{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T19:10:38Z","timestamp":1776280238184,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014168","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000}}],"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Rabies prevention in the United States (US) relies on a robust public health infrastructure that includes pet vaccination, post-exposure prophylaxis (PEP), and wildlife surveillance, costing $245\u2013$510 million annually but saving over $1 billion in avoided healthcare expenditures. While canine rabies has been eliminated from the US, wildlife reservoirs continue to pose a zoonotic threat, particularly bats, skunks, raccoons, and foxes. Oral rabies vaccination (ORV) programs targeting coyotes, foxes, and raccoons have demonstrated significant public health and economic benefits across multiple states, with benefit-cost ratios consistently above 1.0. In 2023, the Texas Oral Rabies Vaccination Program (TX-ORVP) reduced bait density within its ORV program\u2019s barrier maintenance zone (BMZ) to lower fixed costs. This study applies cost-effectiveness analysis (CEA) to assess whether these reductions remain economically viable under scenarios involving increased variable costs. Three scenarios were modeled: (1) enhanced surveillance without contingency actions, (2) rural incursions requiring contingency actions, and (3) comprehensive breaches involving surveillance, contingency actions, and increased PEP. Results indicate that surveillance costs could increase by up to 155% before negating savings, but any scenario requiring contingency actions renders the BMZ2023 cost-inefficient compared to pre-2023 practices. These findings underscore that while reduced bait density may appear cost-saving, heightened risk of rabies incursions can quickly erode economic sustainability. Sustained investment in wildlife rabies ORV programs is necessary for effective and efficient long-term rabies control and public health protection.<\/jats:p>","DOI":"10.1371\/journal.pntd.0014168","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:32:42Z","timestamp":1775064762000},"page":"e0014168","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost effectiveness of the Texas wildlife rabies Border Maintenance Zone"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9065-9017","authenticated-orcid":true,"given":"Stephanie","family":"Shwiff","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenn","family":"Swanson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Shwiff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Bodenchuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne","family":"Maki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"6","key":"pntd.0014168.ref001","doi-asserted-by":"crossref","first-page":"805","DOI":"10.2460\/javma.243.6.805","article-title":"Rabies surveillance in the United States during 2012","volume":"243","author":"JL Dyer","year":"2013","journal-title":"J Am Vet Med Assoc"},{"issue":"10","key":"pntd.0014168.ref002","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.2460\/javma.245.10.1111","article-title":"Rabies surveillance in the United States during 2013","volume":"245","author":"JL Dyer","year":"2014","journal-title":"J Am Vet Med Assoc"},{"issue":"7","key":"pntd.0014168.ref003","doi-asserted-by":"crossref","first-page":"777","DOI":"10.2460\/javma.248.7.777","article-title":"Rabies surveillance in the United States during 2014","volume":"248","author":"BP Monroe","year":"2016","journal-title":"J Am Vet Med Assoc"},{"issue":"10","key":"pntd.0014168.ref004","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.2460\/javma.250.10.1117","article-title":"Rabies surveillance in the United States during 2015","volume":"250","author":"MG Birhane","year":"2017","journal-title":"J Am Vet Med Assoc"},{"issue":"8","key":"pntd.0014168.ref005","doi-asserted-by":"crossref","first-page":"945","DOI":"10.2460\/javma.252.8.945","article-title":"Rabies surveillance in the United States during 2016","volume":"252","author":"X Ma","year":"2018","journal-title":"J Am Vet Med Assoc"},{"issue":"12","key":"pntd.0014168.ref006","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.2460\/javma.253.12.1555","article-title":"Rabies surveillance in the United States during 2017","volume":"253","author":"X Ma","year":"2018","journal-title":"J Am Vet Med Assoc"},{"issue":"2","key":"pntd.0014168.ref007","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2460\/javma.256.2.195","article-title":"Rabies surveillance in the United States during 2018","volume":"256","author":"X Ma","year":"2020","journal-title":"J Am Vet Med Assoc"},{"issue":"11","key":"pntd.0014168.ref008","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.2460\/javma.258.11.1205","article-title":"Rabies surveillance in the United States during 2019","volume":"258","author":"X Ma","year":"2021","journal-title":"J Am Vet Med Assoc"},{"issue":"10","key":"pntd.0014168.ref009","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.2460\/javma.22.03.0112","article-title":"Rabies surveillance in the United States during 2020","volume":"260","author":"X Ma","year":"2022","journal-title":"J Am Vet Med Assoc"},{"issue":"7","key":"pntd.0014168.ref010","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.2460\/javma.23.02.0081","article-title":"Rabies surveillance in the United States during 2021","volume":"261","author":"X Ma","year":"2023","journal-title":"J Am Vet Med Assoc"},{"issue":"11","key":"pntd.0014168.ref011","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.2460\/javma.24.05.0354","article-title":"Rabies surveillance in the United States during 2022","volume":"262","author":"X Ma","year":"2024","journal-title":"J Am Vet Med Assoc"},{"issue":"1","key":"pntd.0014168.ref012","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s44149-023-00078-8","article-title":"Rabies in a postpandemic world: resilient reservoirs, redoubtable riposte, recurrent roadblocks, and resolute recidivism","volume":"3","author":"CE Rupprecht","year":"2023","journal-title":"Anim Dis"},{"key":"pntd.0014168.ref013","author":"Centers for Disease Control and Prevention"},{"key":"pntd.0014168.ref014","author":"Centers for Disease Control and Prevention"},{"key":"pntd.0014168.ref015","author":"Centers for Disease Control and Prevention"},{"key":"pntd.0014168.ref016","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/S0264-410X(98)00446-0","article-title":"Epidemiology and control of fox rabies in Europe","volume":"17","author":"PP Pastoret","year":"1999","journal-title":"Vaccine"},{"issue":"1623","key":"pntd.0014168.ref017","doi-asserted-by":"crossref","first-page":"20120142","DOI":"10.1098\/rstb.2012.0142","article-title":"The elimination of fox rabies from Europe: determinants of success and lessons for the future","volume":"368","author":"CM Freuling","year":"2013","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"issue":"2","key":"pntd.0014168.ref018","doi-asserted-by":"crossref","first-page":"228","DOI":"10.7589\/0090-3558-34.2.228","article-title":"First North American field release of a vaccinia-rabies glycoprotein recombinant virus","volume":"34","author":"CA Hanlon","year":"1998","journal-title":"J Wildl Dis"},{"key":"pntd.0014168.ref019","volume-title":"Rabies biologicals: PEP administered by year 2021","author":"Texas Department of State Health Services"},{"issue":"1","key":"pntd.0014168.ref020","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13567-017-0459-9","article-title":"Oral vaccination of wildlife using a vaccinia-rabies-glycoprotein recombinant virus vaccine (RABORAL V-RG\u00ae): a global review","volume":"48","author":"J Maki","year":"2017","journal-title":"Vet Res"},{"key":"pntd.0014168.ref021","author":"United States Department of Agriculture"},{"issue":"12","key":"pntd.0014168.ref022","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.3201\/eid1412.080876","article-title":"Enzootic rabies elimination from dogs and reemergence in wild terrestrial carnivores, United States","volume":"14","author":"A Velasco-Villa","year":"2008","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"pntd.0014168.ref023","doi-asserted-by":"crossref","first-page":"149","DOI":"10.2460\/javma.24.08.0542","article-title":"Identification of raccoon rabies virus variant in a stray kitten: the role of veterinary practitioners in detection and reporting of a non-native zoonotic pathogen\u2014Nebraska, 2023","volume":"263","author":"A Carpenter","year":"2024","journal-title":"J Am Vet Med Assoc"},{"issue":"7","key":"pntd.0014168.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009461","article-title":"Rabies postexposure prophylaxis in the United States: opportunities to improve access, coordination, and delivery","volume":"15","author":"GT Howington","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014168.ref025","doi-asserted-by":"crossref","first-page":"536","DOI":"10.2460\/javma.1994.204.04.536","article-title":"Epizootic canine rabies transmitted by coyotes in south Texas","volume":"204","author":"KA Clark","year":"1994","journal-title":"J Am Vet Med Assoc"},{"key":"pntd.0014168.ref026","first-page":"17","article-title":"The Texas oral rabies vaccination project and the experimental use of Raboral V-RG rabies vaccine in the south Texas coyote rabies epizootic","volume":"17","author":"MG Fearneyhough","year":"1996","journal-title":"Proc Vertebr Pest Conf"},{"issue":"4","key":"pntd.0014168.ref027","doi-asserted-by":"crossref","first-page":"498","DOI":"10.2460\/javma.1998.212.04.498","article-title":"Results of an oral rabies vaccination program for coyotes","volume":"212","author":"MG Fearneyhough","year":"1998","journal-title":"J Am Vet Med Assoc"},{"issue":"5","key":"pntd.0014168.ref028","doi-asserted-by":"crossref","first-page":"785","DOI":"10.2460\/javma.2005.227.785","article-title":"Evaluation of oral rabies vaccination programs for control of rabies epizootics in coyotes and gray foxes: 1995-2003","volume":"227","author":"TJ Sidwa","year":"2005","journal-title":"J Am Vet Med Assoc"},{"issue":"3","key":"pntd.0014168.ref029","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0928-0197(97)10003-4","article-title":"Molecular epidemiology of rabies epizootics in Texas","volume":"8","author":"RE Rohde","year":"1997","journal-title":"Clin Diagn Virol"},{"issue":"11","key":"pntd.0014168.ref030","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.2460\/javma.233.11.1736","article-title":"Economic evaluation of an oral rabies vaccination program for control of a domestic dog-coyote rabies epizootic: 1995-2006","volume":"233","author":"SA Shwiff","year":"2008","journal-title":"J Am Vet Med Assoc"},{"issue":"4","key":"pntd.0014168.ref031","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.jhin.2014.11.020","article-title":"The impact of economic recession on infection prevention and control","volume":"89","author":"M O\u2019Riordan","year":"2015","journal-title":"J Hosp Infect"},{"issue":"15","key":"pntd.0014168.ref032","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1001\/jama.2011.1515","article-title":"Risk prediction models for hospital readmission: a systematic review","volume":"306","author":"D Kansagara","year":"2011","journal-title":"JAMA"},{"issue":"8","key":"pntd.0014168.ref033","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1086\/605630","article-title":"Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship","volume":"49","author":"RR Roberts","year":"2009","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pntd.0014168.ref034","first-page":"243","article-title":"Nosocomial infection and economic impact","volume":"21","author":"N Graves","year":"2008","journal-title":"Clin Microbiol Rev"},{"key":"pntd.0014168.ref035","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0000000000000576","article-title":"Health economic studies","volume":"39","author":"PD Angevine","year":"2014","journal-title":"Spine"},{"issue":"5","key":"pntd.0014168.ref036","doi-asserted-by":"crossref","DOI":"10.1126\/sciadv.abl4183","article-title":"The costs and benefits of primary prevention of zoonotic pandemics","volume":"8","author":"AS Bernstein","year":"2022","journal-title":"Sci Adv"},{"issue":"7","key":"pntd.0014168.ref037","doi-asserted-by":"crossref","first-page":"920","DOI":"10.2460\/javma.1992.200.07.920","article-title":"Rabies surveillance in the United States during 1990","volume":"200","author":"IJ Uhaa","year":"1992","journal-title":"J Am Vet Med Assoc"},{"issue":"1","key":"pntd.0014168.ref038","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2460\/javma.2002.220.27","article-title":"Cost of distributing oral raccoon-variant rabies vaccine in Ohio: 1997-2000","volume":"220","author":"P Foroutan","year":"2002","journal-title":"J Am Vet Med Assoc"},{"issue":"12","key":"pntd.0014168.ref039","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005062","article-title":"The economics of a successful raccoon rabies elimination program on Long Island, New York","volume":"10","author":"JL Elser","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014168.ref040","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/1471-2458-7-47","article-title":"Potential cost savings with terrestrial rabies control","volume":"7","author":"S Recuenco","year":"2007","journal-title":"BMC Public Health"},{"issue":"1","key":"pntd.0014168.ref041","doi-asserted-by":"crossref","first-page":"227","DOI":"10.7589\/0090-3558-45.1.227","article-title":"Benefit cost scenarios of potential oral rabies vaccination for skunks in California","volume":"45","author":"SA Shwiff","year":"2009","journal-title":"J Wildl Dis"},{"issue":"2","key":"pntd.0014168.ref042","first-page":"681","article-title":"Cost-benefit analysis of controlling rabies: placing economics at the heart of rabies control to focus political will","volume":"37","author":"SA Shwiff","year":"2018","journal-title":"Rev Sci Tech"},{"issue":"8","key":"pntd.0014168.ref043","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.3201\/eid1508.081061","article-title":"Tactics and economics of wildlife oral rabies vaccination, Canada and the United States","volume":"15","author":"RT Sterner","year":"2009","journal-title":"Emerg Infect Dis"},{"key":"pntd.0014168.ref044","first-page":"200","article-title":"Economic analysis of a large scale oral vaccination program to control raccoon rabies.","volume-title":"Human conflicts with wildlife: economic considerations","author":"P Kemere","year":"2000"},{"key":"pntd.0014168.ref045","doi-asserted-by":"crossref","DOI":"10.1016\/j.amepre.2015.11.007","article-title":"Strengthening cost-effectiveness analysis for public health policy","volume":"50","author":"LB Russell","year":"2016","journal-title":"Am J Prev Med"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0014168","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T18:08:42Z","timestamp":1776276522000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014168"}},"subtitle":[],"editor":[{"given":"Stuart Robert","family":"Ainsworth","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014168","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}