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Renewed rabies vigilance needed in China

25 Sep 2008

Paul Chinnock

Source: BMC Infectious Diseases (see original article)

Citation: Si H, Guo ZM, Hao YT, Liu YG, Zhang DM, Rao SQ, Lu JH (2008). Renewed rabies vigilance needed in China. BMC Infect Dis; 8:113.

Rabies is a major public-health problem in many developing countries. In China, however, the disease in humans was largely brought under control in the period 1990–1996, owing to nationwide rabies vaccination programmes. An extensive dog vaccination programme was also initiated. More recently, there have been reports of an increased number of cases. The situation was therefore examined in a study by Guo et al.

The authors analysed epidemiological data for 22527 human rabies cases from January 1990 to July 2007, retrieved from the surveillance database of reportable diseases managed by the Ministry of Health of China. To investigate the efficiency of the post-exposure (PEP) treatment of rabies, the details of 244 rabies patients, including their anti-rabies treatment of injuries or related incidents, were ascertained from one provincial jurisdiction.

The analysis found that incidence rates were below 0.05 per 100,000 people between 1994 and 2000, but there was then a large jump in the number of reported cases up to a new peak (with an incidence rate of 0.20 per 100,000) that was reached in 2004, and where the level has remained until present.

Analysis of the PEP in 244 cases found that 67.2% of patients did not seek medical services or did not receive any PEP. Further analysis of the 80 rabies patients who did receive any type of PEP indicated that almost all of them had not been given proper or timely treatment of their wounds, or post-exposure vaccination or rabies immunoglobulins.

In their conclusions, the study authors note that the issue of under-reporting of rabies in previous years may well be a factor in the apparent upwards trend of human rabies. Nevertheless, their further analysis suggests that failure to receive PEP is a major factor in the number of human cases in China.

The researchers say there is a need for greatly improved availability and timely application of high-quality anti-rabies biologicals, both vaccines and immunoglobulins, for the treatment of human bite victims. Controlling dog rabies through pet vaccination schemes may also play a huge role in reducing the rate of human exposure. Education of the public, health care staff and veterinarians will also help to change the current situation.

2008 Si et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Source

Title:
Rabies trend in China (1990-2007) and post-exposure prophylaxis in the Guangdong province.

Authors:
Si H, Guo ZM, Hao YT, Liu YG, Zhang DM, Rao SQ, Lu JH

References:
BMC Infect. Dis. 2008: Vol. 8, pp. 113

Abstract:
BACKGROUND: Rabies is a major public-health problem in developing countries such as China. Although the recent re-emergence of human rabies in China was noted in several epidemiological studies, little attention was paid to the reasons behind this phenomenon paralleling the findings of the previous reports. The purpose of this study is thus first to characterize the current trends of human rabies in China from 1990 to 2007, and then to define better recommendations for improving the post-exposure prophylaxis (PEP) schedules delivered to rabies patients. METHODS: The most updated epidemiological data for 22527 human rabies cases from January 1990 to July 2007, retrieved from the surveillance database of reportable diseases managed by the Ministry of Health of China, were analysed. To investigate the efficiency for the post-exposure treatment of rabies, the details of 244 rabies patients, including their anti-rabies treatment of injuries or related incidents, were ascertained in Guangdong provincial jurisdiction. The risk factors to which the patients were predisposed or the regimens given to 80 patients who received any type of PEP were analysed to identify the reasons for the PEP failures. RESULTS: The results from analysis of the large number of human rabies cases showed that rabies in China was largely under control during the period 1990-1996. However, there has been a large jump in the number of reported rabies cases since 2001 up to a new peak (with an incidence rate of 0.20 per 100000 people) that was reached in 2004, and where the level has remained until present. Then, we analysed the PEP in 244 rabies cases collected in the Guangdong province in 2003 and 2004, and found that 67.2% of the patients did not seek medical services or did not receive any PEP. Further analysis of PEP for the 80 rabies patients who received any type of PEP indicated that almost all of the patients did not receive proper or timely treatment on the wounds or post-exposure vaccination or rabies immunoglobulins. CONCLUSION: While the issue of under-reporting of rabies in previous years may well be a factor in the apparent upwards trend of human rabies in recent years, the analysis of PEP in the Guangdong province provides evidence that suggests that the failure to receive PEP was a major factor in the number of human cases in China. Thus, the data underline the need for greatly improved availability and timely application of high-quality anti-rabies biologicals, both vaccines and immunoglobulins, in the treatment of human bite victims. Controlling dog rabies through pet vaccination schemes may also play a huge role in reducing the rate of human exposure. Education of the public, health care staff and veterinarians will also help to change the current situation.

PMID: 18717989
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