Rabies

Key facts

  • Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) and is caused by a virus. The disease infects domestic and wild animals, and is spread to people through close contact with infected saliva via bites or scratches.
  • Rabies is a neglected disease of poor and vulnerable populations whose deaths are rarely reported. It occurs mainly in remote rural communities where measures to prevent dog-to-human transmission have not been implemented.
  • Rabies occurs in more than 150 countries and territories.
  • Dogs are the source of the vast majority of human rabies deaths.
  • Wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death.

The situation

  • Rabies is in the list of category B of notifiable diseases to be reported according to the Law of Communicable Diseases Prevention and Control of China.
  • China has the second highest number of reported rabies cases in the world, with over 2,000 deaths on average reported each year for the past 10 years.
  • Government awareness and commitment to controlling rabies are high.
  • According to Ministry of Health statistics in 2009, China administers 12-15 million rabies vaccine doses annually. This makes China the world's largest administer of rabies vaccine.
  • The Chinese authorities are forecasting national rabies elimination by 2025.

History of rabies in China

  • Rabies was highly endemic in almost all provinces of China until the end of the 1980s, with more than 5,200 human deaths reported annually during the period 1987-89.
  • Since then, the number of deaths has been drastically, reduced with about 3,500 deaths in 1990 and only 200 in 1995. This was followed by a decade of increased incidence, which peaked in 2007 with 3,300 deaths reported.
  • The incidence of rabies decreased to fewer than 2000 cases in 2011.
  • Currently most of the human rabies cases are reported in the southeastern part of China.
  • The animal species found to be at the origin of human exposure to rabies in China are mainly dogs, cats, pigs, cattle, ferrets and skunks.
  • Dog is the primary reservoir and transmitter of rabies in the country. Epidemiological investigations in Beijing showed that most of the rabies deaths occurred in persons exposed to rabies-suspected dogs (85-95%) and cats (5%).
  • Multisectoral cooperation is an important feature of rabies control in China. A notice on Strengthening Rabies Prevention and Control in 2003 was issued by four ministries – the Ministry of Health, Ministry of Agriculture, Ministry of Public Security and the State Food and Drug Administration.

Dog population

  • China's dog population has increased dramatically in recent years.
  • The Chinese Government has registered a total of 80 million dogs, 14 million of which live in urban areas.
  • National post-exposure prophylaxis (PEP) guidelines and legislations for dog registrations exist.

Rabies vaccines

  • China banned the nervous tissue vaccines (NTVs) in 1991.
  • The complete replacement of NTVs with cell culture vaccine was done by 2006, according to the Ministry of Health.
  • In 2008, investigations on vaccine coverage in 10 cities in Guangxi, Hunan, Guizhou showed that 4 cities (less than 70%) are below the average (93% vaccine coverage).

Rabies elimination

  • There is worldwide mounting evidence that it is possible to significantly decrease the incidence of rabies in humans. This has happened through implementation of strict control measures – for example, synchronized mass dog vaccination campaigns in Central and South America.
  • The mainstay of rabies elimination, where rabies is also driven by domestic dogs, is mass vaccination of the dog population.
  • Reaching the goal of 70% of vaccination of dogs interrupts rabies transmission in dogs and therefore eliminates rabies if absolute containment of any new introduction is maintained.

WHO’s response

  • WHO, the United Nations Food and Agriculture Organization (FAO) and partners in China propose to form a rabies technical and advisory board composed of independent national and international experts. The board’s aim will be to identify gaps, promote and make recommendations to the Government of China on best practices to eliminate rabies in the country.
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