In response to three deaths in April from rabies and 360 reported dog bites this year, local officials in Yunnan Province, China, ordered the extermination of all dogs regardless of rabies vaccination status, with the exception of military and police canines. Since the start of the campaign on 25 July 2005, a total of 54,429 dogs in Mouding County have been killed by clubbing, hanging, electrocution, or drugs, according to the Shanghai Daily. On Thursday, officials in Shandong Province announced that they soon will kill all dogs within five kilometers of the villages where sixteen people have died from rabies in 2006. The dog-culling programs do not violate Chinese law or international laws because those laws only protect endangered species. The cullings do defy the conclusion by the World Health Organization in June 2005 that dog destruction efforts are ineffective and that the elimination of rabies requires mass vaccination programs. To control the threat to human health by rabies, China is encouraged to pursue a vaccination campaign in accordance with international standards and guidelines and to seek the assistance of international agencies, such as the OIE and WHO, to develop a long-term, integrated strategy.
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|Source: Chinese Center for Disease Control and Prevention, 3 August 2006|
* no data available
** data reporting error suspected
(2004-2005) Chinese Center for Disease Control and Prevention, 3 August 2006
Tang X et al. Pivotal role of dogs in rabies transmission, China. Emerg Infect Dis. 2005 Dec.
Background Information on Rabies in China
With the economic boom in China, more people are breeding, owning, and raising dogs as companion pets. This trend, termed a “pet craze” by the Chinese media, has been accompanied by a statistical increase in the incidences of rabies infections and deaths over the past decade. According to the Chinese Center for Disease Control and Prevention, more than 2,500 people died from rabies in 2005, up from fewer than 200 deaths a decade earlier. Furthermore, the increased translocation of dogs has created the potential for rabies to spread to uninfected areas. Thus, rabies is a national public health concern in China.
In terms of mortality rates, rabies ranks as one of the leading infectious epidemics in China, along with tuberculosis, viral hepatitis, dysentery, and AIDS. The Chinese Center for Disease Control and Prevention, a division within China’s Ministry of Health, tracks 27 infectious diseases with the cooperation of local officials who report data using a web-based software application. The Center reported 198 deaths from rabies in June 2006 in China, making rabies the country’s leading epidemic killer that month. (An article quoting 623 deaths from rabies in June 2006 appears to be inaccurate.) Generally, tuberculosis deaths surpass rabies deaths. Overall for the year, rabies fatalities have increased 36% (961 deaths) during the first six months as compared to the same time period in 2005 (708 deaths). With fatalities continuing to increase monthly, rabies in China poses a serious threat to public health.
To provide historical perspective, a total of 103,200 people died of rabies in China from 1950-2004, with the majority of deaths occurring during four epidemic waves. The most severe epidemic occurred during the 1980s and resulted in 55,367 deaths. From 1990-1996, the deaths declined annually, with the fewest number of deaths reported in 1996 (159 deaths). Since 1996, the number of rabies cases has continued to increase. During the past decade, rabies fatalities peaked at 2,651 in 2004 and then slightly decreased in 2005. A total of 10,626 people died of rabies from 1996-2005. (Tang et al., Pivotal Role of Dogs in Rabies Transmission, China, Emerging Infectious Diseases, Vol. 11 No. 12, (Dec. 2005)).
Dogs are the primary vector for rabies transmission in China and throughout Asia. In contrast, wild raccoons are the increasing threat in the United States, where rabies immunizations are widely applied for domesticated animals. In central-eastern Europe, the fox serves as the primary vector.
An effective rabies control strategy in China is important because Asia accounts for 90% of rabies fatalities worldwide, according to the World Health Organization. The majority of rabies incidences and deaths occur in two countries, China and India, with India accounting for the most deaths. Generally, India reports 30,000 deaths per year from rabies, according to WHO. Other countries in the region, such as Indonesia, Thailand, and Vietnam, also are threatened significantly by the spread of rabies.
Travelers should consider a pre-exposure rabies immunization, particularly for travel to rural areas in China. The U.S. Centers for Disease Control and Prevention recommends a rabies vaccination if you plan to camp, hike, bike, or engage in occupational activities outdoors in China.
Dog Rabies Vaccination Rates in China
Local authorities regulate dog registration, vaccinations, and health inspections. The Chinese Center for Disease Control and Prevention estimates just 3% of China’s pet dogs are vaccinated against rabies. Three percent means about 4.5 million of China’s 150 million pet dogs have been vaccinated. Recent government and private campaigns have increased rabies vaccination rates in the major cities. For example, authorities have increased vaccination rates by reducing fees in urban areas, such as in Beijing and Xi’an. In Shanghai, privately-run animal shelters are providing rabies vaccinations for strays. Still, the rabies vaccination control policies and strategies remain largely reactive, ad hoc, and uncoordinated.
Both Beijing and Xi’an increased vaccination rates by lowering the dog registration and health fees. In Beijing, where an estimated one in ten residents owns a dog, the municipal government in 2003 lowered the dog registration fee to 1,000 yuan and the annual health inspection fee to 500 yuan. (Candy Zeng, 19 July 2006, Asia Times Online). The health inspection fee includes a rabies vaccination. Penalties for non-compliance can reach up to 5,000 yuan. (Sun Xiaohua, 5 August 2006, China Daily).
While still expensive for minimum wage workers, the reduced fees increased rabies vaccination rates. As of June 2006, 534,520 dogs were registered and vaccinated in Beijing. The actual vaccination rate is unknown, with some estimates as high as 90%. The minimum monthly wage in Beijing was 545 yuan in 2004.
In Xi’an, the municipal government in 2004 reduced the registration free from 5,000 yuan to 500 yuan and the health inspection fee from 1,000 yuan to 50 yuan to encourage the vaccination of the city’s estimated 80,000 dogs. (Ma Lie, 20 September 2006, China Daily).
The success of reduced fees as a public policy strategy to increase vaccination rates prompted a similar proposal earlier this year in Guangdong Province, where only a few hundred dogs are vaccinated. With the exception of experimental pricing in the city of Shenzhen, Guangdong charges a registration fee of 10,000 yuan and an annual health fee of 6,000 yuan. Authorities are considering lowering the fees to match Beijing’s rates: registration fee of 1,000 yuan and an annual fee of 500 yuan. In Shenzhen, owners currently are exempt from the registration fee and pay only 300 yuan for the annual fee. An estimated 1.5 million people in Guangdong Province were bitten or scratched by a dog or a cat in 2005 and more than 300 people died. (8 May 2006, CRIEnglish.com).
Beijing also created other incentives during the past three years to increase vaccination rates and to promote dog health. The city implemented animal shelters, a legal marketplace to purchase vaccinated dogs, Asia’s largest dog theme park, and dog toilets on sidewalks. The animal shelters, established in 2005, provide free rabies vaccinations and veterinary care for stray dogs. The Coolbaby Dog Theme Park, located in Chaoyang Park, opened in May 2006. Let me know if the park requires proof of dog registration or rabies vaccination.
Privately-run animal shelters also are working to increase the vaccination rates. In Shanghai, two private individuals, Zhang Yi and Lin Xin, opened the city’s first legal animal shelter for strays in 2003. Through private donations, the Shanghai Small Animal Protection Association (SSAPA), a registered non-profit, vaccinates stray and abandoned dogs against rabies. In Shenzhen, the local pet association is seeking support from the government, corporations and charity funds to implement a shelter and a vaccination campaign for the city’s estimated 10,000 stray dogs. (Chen Hong, 12 May 2006, China Daily).
Other efforts in cities such as Guangzhou, Chongqing, and Wuhan also have helped boost vaccination rates, but vaccination rates throughout China continue to be hampered by fees, cultural reluctance, and lack of public awareness.
Dog-Culling as an Ineffective Response to Rabies in China
The dog-culling programs implemented in Yunnan and Shandong provinces reflect the seriousness and urgency of the rabies epidemic and the desire by local authorities to protect public health against a growing threat. The officials in Mouding County, where three people died from rabies, defended their actions as the best means to protect public health because they concluded a mass vaccination campaign would only be 85% effective. However, in June 2005, the World Organization for Animal Health (OIE) and the the World Health Organization concluded that reactive dog-destruction efforts are ineffective. (Conference Conclusions, 12-15 June 2005). Moreover, WHO found that a rabies vaccination rate of 80% “is sufficient to break the canine transmission chain.” (Rabies Fact Sheet). WHO recommends local, country, and regional coordinated vaccination programs as the primary rabies control strategy.
Reactions and Recommendations from Experts in China
Experts in China have criticized the dog-destruction policies and have recommended dog rabies vaccinations as a more effective strategy. Guo Xiaofeng, a professor at South China Agriculture University (SCAU), sees a continuing trend toward increased contact between people and dogs: “As living standards keep increasing, more people feed dogs, and this increased contact means more chance of infection,” he told the China Daily newspaper. Professor Guo advocates a rabies vaccination program as the long-term, effective solution. Another expert at SCAU, Zhu Xingquan, a professor of parasitology, would like to see more fee-reduction incentives to boost vaccination rates. Professor Zhu also recommends the transfer of oversight from the police to city management authorities. (8 May 2006, China Daily).
China should seek the technical assistance of international organizations when creating and implementing its rabies control strategy. China is a member country of both the World Organization for Animal Health (OIE) and the World Health Organization (WHO). The two organizations have developed standards and guidelines to be used in the prevention and control of rabies. Both organizations stressed the importance of international cooperation and support at the 2005 International Conference on Rabies. The organizations advocate for international technical and financial support when countries lack the resources to implement the recommendations of the conference.