Rabies in China: A looming threat to national public health
Rabies is a preventable viral disease that infects domestic and wild animals and is transmissible to humans. If the virus reaches the central nervous system it is fatal to humans and domestic animals. However, most human rabies deaths can be prevented through vaccination of domestic animals, dog population control, and timely treatment of persons bitten by animals. Based on the 2005 World Health Organization (WHO) estimates, the continent with the greatest number of rabies deaths is Asia. Although numerous wildlife species can be natural reservoirs of rabies virus, the single most important animal reservoir of rabies is the domestic dog. The WHO estimates that rabies causes the deaths of over 55,000 persons every year, and this is known to be a conservative estimate. Most countries do not have the capacity for laboratory confirmation of rabies cases, and most suspected rabies victims do not die in hospital, so rabies is underreported.
In recent years, China has reported the second highest rates of illness and death from human rabies worldwide. For example, from 1950 to 2004, more than 103,000 persons died of rabies throughout the country in four reported epidemic waves that occurred from 1956 to 1983. After 1990, the number of reported human rabies cases declined annually, largely as a result of increased public awareness of risks. In 2008, an open-access article in BMC Infectious Diseases reported surveillance data from the Ministry of Health of China with 22,527 human rabies cases from January 1990 to July 2007. Chinese researchers found that human rabies was under control from 1990 to 1996, when only 159 cases of rabies were reported, but this figure jumped to 3,280 cases in 2006. Most of the patients were children or teenagers, and most contracted the disease after being bitten by a dog. Rabies cases were most frequently encountered in the south-western and southern provinces of China—those bordered by the Yangtze River—especially in highly populated areas.
It is important to note that the human-to-dog ratio in southern China is substantially greater than in northern China, and the potential risk for exposure to a rabid dog is therefore increased. From 1996 to 2002, rabies predominantly affected five southern provinces: Guangxi, Hunan, Jiangxi, Guangdong, and Jiangsu, with human deaths accounting for over seventy percent of the national total. Owned dogs do not have to be registered in rural areas of China. The number of dogs has been estimated at 100–200 million in the whole country. In rural areas, low vaccination coverage of dogs is widespread, largely because of poor awareness of rabies, and the difficulty of vaccine administration without adequate assistance from dog owners.
Rural dogs are not leashed and always have free movement in these regions, thereby increasing the risk of becoming exposed to rabid animals and transmitting the disease to humans. People injured by dog bites in rural areas often do not receive qualified and sufficient post-exposure prophylaxis as recommended by the WHO.
Vaccinating domestic dogs will substantially reduce the numbers of canine rabies and, most importantly, human rabies cases. For this to happen, government-funded registration and licensing of dogs should be made compulsory and enforced at city level. In Shanghai, for example, the government has recently introduced a one-dog per household policy. Overall, dog population management and the promotion of responsible dog ownership combined with vaccination and sterilization of owned dogs in rural and urban areas would have to be implemented, and regular vaccination of dogs continued. If the medical infrastructure in rural areas is strengthened by educating more healthcare and veterinary workers and improving the availability of safe and effective biological products, especially animal vaccines and human rabies post-exposure prophylaxis, China would be able to drastically reduce human rabies cases. Also, the current rabies programs could be improved by better supervision, improving interaction between authorities, increasing rabies awareness, and altering urban planning and development to balance the interaction between humans and animals.
In an attempt to assist the Chinese government in this endeavor, the Emergency Centre for Transboundary Animal Diseases (ECTAD) office of the UN Food and Agriculture Organization (FAO) representation in China, through the coordination of the United Nations Health Theme Group (sub-working group on diseases at the human-animal-ecosystem interface), has created a task force on rabies bringing together both animal and public health professionals and scientists to review the current policy and foster a multidisciplinary approach across agencies involved in rabies surveillance and control.
FAO supports the coordination and collaboration between animal and human health sectors (including wildlife and linking with NGOs and municipalities), addressing surveillance and disease reporting, dog-bite prevention (targeting children), bite protocols in hospitals and proper post-exposure prophylaxis, targeted public awareness, promotion of dog population/responsible dog ownership management, and stressing importance of vaccination of dogs. Lastly, it advocates for the presence of legislation regulating rabies vaccinations, and political commitment and funding for rabies prevention and control.
The rabies situation in China is consistent with what is known about rabies globally: rabies is a terrible, fatal yet entirely preventable disease that is widely underreported. The most important reservoir of rabies is the domestic dog, and through canine vaccination and controlling dog populations, China can dramatically reduce rabies exposure. The prompt and thorough treatment of persons possibly exposed to rabies virus will help to eliminate human rabies from China. This is the goal of the FAO as a partner in the United Nations Health Theme Group, working with the government of China.