Epidemiological investigations of human rabies in China.

BACKGROUND: The epidemic of rabies showed a rising trend in China in recent years. To identify the potential factors involved in the emergence, we investigated and analyzed the status and characteristics of human rabies between 1996 and 2008. Moreover, the status of rabies infection and vaccination in dogs, and prophylaxis of humans after rabies exposure were analyzed. METHODS: Human rabies data in China between 1996 and 2008 collected from the annual reports of Chinese Center for Disease Control and Prevention (China CDC) were analyzed. To investigate the status of dogs and postexposure prophylaxis (PEP) of humans, brain specimens of domestic dogs were collected and detected, and the demographic details, exposure status and PEP of rabies patients were obtained in 2005 and 2006 in Guangxi, Hunan and Guizhou provinces. RESULTS: The results showed 19,806 human rabies cases were reported in China from 1996 to 2008, with an average of 1,524 cases each year, and the incidence almost was rising rapidly, with the peak in 2007 (3,300 cases). It was notable that nearly 50% of the total rabies cases nationwide were reported in Guangxi, Hunan and Guizhou provinces. In these three provinces, the rabies infection rate in dogs was 2.3%, and 60% investigated cities had a dog vaccination rate of below 70%; among the 315 recorded human cases, 66.3% did not receive any PEP at all, 27.6% received inadequate PEP, and only 6.0% received a full regime of PEP. CONCLUSIONS: In recent years, rabies is reemerging and becoming a major public-health problem in China. Our analysis showed that unsuccessful control of dog rabies and inadequate PEP of patients were the main factors leading to the high incidence of human rabies in China, then there are following suggestions: (1) Strict control of free-ranging dogs and mandatory rabies vaccination should be enforced. (2)Establishing national animal rabies surveillance network is imperative. (3) PEP should be decided to initiate or withhold according to postmortem diagnosis of the biting animal. (4) The cost of PEP should be decreased or free, especially in rural areas. (5)Education of the public and health care staff should be enhanced.

[Analysis on the epidemiologic characteristics of human rabies in all the 31 provinces in China, from 1991 to 2005].

OBJECTIVE: To study the epidemic intensity and trend of human rabies from 1991 to 2005 among 31 provinces, metropoli and municipalities in China so as to increase the awareness of the disease. METHODS: Contrastive analyses were performed and the annual publishing data by the Chinese Center for Disease Control and Prevention were used. RESULTS: The total number of reported cases was 14 942 from 1991 to 2005 with an annual average mortality rate as 0.080/100000. The increase of five-years mortality ratio on relative ratio with circular base of mortality rate were--66.24% (1996-2000 to 1991-1995) and 506.13% (2001-2005 to 1996-2000). When comparing incidence rates between 2000-2005 and 1991-1995, the relative ratio with fixed base increase became 104.62%. CONCLUSION: Among the 31 provinces, metropolis and municipalities, 27 had reported human rabies cases. The enzootic areas mainly distributed in the drainage area along the Yangtze River. The incidence rates of Guangxi, Hunan, Guizhou, Jiangxi and Guangdong were the highest.

[Analysis on the factors related to rabies epidemic in China, in 2005].

OBJECTIVE: To analyse the related epidemic factors of rabies and to provide basic evidence for developing rabies control and prevention programs in China. METHODS: Possible factors that causing rabies epidemics in the southern part of China were obtained through collecting both epidemic and surveillance data of rabies in 2005, and to analyse every factor by software of Excel 2002. RESULTS: The number of rabies cases was 2548 in 2005. Among 885 cases being investigated, 60.56%, 49.04%, 96.16% had not had any chance to receive treatment, vaccine or immunoglobulin. Among the exposed persons, 89.95% received treatment on wounds and 94.93% were immunized, and 8.56% received immunoglobulin. 94.86% of them accomplished the full rabies post-exposure prophylaxis course, but 8.56% of them did not accomplish it. 88.50% of the cases and 92% of the persons under exposure were bitten by dogs. The density of dogs was 3.20-13.37 per 100 persons. The vaccination coverage rates among dogs were 5.31% -75.11% with a positive rate of 2.93 % -6.40%. CONCLUSION: Factors as: low rate of post-exposure prophylaxis and failed to have finished the necessary post-exposure treatment (PET) of the cases, nonstandard PET in hospital or local clinic, low rabies vaccination coverage and high infectivity of rabies virus in animal host (mainly for dog) might be responsible for rabies epidemics in China, in 2005.

[Analysis on the epidemiology of rabies in Hunan province in the past 10 years].

OBJECTIVE: To explore the possible factors causing the increase of rabies cases and to provide references for the development of related prevention and control strategy in Hunan. METHODS: Data was collected and analyzed on epidemic situation of rabies in the past ten years, and studies were carried in some counties. RESULTS: From 1994 to 1999, the annual cases sustained between 17 and 78. However, the number of cases has continued to increase since 2000. The annual reported cases in 2001 and 2002 were 311 and 313, and accounted for 34.8% and 30.0% of the total cases in the whole country respectively. The epidemic areas were mainly located in the south and middle parts of Hunan. Furthermore, the epidemic areas had been expanding. In 1997, human rabies cases were only reported in 7 cities but increased to 12 cities in 2004. CONCLUSION: Factors as increasing number but low inoculating rate to dogs, and incorrect treatment on the wounds etc. might have served important roles for the recurrence of rabies. Hence, it is necessary to take comprehensive preventive measures to control and prevent the epidemics of rabies in Hunan.