Reemerging Rabies and Lack of Systemic Surveillance in People’s Republic of China

Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Emerging Infectious Diseases (Impact Factor: 6.75). 08/2009; 15(8):1159-64. DOI: 10.3201/eid1508.081426
Source: PubMed


Rabies is a reemerging disease in China. The high incidence of rabies leads to numerous concerns: a potential carrier-dog phenomenon, undocumented transmission of rabies virus from wildlife to dogs, counterfeit vaccines, vaccine mismatching, and seroconversion testing in patients after their completion of postexposure prophylaxis (PEP). These concerns are all scientifically arguable given a modern understanding of rabies. Rabies reemerges periodically in China because of high dog population density and low vaccination coverage in dogs. Mass vaccination campaigns rather than depopulation of dogs should be a long-term goal for rabies control. Seroconversion testing after vaccination is not necessary in either humans or animals. Human PEP should be initiated on the basis of diagnosis of biting animals. Reliable national systemic surveillance of rabies-related human deaths and of animal rabies prevalence is urgently needed. A laboratory diagnosis-based epidemiologic surveillance system can provide substantial information about disease transmission and effective prevention strategies.

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Available from: Xianfu Wu, Feb 09, 2015
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    • "All review articles [15,16,19,28-31] showed a dearth of knowledge about rabies in the general public and among health workers – particularly in rural areas. This was based on patchy data collected in limited areas. "
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    ABSTRACT: In China, rabies is a significant public health concern where dogs remain the main reservoir of disease transmission to humans; rabies-related mortality ranks second in the world. We compiled all published articles and official documents on rabies in mainland China to examine challenges and needs to eliminate rabies in the country. The Chinese authorities have identified rabies as a priority, recognized rabies control in dogs as key to control rabies in humans and required intersectoral collaborations. Efforts have been made to respond effectively to the latest re-emergence of rabies, which peaked in 2007 with >3,300 cases. Despite these outcomes and the increasing volume of publications and regulations in the recent years, our review points to some major information gaps to improve rabies control activities and envisage elimination program. An emphasis on laboratory or pathogen-associated and basic epidemiology research in the literature has contrasted with the absence of information to monitor various systems in humans and animals (e.g. quality of surveillance, response and post-exposure prophylaxis). Information is also lacking to appropriately inform policymakers (e.g. economic disease burden, impact of policies) and assist program managers (e.g. comprehensive and strategic guidance for cost-effective prevention and control activities, public education and dog population management). In conclusion, strategic planning is needed to provide a sense of direction, demonstrate feasibility of elimination in China, and develop a research agenda, addressing country’s operational needs and constraints. The planning should be a multisectoral effort.
    Infectious Diseases of Poverty 10/2013; 2(1):23. DOI:10.1186/2049-9957-2-23 · 4.11 Impact Factor
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    • "Understanding the spatial distribution of rabies in animals or humans and its transmission dynamics are critical for forecasting its emergence and spread into new geographic regions, and help inform targeted interventions. Unfortunately, limited data are currently available about the burden of canine rabies in China given the poor surveillance of animal rabies in the country [12], [13]. As human rabies is a dead end infection, reported human rabies cases are a useful indicator for public health authorities to plan and implement strategies for the control of human rabies transmitted by dogs such as, promote community awareness and knowledge of dog bite prevention, first aid and management of animal bites, PEP and responsible dog ownership [14]. "
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    ABSTRACT: Rabies is a significant public health problem in China in that it records the second highest case incidence globally. Surveillance data on canine rabies in China is lacking and human rabies notifications can be a useful indicator of areas where animal and human rabies control could be integrated. Previous spatial epidemiological studies lacked adequate spatial resolution to inform targeted rabies control decisions. We aimed to describe the spatiotemporal distribution of human rabies and model its geographical spread to provide an evidence base to inform future integrated rabies control strategies in China. We geo-referenced a total of 17,760 human rabies cases of China from 2005 to 2011. In our spatial analyses we used Gaussian kernel density analysis, average nearest neighbor distance, Spatial Temporal Density-Based Spatial Clustering of Applications with Noise and developed a model of rabies spatiotemporal spread. Human rabies cases increased from 2005 to 2007 and decreased during 2008 to 2011 companying change of the spatial distribution. The ANN distance among human rabies cases increased between 2005 and 2011, and the degree of clustering of human rabies cases decreased during that period. A total 480 clusters were detected by ST-DBSCAN, 89.4% clusters initiated before 2007. Most of clusters were mainly found in South of China. The number and duration of cluster decreased significantly after 2008. Areas with the highest density of human rabies cases varied spatially each year and in some areas remained with high outbreak density for several years. Though few places have recovered from human rabies, most of affected places are still suffering from the disease. Human rabies in mainland China is geographically clustered and its spatial extent changed during 2005 to 2011. The results provide a scientific basis for public health authorities in China to improve human rabies control and prevention program.
    PLoS ONE 08/2013; 8(8):e72352. DOI:10.1371/journal.pone.0072352 · 3.23 Impact Factor
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    • "Similar to the situation in many developing countries, rabies is a serious reemerging disease in China (Wu et al., 2009). Despite the high public health burden of more than 120,000 human deaths from rabies from 1950 to 2010, rabies is still neglected and not regarded as a priority in the disease control and prevention system in China (Hu et al., 2009). "
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    ABSTRACT: Rabies is a major public health problem in some developing countries including China. One of the reasons is that there is a very large number of dogs, both domestic and stray, especially in Guangdong Province which has the third most rabies cases (after Guangxi and Hunan) among the 31 provinces, autonomous regions and municipalities in Mainland China, and at least 18.2% of the human rabies cases are caused by stray dogs. In this paper, based on the reported data and characteristics of the rabies infection in Guangdong Province, we propose a mathematical model for the dog-human transmission of rabies. We first determine the basic reproduction number R₀ and discuss the stability of the disease-free equilibrium and persistence of the disease. By carrying out sensitivity analysis of the basic reproduction number in terms of some parameters, we find that the domestic dog vaccination rate, the recruitment rate of domestic dogs, and the quantity of stray dogs play important roles in the transmission of rabies. This study suggests that rabies control and prevention strategies should include public education and awareness about rabies, increase of the domestic dog vaccination rate and reduction of the stray dog population.
    Journal of Theoretical Biology 01/2012; 300:39-47. DOI:10.1016/j.jtbi.2012.01.006 · 2.12 Impact Factor
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