Human Rabies in China

To the Editor: Rabies has occurred in China for >2,000 years and was first described in ≈556 BC (1). Since 1950, human rabies has been a class II noti-fiable disease in China, and the annual number and distribution of human rabies cases have been archived. We examined the archived data from 1950 to 2004 and analyzed epidemiologic characteristics. During the 55-year period, 108,412 human rabies cases were recorded in China. The Figure shows the number of annual cases from 1950 to 2004; 3 major epidemics of human rabies in China are apparent. In the early 1950s, only a few cases occurred; the first peak occurred from 1956 to 1957 with ≈2,000 cases each year. Then the number of cases declined during subsequent years and was relatively constant throughout the 1960s. By 1969, the number of cases increased again to ≈2,000. This ascending phase continued throughout the 1970s and 1980s. The second epidemic peaked in the early 1980s. In 1981, 7,037 cases were recorded, the largest number of cases in a single year during the 55-year period. During the 1980s, 55,367 cases were reported (>5,000 cases annually), representing >50% of the 108,412 cases seen during the entire period. In the early 1990s, the number of human cases decreased dramatically from 3,520 in 1990 to 159 in 1996. However, this downward trend reversed its course in 1998, and annual cases have increased gradually since then. In 2004, a total of 2,651 cases were reported , an increase of >16 fold when compared with the numbers in 1996. This third rabies epidemic apparently has not yet peaked. The compiled data also showed substantially more rabies cases in the summer and autumn than in the spring and winter. Similar seasonality was reported in animals (2), indicating the pattern of transmission from animals to humans. Rabies patients range in age from infancy to >65 years of age. The ratio of male to female victims is 68 to 32. Although human rabies has been reported in almost all provinces, 15 provinces have had >1,000 cumulative cases each. These 15 provinces account for >93% of the total cases. Four provinces (Hunan, Guangdong, Sichuan, and Guangxi) have had >7,000 cumulative cases each. Most of the human patients were infected with rabies by dog bites. The number of dogs has increased gradually in China since the late 1970s. Now ≈70% of households in Guangxi, Guizhou, and Jiangsu, and Hunan, …