China sees spike in rabies cases

A new Chinese study has reported a dramatic spike in rabies infections. The research, published today in the open access journal BMC Infectious Diseases, shows that in some provinces of China the number of human rabies cases has jumped dramatically since the new millennium.

Jia-Hai Lu, from the School of Public Health at Sun Yat-Sen University, China, led a team of researchers who studied the rabies trend in China between 1990 and 2007. Lu describes how things have changed in the last eight years "In China, human rabies was largely under control during the years 1990-1996, via nation-wide rabies vaccination programmes. Since the end of the century, however, cases of human rabies have jumped high enough to trigger a warning sign for control and prevention".

Rabies, an infection of the nervous system, transmitted by animal bites, causes over 50,000 deaths each year around the world. During recent years, most of the research on control of rabies has concentrated on the development of post-exposure prophylaxis (preventative treatment – in this case, preventing the worsening of an infection). According to the researchers, "The use of human and equine rabies immunoglobulins (HRIG/ERIG) has saved the lives of countless patients who would have died if treated with vaccine alone. However, both products are often in short supply worldwide and are virtually unaffordable in developing countries".

Data from 22,527 human rabies cases from January 1990 to July 2007 were obtained from a surveillance database from the Ministry of Health of China. The authors found that human rabies was under control from 1990 to 1996, when only 159 cases of rabies were reported, but this figure had leapt to 3279 cases in 2006.

The authors found that rabies was most frequently encountered in the south-western and southern territories of China, especially in highly populated areas. Lu said "the four rabies-endemic provinces lacked strictly enforced measures to eliminate dog rabies or an ample supply of modern cell culture rabies vaccines for humans". Most of the patients were children or teenagers, and most contracted the disease after being bitten by a dog, usually on the head and neck. According to the authors, "In the worst-affected province, Guandong, 62.5% of patients did not receive proper treatment on their wounds, 92.5% did not receive adequate post-exposure vaccination and 91.25% did not receive any anti-rabies immunoglobulin".

The authors recommend that the current rabies control programme be improved by increasing supervision, improving the interaction between local and national authorities, increasing rabies awareness and altering urban planning and development to balance the interaction between humans and animals.

1. Rabies trend in China (1990-2007) and post-exposure prophylaxis in the Guangdong province
Han Si, Zhong-Min Guo, Yuan-Tao Hao, Yu-Ge Liu, Ding-Mei Zhang, Shao-Qi Rao and Jia-Hai Lu
BMC Infectious Diseases (in press)

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