Human Rabies in China, 1960-2014: A Descriptive Epidemiological Study

Abstract

Background: Rabies in China remains a public health problem. In 2014, nearly one thousand rabies-related deaths were reported while rabies geographic distribution has expanded for the recent years. This report used surveillance data to describe the epidemiological characteristics of human rabies in China including determining high-risk areas and seasonality to support national rabies prevention and control activities.

Methods: We analyzed the incidence and distribution of human rabies cases in mainland China using notifiable surveillance data from 1960-2014, which includes a detailed analysis of the recent years from 2004 to 2014.

Results: From 1960 to 2014, 120,913 human rabies cases were reported in mainland China. The highest number was recorded in 1981(0.7/100,000; 7037 cases), and in 2007(0.3/100,000; 3300 cases). A clear seasonal pattern has been observed with a peak in August (11.0% of total cases), Human rabies cases were reported in all provinces with a yearly average of 2198 from 1960 to 2014 in China, while the east and south regions were more seriously affected compared with other regions. From2004 to 2014, although the number of cases decreased by 65.2% since 2004 from 2651 to 924 cases, reported areas has paradoxically expanded from 162 prefectures to 200 prefectures and from southern to the central and northern provinces of China. Farmers accounted most of the cases (65.0%); 50-59 age group accounted for the highest proportion (20.5%), and cases are predominantly males with a male-to-female ratio of 2.4:1 on average.

Conclusions: Despite the overall steady decline of cases since the peak in 2007, the occurrence of cases in new areas and the spread trend were obvious in China in recent years. Further investigations and efforts are warranted in the areas have high rabies incidence to control rabies by interrupting transmission from dogs to humans and in the dog population. Furthermore, elimination of rabies should be eventually the ultimate goal for China.

Fig 1. The incidence and number of human rabies cases reported in mainland China, 1960–2014 (N = 120,913).

Fig 2. Spatiotemporal distribution of human rabies by prefecture level in mainland China, from 2004 to 2014.

Fig 3. The variation of average cases in high risk prefectures from 2010 to 2014 compared with 2004 to 2009.

Note: The dark gray column means the average cases during 2010 to 2014 were increase than 2004 to 2009, the light gray column means cases were decrease than before.

Fig 4. The reported human rabies cases by month in mainland China.

(A) The reported human rabies cases by month in mainland China from 1960 to 2014. (B) The reported human rabies cases by month in mainland China from 2004 to 2014.

Fig 5. The proportion of gender and diagnosis of human rabies cases by age and year, 2004–2014.

(A) The number of male and female of human rabies cases by age. (B) The proportion of male and female of cases by age. (C) The proportion of occupation of cases by year of illness onset. Kids includes kindergarten children and diaspora children, student includes primary, secondary and college students. Others included teacher, laborers, self-employed and unemployed, workers, food industry personnel, retired and cadres of staff, etc. (D) The proportion of confirmed cases by year of illness onset.