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[BEIJING] Improved post-exposure treatment is urgently needed to control China's surging human rabies cases, a study reveals.

China has experienced a dramatic increase in the number of human deaths from rabies since the 1990s, according to the study published last week (21 August) in BMC Infectious Diseases. In 2006, 3,279 cases of human rabies were reported — compared to 159 in 1996.

Rabies, a viral infection of the nervous system transmitted by animal bites, kills around 50,000 globally each year. With a nearly 100 per cent death rate, the best prevention against human rabies is preventive treatment, termed post-exposure prophylaxis (PEP), which consists of wound cleaning, multiple vaccinations and injections of rabies antibodies after suffering a bite.

But Lu Jiahai of China's Sun Yat-Sen University and colleagues found that in the last four years, only about one-third of patients who died from rabies each year received vaccinations.

Their conclusions are based on analysis of human rabies data in China between 1990 and 2007 and a further analysis of 244 rabies cases in the Guangdong region between 2003 and 2004.

They discovered that of the 244 deaths, 67 per cent did not seek any medical treatment and of the 33 per cent who received PEP, only six received a full regime. These six patients also died, possibly because improper storage reduced the quality of the vaccine or the severity of the bites.

"According to the current WHO guidelines, none of the 244 cases reported received both adequate and sufficient post-exposure treatment," the researchers write.

Lack of awareness about rabies, the relatively high cost of vaccines, relaxed vaccination of dogs and a lack of coordination between the medical and veterinary sectors are also contributing to the high number of cases, Lu says.

In the early 1990s, national dog vaccination campaigns were able to dramatically reduce rabies cases, and Lu says that vaccinations of dogs and humans should be included in the voluntary national vaccination programmes.

He adds that investment in public education and training grassroots medical workers should be enhanced, and a specialised public body should be established to regulate animal-transmitted diseases in China.

Tang Qing, a rabies researcher at the Chinese Centre for Disease Control and Prevention, says her research has also revealed inadequate PEP.

"The Ministry of Health has paid attention to this problem and released a guideline, and our centre has drafted operation details to be distributed among hospital medical workers who are being trained in this measure," she told SciDev.Net.

Link to full paper in BMC Infectious Diseases


BMS Infectious Diseases doi 10.1186/1471-2334-8-113 (2008)