Risk of rabies virus reintroduction on the cost-effectiveness of mass vaccination strategies in Flores Island, Indonesia

.....................................................................................................3 Table of contents...........................................................................................5 1.Introduction................................................................................................7 1.1 General background..............................................................................7 1.2 Rabies in Flores Island...........................................................................7 1.2 Main objective and research questions........................................................9 2. Rabies reviewed; current situation and lessons learned so far...................................11 2.1 Global rabies situation ........................................................................11 2.2 Summary on the rabies situation in Indonesia..............................................11 2.3 Rabies control and prevention strategies in Flores island.................................12 2.4 Socio-economic aspects of rabies control in Flores island................................12 2.5 Rabies Modelling in general...................................................................13 3. Materials and methods................................................................................15 3.1 The models considering a single virus introduction.......................................15 3.2 Stochastic models accounting for the risk of virus re-introduction.......................23 4. Results...................................................................................................25 4.1 Cost-effectiveness of vaccination strategies given a single virus introduction.........25 4.2 Cost-effectiveness of vaccination strategies accounted for virus reintroduction......36 4.2.1 The probability of reintroduction in once every year (P = 0.019) .................36 4.2.2 The probability of reintroduction in once every 3 years (P = 0.006) ..............42 5. Discussion..............................................................................................47 6. Conclusion.............................................................................................51 7. Acknowledgements....................................................................................53 8. References..............................................................................................55 9. Appendix................................................................................................59