Rabies has been a major public health concern in many parts of the world, including China, where it remains endemic. The majority of human rabies cases in China are caused by bites from dogs infected with the virus. Despite widespread vaccination campaigns and other control measures, the disease continues to pose a significant threat to both human and animal health. In an effort to assess progress towards dog-mediated rabies elimination in China, a scoping review was conducted. This article summarizes the findings of this review, highlighting the challenges and successes encountered in the ongoing battle against rabies.
China has made significant strides in its efforts to prevent and control human rabies in recent years. Since the establishment of a direct network reporting system for infectious disease epidemics and public health emergencies in 2004, the average information reporting time has been shortened from five days to just four hours. This has allowed for quicker and more effective responses to outbreaks of infectious diseases, including rabies.
In 2005, China established a National Rabies Surveillance System, which provided authoritative data on the incidence of rabies in China from 2004. The data showed that, excluding Macau, Hong Kong, and Taiwan, 31 provincial-level administrative divisions (PLADs) in the Chinese mainland have reported human rabies cases. Since 2007, when China reported its highest incidence of rabies in the 21st century, the incidence of rabies in humans has shown a downward trend, with the total number of rabies deaths nationwide falling to around 200 in 2020.
The incidence of rabies varies among PLADs, with some provinces still reporting critical levels of the disease while others, including Tibet, Qinghai, Xinjiang, Liaoning, Jilin, and Heilongjiang, have not reported any cases of human rabies in recent years. The population at high risk in China has shifted to the age group of 40–70 years old, which accounted for 69% of cases in 2020.
Farmers, students, and children are the groups most afflicted by rabies, accounting for 63%, 17%, and 8% of the total cases, respectively. Data for the period 2004–2018 show that individuals aged 0–10 and from 40 to 60 account for a high proportion of people infected with rabies. However, over the past five years, the number of human rabies cases shows that infection has mainly affected farmers, with the proportion of students and children decreasing to 8% and 5% respectively.
Rabies is nearly 100% preventable, and many rabies victims were not able to obtain post-exposure prophylaxis in time. China has made significant efforts to increase the accessibility and availability of rabies post-exposure disposal, and the awareness of the population about rabies has also increased. However, post-exposure prophylaxis vaccination rates vary greatly in different regions of China, reflecting regional differences in economic development, transportation infrastructure, per capita health resources, and knowledge of rabies.
To eliminate human rabies deaths, the most critical step is to achieve 70% immune coverage in dogs to interrupt transmission. However, this is problematic in China, where the high cost of dog vaccine, lack of awareness of dog vaccination, lack of professional veterinarians, and the large number of free-roaming dogs has resulted in the vaccination coverage rate of dogs that is lower than 70%. While the dog density in China peaked in 2008, it has since remained stable at around 7 dogs per 100 people. The dog immunization rate is observed to markedly fluctuate at different surveillance sites, but overall is around 30%.
In conclusion, while China has achieved significant progress in preventing and controlling human rabies in recent years, challenges remain. To eliminate human rabies deaths, China must achieve 70% immune coverage in dogs to interrupt transmission. This requires addressing key challenges, such as the high cost of dog vaccine, lack of awareness of dog vaccination, lack of professional veterinarians, and the large number of free-roaming dogs in China.
