deaths across 40 agricultural communities with differing access to health resources and epidemiological histories of vampire bat rabies (VBR) in the regions of Apurimac, Ayacucho and Cusco in southern Peru. Farmers who believed VBR was absent from their communities were one third as likely to report livestock deaths from disease as those who believed VBR was present, and under-reporting increased with distance from reporting offices. Using generalized mixed-effect models that captured spatial autocorrelation in reporting, we project 4.6 (95% CI: 4.4–8.2) rabies cases per reported case and identify geographic areas with potentially greater VBR burden than indicated by official reports. Spatially-corrected models estimate 505–724 cattle deaths from VBR in our study area during 2014 (421–444 deaths/100,000 cattle), costing US$121,797–171,992. Cost benefit analysis favoured vaccinating all cattle over the current practice of partial vaccination or halting vaccination all together.

          Conclusions

          Our study represents the first estimate of the burden of VBR in Latin America to incorporate data on reporting rates. We confirm the long-suspected cost of VBR to small-scale farmers and show that vaccinating livestock is a cost-effective solution to mitigate the burden of VBR. More generally, results highlight that ignoring geographic variation in access to health resources can bias estimates of disease burden and risk.

          Author summary

          The number of cases and monetary cost of a disease guides how resources for prevention and control are allocated. In Latin America, rabies transmitted by vampire bats is one of the most recognized zoonoses affecting humans and livestock, but its burden on lives and livelihoods has been difficult to calculate because the percentage of outbreaks that are not reported to surveillance systems is unknown. Here, using surveys to calculate farmers’ tendencies to report livestock deaths, we estimate that over 500 cattle died of rabies in southern Peru in 2014, a loss of approximately US$170,000 or over 700 months of local income. Our results also show that the perceived risk of rabies strongly affected reporting of cattle mortality and vaccination coverage, suggesting that campaigns to increase awareness could reduce the burden of rabies.

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          Most cited references29

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          Traveling towards disease: transportation barriers to health care access.

          Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.
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            Adaptation: Statistics and a Null Model for Estimating Phylogenetic Effects

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              Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. The Infectious Intestinal Disease Study Executive.

              To establish the incidence and aetiology of infectious intestinal disease in the community and presenting to general practitioners. Comparison with incidence and aetiology of cases reaching national laboratory based surveillance. Population based community cohort incidence study, general practice based incidence studies, and case linkage to national laboratory surveillance. 70 general practices throughout England. 459 975 patients served by the practices. Community surveillance of 9776 randomly selected patients. Incidence of infectious intestinal disease in community and reported to general practice. 781 cases were identified in the community cohort, giving an incidence of 19.4/100 person years (95% confidence interval 18.1 to 20.8). 8770 cases presented to general practice (3.3/100 person years (2.94 to 3.75)). One case was reported to national surveillance for every 1.4 laboratory identifications, 6.2 stools sent for laboratory investigation, 23 cases presenting to general practice, and 136 community cases. The ratio of cases in the community to cases reaching national surveillance was lower for bacterial pathogens (salmonella 3.2:1, campylobacter 7.6:1) than for viruses (rotavirus 35:1, small round structured viruses 1562:1). There were many cases for which no organism was identified. Infectious intestinal disease occurs in 1 in 5 people each year, of whom 1 in 6 presents to a general practitioner. The proportion of cases not recorded by national laboratory surveillance is large and varies widely by microorganism. Ways of supplementing the national laboratory surveillance system for infectious intestinal diseases should be considered.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Methodology
                Role: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                21 December 2017
                December 2017
                : 11
                : 12
                Affiliations
                [1 ] Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Graham Kerr Building, Glasgow, Scotland, United Kingdom
                [2 ] Association for the Conservation and Development of Natural Resources, Lima, Peru
                [3 ] MRC-University of Glasgow Centre for Virus Research, Sir Henry Wellcome Building, Glasgow, Scotland, United Kingdom
                Wistar Institute, UNITED STATES
                Author notes

                The authors have declared that no competing interests exist.

                Article
                PNTD-D-17-01215
                10.1371/journal.pntd.0006105
                5739383
                29267276
                79d34ade-888d-48c1-8346-b1a7dd6c10a0
                © 2017 Benavides et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 4, Tables: 4, Pages: 17
                Product
                Funding
                Funded by: Sir Henry Dale Fellowship, jointly funded by the Wellcome Trust and Royal Society
                Award ID: 102507/Z/13/Z
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 095787/Z/11/Z
                Award Recipient :
                DS and JB were supported by a Sir Henry Dale Fellowship, jointly funded by the Wellcome Trust and Royal Society (Grant number: 102507/Z/13/Z). KH was supported by the Wellcome Trust (Grant number: 095787/Z/11/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Agriculture
                Livestock
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                Rabies
                Medicine and Health Sciences
                Infectious Diseases
                Viral Diseases
                Rabies
                Medicine and Health Sciences
                Infectious Diseases
                Zoonoses
                Rabies
                Biology and Life Sciences
                Veterinary Science
                Veterinary Diseases
                Medicine and Health Sciences
                Public and Occupational Health
                People and places
                Geographical locations
                South America
                Peru
                Biology and Life Sciences
                Agriculture
                Farms
                Social Sciences
                Economics
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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