One Health Strategies for Rabies Control in Rural Areas of China

In December, 2015, WHO proposed to eradicate rabies transmission from dogs to human beings by 2030 as described in a Comment by Dara Mohammadi.1Mohammadi D Moves to consign rabies to history.Lancet Infect Dis. 2016; 16: 1115-1116Summary Full Text Full Text PDF PubMed Google Scholar At present, about 59 000 people die of rabies every year worldwide, and the number of rabies cases in China is second only to India.2Feng Y Wang W Guo J et al.Disease outbreaks caused by steppe-type rabies viruses in China.Epidemiol Infect. 2015; 143: 1287-1291Crossref PubMed Scopus (18) Google Scholar, 3Zhou H Vong S Liu K et al.Human rabies in China, 1960–2014: a descriptive epidemiological study.PLoS Negl Trop Dis. 2016; 10: e0004874Google Scholar Although prevention and control methods have been effective in reducing the number of overall cases (figure; appendix pp 5–7), prevention of human cases is still a challenge, especially in rural areas, because rabies virus is a reemerging pathogen in China.4Ma C Hao X Deng H et al.Re-emerging of rabies in Shaanxi Province, China, 2009 to 2015.J Med Virol. 2017; (published online Jan 23.)https://doi.org/10.1002/jmv.24769Crossref Scopus (11) Google Scholar After analysing epidemiological characteristics of the human–animal rabies cases in China (appendix pp 3–7), we find that the highest incidence of human rabies was in 2007. Only 804 cases were reported in 2015, and only Tibet reported no human rabies cases (figure, appendix pp 6–7). Cases were mainly localised to rural areas in the southern and eastern provinces, and were rare in urban areas such as Beijing and Shanghai (figure, appendix pp 6–7), despite pet bites being a fairly common occurrence. Rabies has expanded geographically to the west and north since, with reemergence in areas that had not reported human cases previously. The immunisation of urban stray or pet dogs, pet owners as well as rural populations at high risk of exposure, and wild or domestic animals is crucial to rabies prevention and control. Accumulating evidence shows that rabies viruses can also be found in other wild animals and livestock, such as rats, foxes, sheep, pigs, deer, and ferret-badgers (appendix p 8).2Feng Y Wang W Guo J et al.Disease outbreaks caused by steppe-type rabies viruses in China.Epidemiol Infect. 2015; 143: 1287-1291Crossref PubMed Scopus (18) Google Scholar Furthermore, phylogenetic analysis shows that rabies viruses from wildlife and livestock are grouped within various clades (appendix p 3), and wildlife strains are mostly in the China IV clade.5Tao XY Guo ZY Li H et al.Rabies cases in the west of China have two distinct origins.PLoS Negl Trop Dis. 2015; 9: e0004140Crossref Scopus (19) Google Scholar Notably, the reemerging rabies virus found in stray dogs in Qinghai province belongs to the China IV clade, the same as that found in Tibet, and could be a consequence of spillover from wildlife (figure; appendix p 3).5Tao XY Guo ZY Li H et al.Rabies cases in the west of China have two distinct origins.PLoS Negl Trop Dis. 2015; 9: e0004140Crossref Scopus (19) Google Scholar The better transportation network and the increase of dog trade among Chinese provinces has contributed to the geographical spread of rabies.4Ma C Hao X Deng H et al.Re-emerging of rabies in Shaanxi Province, China, 2009 to 2015.J Med Virol. 2017; (published online Jan 23.)https://doi.org/10.1002/jmv.24769Crossref Scopus (11) Google Scholar In addition, this reemergence could be caused by transmission from wildlife to dogs.5Tao XY Guo ZY Li H et al.Rabies cases in the west of China have two distinct origins.PLoS Negl Trop Dis. 2015; 9: e0004140Crossref Scopus (19) Google Scholar Moreover, subtypes from other Asian countries were identified in Chinese wildlife.6Liu Y Zhang HP Zhang SF et al.Rabies outbreaks and vaccination in domestic camels and cattle in northwest China.PLoS Negl Trop Dis. 2016; 10: e0004890Google Scholar In the nucleoprotein (N) gene phylogenetic tree, wildlife rabies viruses in China are distributed in three lineage clades: Asian, Arctic, and Cosmopolitan (appendix p 4). Of note, the rabies virus isolated from domestic and wild animals matches closely the strains identified in neighbouring countries (appendix p 4), indicating the possibility of transmission of the virus between China and other countries through transborder passage of wild animals. There is a need to pay attention to rabies spread across borders (figure), and immunisation of wild animals and livestock might be the next challenge for China. Epidemiological surveys and phylogenetic analyses show that there are two levels of rabies control in China. The first level, the control of human rabies, is straightforward to implement. Strengthening of rabies prevention and vaccination in rural areas will be essential through the government, news organisations, and medical institutions. Public awareness of rabies in high-risk populations living in rural areas also needs to be improved. The second level is to eliminate rabies in wild animals and stray dogs, which will be important to address the reemergence of rabies in areas that were previously declared rabies free. More research on immunisation strategies and surveillance of rabies from wild animals and stray dogs is needed. Studies showed that domestic animals can be infected with rabies virus after being bitten by wild, infected animals.6Liu Y Zhang HP Zhang SF et al.Rabies outbreaks and vaccination in domestic camels and cattle in northwest China.PLoS Negl Trop Dis. 2016; 10: e0004890Google Scholar, 7Wang L Tang Q Liang G Rabies and rabies virus in wildlife in mainland China, 1990–2013.Int J Infect Dis. 2014; 25: 122-129Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar Therefore, strengthening the surveillance of wild animals and livestock and establishing a detailed monitoring network in wild and domestic animals in rural China is needed. A novel strategy for combating rabies in China is the interdisciplinary One Health collaborative. The American Veterinary Association defines One Health as “the collaborative effort of multiple disciplines—working locally, nationally, and globally—to attain optimal health for people, animals and the environment”.8American Veterinary Medical FoundationOne Health—what is One Health?.https://www.avma.org/KB/Resources/Reference/Pages/One-Health94.aspxGoogle Scholar Although the Chinese Government is doing its best to eliminate rabies, the immunisation rates of human beings as well as wild and domestic animals at high risk of exposure, and surveillance in rural areas can still be improved. Promoting the development of immunological products for use in wild and domestic animals, as well as vaccines, is necessary.6Liu Y Zhang HP Zhang SF et al.Rabies outbreaks and vaccination in domestic camels and cattle in northwest China.PLoS Negl Trop Dis. 2016; 10: e0004890Google Scholar Wildlife biologists, ecologists, and doctors in human and veterinary medicine need to partner with the government to implement vaccination and surveillance efforts, using the concept of One Health to promote exchange across disciplines, share data, and coordinate anti-rabies efforts. For the The Public Health Sciences Data Center see http://www.phsciencedata.cn/Share/en/index.jsp For the The Public Health Sciences Data Center see http://www.phsciencedata.cn/Share/en/index.jsp This work was financially supported by the National Key Research and Development Program of China (2016YFD0500402 and 2016YFC1201604); the Fundamental Research Funds for the Central Universities Y0201600147 and the Priority Academic Program Development of Jiangsu Higher Education Institutions. We are very grateful to Gary Wong (Institute of Microbiology, Chinese Academy of Sciences) for critical contributions in the correction of this letter. We declare no competing interests. Download .pdf (1.15 MB) Help with pdf files Supplementary appendix Moves to consign rabies to historyProgress towards the elimination of rabies in human beings has been slow, but there is hope on the horizon. Dara Mohammadi reports. Full-Text PDF