Epidemiological characteristics and post-exposure prophylaxis of human rabies in Chongqing, China, 2007–2016

Abstract

BackgroundAccording to the global framework of eliminating human rabies, China is responding to achieve the target of zero human death from dog-mediated rabies by 2030. Chongqing is the largest municipality directly under central government in China. We described the epidemiological characteristics and post-exposure prophylaxis (PEP) of human rabies in this area, in order to provide a reliable epidemiology basis for further control and prevention of human rabies.MethodsThe most updated epidemiological data for human rabies cases from 2007 to 2016 in Chongqing were collected from the National Disease Reporting Information System. A standardized questionnaire was applied to the human rabies cases or family members of cases as proxy to investigate the PEP situation.ResultsA total of 809 fatal human rabies cases were reported in Chongqing from 2007 to 2016. There was a trend of gradual annual decline about number of cases from 2007 to 2013, followed by stable levels until 2016. Rabies was mostly reported in summer and autumn; a majority of cases were noted in farmers (71.8%), especially in males (65.3%). The cases aged 35–74 and 5–14 years old accounted for 83.8% of all the cases. We collected information of 548 human rabies cases’ rabies exposure and PEP situation. Of those, 95.8% of human rabies cases were victims of dog bites or scratch, and 53.3% of these dogs were identified as stray dogs. Only 4.0% of the domestic dogs were reported to have been vaccinated previously. After exposure, 87.8% of the 548 human rabies cases did not seek any medical services. Further investigation showed that none of the 548 cases received timely and properly standardized PEP.ConclusionHuman rabies remains a major public health problem in Chongqing, China. Dogs are the main reservoir and source of human rabies infection. Unsuccessful control of canine rabies and inadequate PEP of cases might be the main factors leading to the serious human rabies epidemic in this area. An integrated “One Health” approach should be encouraged and strengthened in this area; with combined effort it would be possible to achieve the elimination of human rabies in the expected date.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2830-x) contains supplementary material, which is available to authorized users.

Trends and clinico-epidemiological features of human rabies cases in Bangladesh 2006–2018

“…We found a difference in incubation times, depending on the sites of exposure. Similar findings have also documented in another study where the incubation period was shorter in cases with exposure sites on the head and neck than in cases with a wound on the trunk, upper or lower limbs 37 . The incubation period depends on a number of factors including the site and type of bite wound(s), virus inoculum and rapid treatment of wounds, viral strains, and host factors 9,38,39 .…”

Human death from suspected rabid dog bite in Zamfara State, Nigeria

“…The incubation period observed in this case is consistent with 1-3 months previously stated by the World Health Organization, and also coincides with the results of other studies (World Health Organization, 2013;Wallace et al, 2016;Ahmad et al, 2017;Qi et al, 2018;Tran et al, 2018). Preceding reports have indicated a shorter incubation period in cases with category III exposure site on the upper limb (Wallace et al, 2016;Qi et al, 2018). Bite on the hands has been considered as one of the factors leading to a shorter eclipse period in rabies exposure, due to the decreased length to travel by the viral inoculum to reach the central nervous system and greater number of neurons (Singh et al, 2017).…”

“…After the victim was bitten, it took almost two months before the onset of clinical signs while death ensued within 10 days following the noticeable symptoms. The incubation period observed in this case is consistent with 1-3 months previously stated by the World Health Organization, and also coincides with the results of other studies (World Health Organization, 2013;Wallace et al, 2016;Ahmad et al, 2017;Qi et al, 2018;Tran et al, 2018). Preceding reports have indicated a shorter incubation period in cases with category III exposure site on the upper limb (Wallace et al, 2016;Qi et al, 2018).…”

“…This incident occurred in a rural area at the peak of the farming season, during which outdoor activities of the farmers increased, leading to an enhanced chance of contact with the stray dog and potential exposure to rabies. Previous studies support this view, which showed that most human rabies-related deaths are being recorded from rural communities (Wallace et al, 2016;Tarantola et al, 2017;Qi et al, 2018;Tran et al, 2018). However, access to highly effective intervention such as timely PEP, has been considered challenging especially in rabies-endemic developing countries, where most exposures occur in rural areas (Tarantola et al, 2017).…”

Rabies in Asian Countries: Where we are stand?

“…In Asia, India is the leading county accounts for the most human rabies deaths (59.9%) and globally (35%) 2 . After India, China is another country that experience most serious impact from rabies, among the list of 39 notifiable infectious diseases in the country, deaths due to rabies ranked third 3 . However, after a huge economic investment rabies is still a significant major health problem in Asian and African countries.…”