The situation of rabies prevention and control in China is grim, and the vaccine should be given to dogs.

　　Our reporter Wang Xian Hou Wenkun

　　Dogs are one of human’s closest animal friends, but they are also the biggest source of human rabies infection. According to the data of the World Health Organization, more than 95% of human rabies cases worldwide are caused by dog injuries.

　　At present, the prevention and control of human rabies in China has achieved remarkable results, and the annual incidence of human rabies has decreased by 84% in the past 10 years. However, the situation of rabies prevention and control is still very serious: in 2017, a total of 516 rabies deaths were reported nationwide, making it the second highest incidence country in the world after India; The number of rabies deaths in China has been at the forefront of all kinds of reported infectious diseases for many years, second only to AIDS and tuberculosis.

　　Rabies is a zoonotic disease with a mortality rate of almost 100%, and it is also the most easily controlled and eliminated human infectious disease in the world through technical means. Western developed countries and some developing countries have eliminated human rabies. Many authoritative experts believe that the elimination of human rabies in China has both financial resources and technical foundation. In recent years, the country has also spent a lot of human and financial resources on the prevention and treatment of rabies. However, this infectious disease that should disappear is still popular for a long time in China, and many people even talk about the dog’s discoloration and suffering from "phobia", which is incredible.

　　How harmful is rabies in China, and what secrets are hidden behind the high incidence of rabies? Xinhua Daily Telegraph reporter recently launched an investigation on this issue.

　　The tragedy of rabies happens every day.

　　In 2017, the number of rabies deaths exceeded 500. "These people should not die at all. As long as the measures are proper, rabies can be completely prevented and controlled."

　　On September 19, 14 days after being bitten by a dog, Tang Moumou, a 6-year-old boy from Nanxun District, Huzhou City, Zhejiang Province, died of rabies despite being injected with rabies vaccine and rabies immunoglobulin immediately. This is another family tragedy caused by rabies, which has aroused widespread concern in society.

　　The terrible thing is that such tragedies happen every day. According to data from the World Health Organization, about 60,000 people die of rabies every year, most of them in Asia and Africa. China is the second highest incidence country of rabies in the world, and there are rabies epidemics in 28 provinces and cities.

　　According to the report of China Center for Disease Control and Prevention, the epidemic situation of rabies in China is mainly distributed in densely populated areas of Central China, South China, Southwest China and East China. The population distribution is characterized by "more than three": there are more cases in rural areas, more cases in men, and more cases in children under 15 and people over 50. Among the cases in 2017, farmers accounted for the most (76.74%), followed by students (6.4%).

　　At the peak of the epidemic from 2003 to 2012, the average number of rabies deaths in China exceeded 2,300 each year. In the past five years, the number of reported cases has decreased year by year, but the number of deaths in 2017 still exceeded 500. Most experts believe that the actual death toll is much higher due to underreporting and negligence.

　　"These people should not die at all. As long as the measures are proper, rabies can be completely prevented and controlled." Yu Yongxin, academician of China Academy of Engineering and researcher of China Food and Drug Administration, said sadly.

　　Tu Changchun, an expert on animal rabies and a researcher at the Military Veterinary Research Institute of the Academy of Military Medicine, said that more than 95% of human rabies is caused by infected dogs. The number of dogs in China exceeds 100 million, and more than 12 million people are injected with rabies vaccine every year because of dog bites. The cost of a patient’s light vaccine immunization is around 350 yuan. If the bite penetrates the skin, it will cost thousands of dollars to inject rabies immunoglobulin. Every year, people spend more than 5 billion yuan on rabies vaccine immunization and immunoglobulin.

　　"The rabies vaccine should be injected in five times, which means that once bitten by a dog, it will take about three days for each person, resulting in huge losses." Yu Yongxin said.

　　The high incidence of rabies not only consumes huge time and economic costs, but also damages the national image. In December 2015, international organizations such as the World Health Organization, the World Organization for Animal Health, the Food and Agriculture Organization of the United Nations and the Global Rabies Prevention and Control Alliance proposed in Geneva that human rabies transmitted by dogs should be eliminated globally in 2030. The World Health Organization has confirmed that there is no rabies in 43 countries and regions including Western Europe, Central and South Europe except some Baltic countries, Japan, Malaysia, Hong Kong, Macao and Taiwan.

　　Experts said that the current countries where human rabies is prevalent are all underdeveloped and poor countries. China is the only country in the world with financial resources, technology and products, but human rabies is still prevalent, which is extremely disproportionate to China’s increasing international image and status.

　　Vaccination Absence and Abuse

　　The vast majority of rabies cases in China occur in rural areas, but the data show that the vaccination rate of scattered dogs in rural areas may be only one to twenty percent.

　　"Dogs may get rabies when they bite people. I haven’t heard that people bite dogs and dogs get rabies." Cai Xuepeng, president of China Veterinary Medicine Association, said that it is passive immunity for people to get rabies vaccine after being injured by animals. The focus of rabies epidemic prevention should be on animals and vaccinate dogs. "But at present, this work is not done enough, and the relevant parties do not understand it. People are more important than dogs, and the prevention and control work is putting the cart before the horse."

　　A survey by Xinhua Daily Telegraph reporter found that in cities, the regulations for handling dog-raising licenses and animal vaccination are mere formality, and vaccination is not fully in place; In rural areas, the vaccination rate of dogs is extremely low. There are many scattered dogs in several villages visited by reporters, but dog owners have never heard of vaccinating dogs. The vast majority of rabies cases in China occur in rural areas, but data from various parties show that the vaccination rate of scattered dogs in rural areas may be only one to twenty percent.

　　Academician Yu Yongxin, an authoritative virologist known as "the father of Japanese encephalitis live vaccine", is 89 years old, but he is still active in various conferences on rabies prevention and control, encouraging and calling for rabies prevention and control in China.

　　"To eliminate rabies, animals must be immunized, and the most important thing in immunized animals is oral vaccine; In the long run, rabies must be controlled by oral bait vaccine for dogs. " Yu Yongxin said that there are hundreds of millions of dogs in China, most of which are scattered in rural areas and run around. It is very difficult and not safe to rely solely on injection. Only by spreading oral rabies vaccine for dogs in the wild can we achieve sufficient immune coverage, which is also advocated by the World Health Organization.

　　Yu Yongxin said that at the academic conference on rabies prevention and control he attended, a report would be delivered at the end of the conference, and almost every time, suggestions would be made to speed up the research and use of oral bait vaccine for rabies in dogs.

　　The reporter learned that domestic enterprises have carried out research on oral bait vaccine for rabies for dogs for many years, and have formed relatively systematic results. Enterprises have also repeatedly applied to the Ministry of Agriculture and Rural Affairs. However, so far, the transformation process of relevant results is still very slow.

　　On the one hand, the research on dog vaccination and oral vaccine for dogs is absent and lagging behind; On the other hand, the rabies vaccine that should not be given to people has been abused. Some incredible vaccinations are not uncommon. Aunt Liu, a farmer in Dongxihu District of Wuhan City, was pecked by a chicken at home and immediately rushed to the Municipal Center for Disease Control and Prevention to ask for rabies vaccine.

　　The theme of this year’s World Rabies Day is "Rabies: Sharing Information, Saving Lives". The core of phobia patients is excessive fear of rabies — — Some people have been vaccinated in time after being bitten by a dog, but they still suspect that the virus has not been completely eliminated, and they have been vaccinated frequently. Some people have taken 150 shots in 10 years. Some people suspect that rabies virus can spread through the air and struggle with endless troubles every day … … According to Yan Jiaxin, a blogger of Science Network and a well-known rabies expert, there are at least hundreds of thousands of such "phobia" groups in China, ranking first in the world.

　　Experts said that now everyone knows that people who have been bitten by dogs should be vaccinated, but many people are "over-defended" and have been pecked by chickens and birds, and they also require rabies vaccination. "Birds don’t carry rabies virus at all, and they are pecked by birds and chickens. In most cases, rabies vaccine is not needed, unless this chicken has just been attacked by a mad dog and just pecked you, but this probability is extremely low."

　　At the same time, the strange phenomenon of rabies "rural people get sick and urban people take injections" is common in China. The immunization rate of scattered dogs in rural areas is low, and they are more prone to rabies after being bitten by dogs. However, due to the high medical expenses, many people bitten by dogs often have luck, and the proportion of people who do not accept post-exposure treatment is high. However, the immunization of domestic dogs in cities is relatively high, but many urban people lack the basic knowledge of rabies, causing great panic. After being bitten by dogs that have been immunized and do not carry rabies virus, they still insist on vaccination, resulting in vaccine abuse.

　　"The prevention and control of rabies in dogs has a public welfare nature and needs government funding. The relevant departments and the public have no clear understanding of this. On the contrary, they have seen the huge economic benefits of rabies vaccine for human use. On the one hand, the funds for the prevention and treatment of animal rabies cannot be implemented. On the other hand, the huge economic burden of ordinary people has become a source of huge profits and taxes for vaccine companies. " Tu Changchun bluntly said, "It is this interest that has led to putting the cart before the horse in the prevention and treatment of rabies in China. The needle that should be given to dogs can’t be played, but the needle that should not be given to people is played hard."

　　In addition, the division of labor and responsibility of dog management in China is unclear. Although local laws and regulations on dog management have been issued in many places, the responsibilities involve agriculture, public security, health and other departments, and there are some problems such as inadequate implementation of responsibilities, loopholes in work connection, some systems becoming a mere formality, and the regulatory authorities pay more attention to post-event disposal than pre-event supervision, so it is difficult to carry out dog immunization work, and there is no corresponding prevention and control fund.

　　Zhang Gaiping, an expert in animal disease research and academician of China Academy of Engineering, bluntly said that although grass-roots veterinarians are weak and face many practical difficulties, veterinarians should take greater responsibility for the prevention and treatment of rabies, and they should not put all the blame on human doctors.

　　Controlling rabies in dogs is fundamental.

　　At present, one tenth of the funds used for the treatment of human rabies exposure is enough to eradicate rabies in dogs at the source.

　　Cai Xuepeng believes that animal disease prevention and control is the frontier and important foundation of human disease prevention and control, and controlling rabies in dogs and other animals is the only effective way to ensure that people are not rabies. Strengthening dog management and immunization is the core strategy to eliminate rabies in China, and it is also a difficult task.

　　At the same time, rabies is a zoonotic disease that is prevalent in China and has attracted much attention internationally. Realizing the goal of eliminating human rabies transmitted by dogs in 2030 will explore an inter-ministerial joint public health system that is in line with China’s national conditions and effectively control zoonotic diseases, and has a demonstration role in preventing and controlling other zoonotic diseases such as avian influenza, tuberculosis, brucellosis and schistosomiasis.

　　Cai Xuepeng, Yu Yongxin, Tu Changchun and other authoritative experts in rabies research believe that, first of all, we should move forward, strengthen the core role of veterinary departments in rabies prevention and control, and implement a compulsory rabies immunization system for dogs throughout the country. Strengthen the scientific research, transformation and application of rabies, vigorously encourage and support qualified units and enterprises to carry out research on oral bait vaccine for rabies in dogs, learn from the successful experience of developed countries and regions, and spread oral bait vaccine in the field surgery, so that the vaccination rate of dogs can quickly reach the internationally recognized level of over 70%, and the spread of the virus among dogs can be blocked. At the same time, strengthen animal rabies monitoring, further enhance the laboratory capacity, and establish a rabies monitoring network covering the whole country.

　　Secondly, it is necessary to strengthen the top-level design and form a strong synergy between all parties. Tu Changchun suggested establishing a joint prevention and control mechanism, organizing and leading the national rabies prevention and control work in a unified way, and formulating national dog management measures and national rabies prevention and control plans. Agriculture, health, public security and other departments should join hands, work together, and make overall plans. It is necessary to strengthen daily monitoring and management, let urban pet dogs "register", implement the management of rural dogs, and control stray dogs at the same time.

　　At the recent seminar on rabies elimination in China, Gao Fu, director of the China Center for Disease Control and Prevention, suggested strengthening dog management in rural areas. "We can implement the village director responsibility system in this respect and do a good job in grassroots management."

　　At the same time, it is necessary to increase investment guarantee to ensure the implementation of prevention and control measures. According to the report of the World Organization for Animal Health, at present, one tenth of the funds used for the treatment of human rabies exposure is enough to eradicate rabies in dogs at the source, thus preventing the epidemic of human rabies. It is suggested that the Ministry of Finance allocate special funds for animal rabies prevention and control, which should be included in the fiscal expenditure budget of animal disease prevention and control of governments at all levels; The National Health and Wellness Commission has incorporated the immune treatment after rabies exposure into the medical insurance to ensure that the dog injured people get timely and effective treatment.

　　In addition, rabies must be comprehensively prevented and controlled. It is necessary to increase the publicity of rabies prevention and control, improve the awareness and understanding of rabies among dog owners and the public, and enhance the awareness of healthy dog raising and epidemic prevention among the whole people.