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Tian Di, a specialist at Beijing’s Ditan Hospital, vividly recalls losing a young patient to rabies last year.“When Lin Hao (pseudonym) walked into the hospital last September, it was raining heavily,” Tian said. “The only thing that really struck me was how tightly he had wrapped himself in a blanket. Once inside, after unwrapping himself, he seemed perfectly normal.”
However, Tian soon learned the reason Lin clung so tightly to his blanket: an extreme fear of water. After a short period of observation, Lin’s fear of water and light became evident and Tian knew at that point that his 20-year-old patient was suffering from rabies and would be dead within a matter of days.
“The diagnosis of rabies equals a death sentence, there is no cure and no one ever survives the disease,” said Chen Zhihai, head of the Infectious Disease Ward at Ditan Hospital.
He said that in the cases he had treated, early symptoms of rabies include anxiety, delirium and insomnia while later symptoms include drooling, fear of water, light and air. Respiratory failure was the usual cause of death.
“Once a diagnosis of rabies is made, our doctors cannot do anything besides using sedatives and ventilators. Therefore, it is not unusual for patients to be taken home to die in the company of their families. This is especially common for patients from areas out of Beijing,” Chen said.
As one of the most lethal zoonotic or animal-transmitted diseases in the world, rabies is nearly always fatal after its symptoms appear. The rabies virus infects domestic and wild animals and is spread to people through close contact with infected saliva via bites or scratches. Symptoms in humans may take from several days to more than a year to appear, although most people present signs of the disease within two to three months. The virus damages the central nervous system, which includes the brain and spinal cord. Dogs are the source of 99 percent of human rabies deaths.
According to the World Health Organization (WHO), more than 55,000 people die of rabies worldwide every year and more than 95 percent of human deaths occur in Asia and Africa.
In 2009, China’s Ministry of Health(MOH) announced that in recent years the total number of annual deaths from rabies reported in China averaged around 2,400 and only India reported more deaths from the disease.
The WHO says that rabies takes a disproportionate toll on the young, with 40 percent of the people bitten by rabid animals being under 15 years of age.
Heavily vaccinated people
In China, rabies victims are predominantly farmers, males and often under 15 years or above 50 years of age.
Yin Wenwu, an official at the Chinese Center for Disease Control and Prevention, said that farmers accounted for 90 percent of China’s rabies cases in 2010.
According to a MOH study released at the end of 2009, there was a clear increase in the prevalence of rabies across the country. The number of counties with human rabies cases surged from 120 in 1999 to 855 in 2008. The study attributed the deterioration in rabies control mainly to the increase in the population of domestic dogs and cats.
Since no tests are available to diagnose the presence of the rabies virus in humans before the onset of clinical disease, the only effective way to save the life of a person exposed to the disease is by treating the wound, injecting rabies immuno-globulin that provides fast and effective protection, and administering the rabies vaccines.
However, not everyone who needs rabies vaccines is being inoculated, as the vaccines and rabies immuno-globulin are not covered
by medical insurance in most parts of China.
Hu Liangrong, a veterinary expert from the Academy of Military Medical Sciences, said that during one of his field trips to the countryside in Chongqing Municipality, he saw a man refusing to be vaccinated, even after his wife had died from rabies, because he couldn’t afford the shots.
Even those who seek post-exposure vaccination often do not choose to receive rabies immuno-globulin shots and instead wait for the slow acting rabies vaccine to become effective. It is partially because the cost of immuno-globulin shots in China is prohibitive. For example, an adult weighing 60 kg would need an immuno-globulin shot costing 1,500 yuan ($234), five times more expensive than the rabies vaccines.
The Beijing News reported that only 10 percent of people with bleeding animal bites in China opt for the immuno-globulin injection.
Given the rising incidence of rabies, China has devoted a large amount of financial resources to the provision of anti-rabies vaccines.
According to statistics reported in the China Youth Daily, 15 million doses of human rabies vaccines are administered in China each year, accounting for 80 percent of total global consumption. The production and administration of human rabies vaccines cost the country more than 10 billion yuan($1.56 billion) each year.
Actually, not all the people vaccinated against rabies in China really need the shots, said Yan Jiaxin, an expert on rabies from the Wuhan Institute of Biological Products. He estimated that 99.8 percent of the people who receive rabies shots have actually been bitten by healthy animals and don’t need to be vaccinated.
The problem is how to identify the 0.2 percent of victims who really need immunization.
To prevent the overuse of the rabies vaccines, Yan suggested that offending animals should be confined and observed for signs of rabies for 10 days. In cases where the animal proves to be healthy the multiple-dose vaccination regimen should terminate. This method has been recommended by the WHO and adopted worldwide. However, its feasibility in China has been hampered by the lack of an effective canine rabies vaccination program.
Poorly vaccinated dogs
“Dogs that bite human beings and behave strangely are often culled immediately. How can you implement a 10-day observation period?” Yan was asked by a colleague at a symposium in late September. Even if the offending animal is not killed, there are currently no regulations in China governing the confinement and observation of potentially rabid animals.
“Moreover, a 10-day observation period is feasible in countries where 70 percent of dogs are vaccinated against rabies while China’s vaccination rates are much lower,”said Xiao Donglou, a disease control official from the MOH. Although animal vaccines are much cheaper than human vaccines and can eliminate the disease at its source, dogs in China are poorly vaccinated. Yan estimated that 20 percent of dogs in China had been inoculated.
According to the WHO, the most costeffective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Several Latin American countries have succeeded in dramatically reducing the number of human rabies cases by conducting extensive dog vaccination campaigns.
Disease control experts estimated that the cost of a vaccination campaign covering 70 percent of China’s dogs, whose population is estimated at 100 million, stands at between 500 million yuan ($78 million) and 700 million yuan ($109 million), far below the current total expenditure on administering human rabies vaccines.
However, a key factor in China’s unvaccinated dog population is the fact that the Ministry of Agriculture, which is responsible for vaccinating domestic animals, mainly focuses on farm animals such as cows and sheep. The MOH on the other hand focuses only on ensuring the adequate provision of the human rabies vaccines.
Xiao cautioned that vaccinating dogs in China may be more difficult than vaccinating humans as the country has a large population of stray and unconfined dogs.
“I don’t understand how some local governments have the resources to have all the dogs culled instead of vaccinated,” Yan said.
On September 27, the day before this year’s World Rabies Day, the MOH organized a symposium to solicit experts’opinions on a draft national plan for rabies control. According to the draft, by 2015 China intends to reduce its human rabies cases by half and to achieve this goal, a joint working committee consisting of 14 government departments will be established.
However, Tian soon learned the reason Lin clung so tightly to his blanket: an extreme fear of water. After a short period of observation, Lin’s fear of water and light became evident and Tian knew at that point that his 20-year-old patient was suffering from rabies and would be dead within a matter of days.
“The diagnosis of rabies equals a death sentence, there is no cure and no one ever survives the disease,” said Chen Zhihai, head of the Infectious Disease Ward at Ditan Hospital.
He said that in the cases he had treated, early symptoms of rabies include anxiety, delirium and insomnia while later symptoms include drooling, fear of water, light and air. Respiratory failure was the usual cause of death.
“Once a diagnosis of rabies is made, our doctors cannot do anything besides using sedatives and ventilators. Therefore, it is not unusual for patients to be taken home to die in the company of their families. This is especially common for patients from areas out of Beijing,” Chen said.
As one of the most lethal zoonotic or animal-transmitted diseases in the world, rabies is nearly always fatal after its symptoms appear. The rabies virus infects domestic and wild animals and is spread to people through close contact with infected saliva via bites or scratches. Symptoms in humans may take from several days to more than a year to appear, although most people present signs of the disease within two to three months. The virus damages the central nervous system, which includes the brain and spinal cord. Dogs are the source of 99 percent of human rabies deaths.
According to the World Health Organization (WHO), more than 55,000 people die of rabies worldwide every year and more than 95 percent of human deaths occur in Asia and Africa.
In 2009, China’s Ministry of Health(MOH) announced that in recent years the total number of annual deaths from rabies reported in China averaged around 2,400 and only India reported more deaths from the disease.
The WHO says that rabies takes a disproportionate toll on the young, with 40 percent of the people bitten by rabid animals being under 15 years of age.
Heavily vaccinated people
In China, rabies victims are predominantly farmers, males and often under 15 years or above 50 years of age.
Yin Wenwu, an official at the Chinese Center for Disease Control and Prevention, said that farmers accounted for 90 percent of China’s rabies cases in 2010.
According to a MOH study released at the end of 2009, there was a clear increase in the prevalence of rabies across the country. The number of counties with human rabies cases surged from 120 in 1999 to 855 in 2008. The study attributed the deterioration in rabies control mainly to the increase in the population of domestic dogs and cats.
Since no tests are available to diagnose the presence of the rabies virus in humans before the onset of clinical disease, the only effective way to save the life of a person exposed to the disease is by treating the wound, injecting rabies immuno-globulin that provides fast and effective protection, and administering the rabies vaccines.
However, not everyone who needs rabies vaccines is being inoculated, as the vaccines and rabies immuno-globulin are not covered
by medical insurance in most parts of China.
Hu Liangrong, a veterinary expert from the Academy of Military Medical Sciences, said that during one of his field trips to the countryside in Chongqing Municipality, he saw a man refusing to be vaccinated, even after his wife had died from rabies, because he couldn’t afford the shots.
Even those who seek post-exposure vaccination often do not choose to receive rabies immuno-globulin shots and instead wait for the slow acting rabies vaccine to become effective. It is partially because the cost of immuno-globulin shots in China is prohibitive. For example, an adult weighing 60 kg would need an immuno-globulin shot costing 1,500 yuan ($234), five times more expensive than the rabies vaccines.
The Beijing News reported that only 10 percent of people with bleeding animal bites in China opt for the immuno-globulin injection.
Given the rising incidence of rabies, China has devoted a large amount of financial resources to the provision of anti-rabies vaccines.
According to statistics reported in the China Youth Daily, 15 million doses of human rabies vaccines are administered in China each year, accounting for 80 percent of total global consumption. The production and administration of human rabies vaccines cost the country more than 10 billion yuan($1.56 billion) each year.
Actually, not all the people vaccinated against rabies in China really need the shots, said Yan Jiaxin, an expert on rabies from the Wuhan Institute of Biological Products. He estimated that 99.8 percent of the people who receive rabies shots have actually been bitten by healthy animals and don’t need to be vaccinated.
The problem is how to identify the 0.2 percent of victims who really need immunization.
To prevent the overuse of the rabies vaccines, Yan suggested that offending animals should be confined and observed for signs of rabies for 10 days. In cases where the animal proves to be healthy the multiple-dose vaccination regimen should terminate. This method has been recommended by the WHO and adopted worldwide. However, its feasibility in China has been hampered by the lack of an effective canine rabies vaccination program.
Poorly vaccinated dogs
“Dogs that bite human beings and behave strangely are often culled immediately. How can you implement a 10-day observation period?” Yan was asked by a colleague at a symposium in late September. Even if the offending animal is not killed, there are currently no regulations in China governing the confinement and observation of potentially rabid animals.
“Moreover, a 10-day observation period is feasible in countries where 70 percent of dogs are vaccinated against rabies while China’s vaccination rates are much lower,”said Xiao Donglou, a disease control official from the MOH. Although animal vaccines are much cheaper than human vaccines and can eliminate the disease at its source, dogs in China are poorly vaccinated. Yan estimated that 20 percent of dogs in China had been inoculated.
According to the WHO, the most costeffective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Several Latin American countries have succeeded in dramatically reducing the number of human rabies cases by conducting extensive dog vaccination campaigns.
Disease control experts estimated that the cost of a vaccination campaign covering 70 percent of China’s dogs, whose population is estimated at 100 million, stands at between 500 million yuan ($78 million) and 700 million yuan ($109 million), far below the current total expenditure on administering human rabies vaccines.
However, a key factor in China’s unvaccinated dog population is the fact that the Ministry of Agriculture, which is responsible for vaccinating domestic animals, mainly focuses on farm animals such as cows and sheep. The MOH on the other hand focuses only on ensuring the adequate provision of the human rabies vaccines.
Xiao cautioned that vaccinating dogs in China may be more difficult than vaccinating humans as the country has a large population of stray and unconfined dogs.
“I don’t understand how some local governments have the resources to have all the dogs culled instead of vaccinated,” Yan said.
On September 27, the day before this year’s World Rabies Day, the MOH organized a symposium to solicit experts’opinions on a draft national plan for rabies control. According to the draft, by 2015 China intends to reduce its human rabies cases by half and to achieve this goal, a joint working committee consisting of 14 government departments will be established.