Vaccination and Challenges of Rabies in China

Rabies is a major fatal zoonosis caused by the rabies virus, which infects wild animals, livestock, and humans. Its virus belongs to the lyssavirus genus, which also includes other lysaavirus species that cause rabies-like diseases and can be carried by domestic animals, wild carnivores and many bat species. The rabies virus is the only pathogen responsible for the large majority of rabies cases in humans. Rabies virus infects the peripheral nerves and then migrates into the central nervous system of the brain through the spinal cord, causing fatal encephalitis and myelitis and resulting the death of the infected subjects. Predominant rabies reservoirs are dogs in major vector of rabies throughout the world, particularly Asia, Latin American and Africa; foxes, in Europe, Arctic and North American; Raccoons in Eastern United States; skunks in Modwestern United States, Western Canada; coyotes in Asia, Africa and North America, mongooses in yellow mongoose in Asia and Africa, Indian mongoose in the Caribbean Islands, and bats in North American Europe, Center and South America. The genomic RNA of the classic rabies virus (RAVB) encodes five structural proteins: nucleoprotein (N), phosphoprotein (P), matrix protein (M), glycoprotein (G0, and large protein (L). The G protein is the only protein on the surface of mature virus and plays an essential role in virus infection. Also, the G protein is a major antigenic stimulus of the hose immune system during infection and vaccination. There are three categories of exposure, (I) touching, feeding of animals or licks on intact skin, (II) Minor scratches or abrasions without bleeding or licks on broken and nibbling of uncovered skin which needs immediate vaccination and administration of rabies immunoglobulin, (III) single or multiple transdermal bites, scratches or vaccine contamination of mucous membrane saliva which needs local wound treatment. Vaccination against rabies is of primary importance in control of infection in both animals and humans. WHO also recommended only vaccines of high quality and efficacy. Rabies is preventable through prompt administration of post-exposure prophylaxis (PEP) to exposed persons, but PEP access is limited in many rabies-endemic countries. The death toll can be significantly reduced through access to post-exposure prophylaxis (PEP), consisting of wound cleaning, rabies immunoglobulin (RIG) and vaccination. Access to PEP is limited in many developing and under-developed countries with endemic rabies and PEP is often only available from health facilities in mega cities. Patients also need to pay for PEP and the costs are reported as a major obstacle for many victims. Rabies have been reported in all over the China, especially Hunan, Guangdong, Sichuan, Guangxi, Guizhou, Hubei, Jiangxi, Shandong, Henan, Anhui, Jiangsu, Hebei, Fujian, Yunnan and Liaoning. In China, rabies remains is still a public health problem and the strategies to control and prevent human rabies should be included public education and awareness about rabies, pet vaccination programs, elimination of stray animals and enhanced postexposure management. Domestic dogs are the primary reservoir and vector of rabies transmission in China, although RAVB has been isolated and detected in other animal species, such as cat, ferret badger, fox, pig, cattle and donkey. Unsuccessful control of rabies and inadequate PEP of cases might be the main parameters leading to the serious human rabies epidemic in China. It is widely accepted that rabies elimination requires an integrated approach by animal and human related services. There is an urgent need to have public health management which may improve sustainability and effectiveness of rabies eliminating programs. China needs to focus on prevention, strengthen multi-agency coordination mechanism, increase the quality of public health services in the years to come.