Fatal cases in pediatric patients after post-exposure prophylaxis for rabies:A report of two cases

Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.

Spontaneous Rabies in a Stray Bitch after Parturition Induced Immunosuppression —Investigating an Impending Outbreak of Rabies with One Health Approach

Background: Rabies is endemic in India and every half an hour a person dies of this dreaded disease. Stray roaming dogs, mostly unvaccinated, are most dangerous host in spread of rabies in India and in our state of Himachal Pradesh. Timely prophylaxis is the only method to save animal bite victims, including that of rabid dog bite patients. Objectives: Objective of this study was to investigate an impending outbreak of rabies in Shimla town in the absence of life saving rabies immunoglobulins (RIGs) in the market, and to know the source of infection by using one health approach and using epidemiological tools. Methods: On April 7, 2015, there was a sudden surge in cases of suspected rabid dog bites. Impending rabies outbreak was suspected as there were no RIGs available in the market. A rapid Response Team (RRT) consisting of the author, veterinary doctor, dog squad of Municipal Corporation (MC) Shimla along with the vehicles to impound rabid dogs was constituted to investigate the terror spread by two rabid dogs on biting spree in the Shimla Municipality. Results: A total of 18 people were bitten by suspected rabid dogs within three days period. A black bitch and a brown dog, on the identity of affected people, were captured by the dog squad of Municipality next day on April 8, 2015 and taken to Dog Sterilization Centre, Animal Birth Control (ABC) programme, MC Shimla for observation. The most furious Black bitch died of clinically confirmed symptoms of furious rabies after three days. The second rabid dog, brown in color, died after a month of observation due to paralytic dumb rabies. The brain of the brown dog was extracted for Fluorescent Antibody Testing (FAT) at central research Institute (CRI) Kasauli and was found to be positive for FAT. Follow up of patients was 100% by house to house visit and over telephone and no casualty was reported. Conclusion: While we were working on hypothesis of rabid dogs getting the infection from nearby forest about 8 - 10 KM away but on follow up of the patients, they reported that both the dog and bitch used to stay in the compound of their colony since the bitch was pregnant and there was no history of the bitch moving for away to forests neither any outside dog which was seen near them in the compound. This led us to think of other causes of what must had happened to the bitch that caused her to be rabid as for the past 9 years we had observed bitches becoming rabid after litter birth (Whelping) and making their pups rabid due to licking. Since the carrier state for rabies virus in bitches/dogs is known and a state of immunosuppression after whelping/parturition is also known, therefore there is a possibility of latent rabies virus getting activated due to immunosuppression after litter birth and it is thought to be as one of the probable causes of black bitch getting rabid and inflicting the infection to accompanying brown dog. We need to do further studies to ascertain this phenomenon before coming to a definite conclusion and suspect such a possibility in case a dam suddenly becomes rabid among a pack of stray dogs in rabies endemic countries like ours.

Comparative Study on the Immunogenicity and Efficacy of Different Post-exposure Intramuscular Rabies Vaccination Regimens in China

Objective This study aimed to compare the current Essen rabies post-exposure immunization schedule(0-3-7-14-28)in China and the simple 4-dose schedule(0-3-7-14)newly recommended by the World Health Organization in terms of their safety,efficacy,and protection.Methods Mice were vaccinated according to different immunization schedules,and blood was collected for detection of rabies virus neutralizing antibodies(RVNAs)on days 14,21,28,35,and 120after the first immunization.Additionally,different groups of mice were injected with lethal doses of the CVS-11 virus on day 0,subjected to different rabies immunization schedules,and assessed for morbidity and death status.In a clinical trial,185 rabies-exposed individuals were selected for post-exposure vaccination according to the Essen schedule,and blood was collected for RVNAs detection on days 28and 42 after the first immunization.Results A statistically significant difference in RVNAs between mice in the Essen and 0-3-7-14 schedule groups was observed on the 35th day(P<0.05).The groups 0-3-7-14,0-3-7-21,and 0-3-7-28 showed no statistically significant difference(P>0.05)in RVNAs levels at any time point.The post-exposure immune protective test showed that the survival rate of mice in the control group was 20%,whereas that in the immunization groups was 40%.In the clinical trial,the RVNAs positive conversion rates on days 28(14 days after 4 doses)and 42(14 days after 5 doses)were both 100%,and no significant difference in RVNAs levels was observed(P>0.05).Conclusion The simple 4-dose schedule can produce sufficient RVNAs levels,with no significant effect of a delayed fourth vaccine dose(14–28 d)on the immunization potential.

A Single-chain Antibody for One-pot Fabrication of Luminescent Gold Nanoclusters and Rabies Virus Imaging in Cells

The fragile antibody leads to a great challenge as a scaffold to fabricate the luminescent metal nanoclusters using one-pot method.This study presents a stable single-chain anti-body(scFv57R-ATS)for the fabrication of luminescent gold nanoclusters(AuNCs@scFv57R-ATS)and a quick,sensitive rabies virus detection in living cells.In this paper,AuNCs@scFv57R-ATS was designed to specifically recognize antigen RV in modified HeLa cells,which promoted the demonstration of metal nanocluster fluorescent probes for antigen targeting and therapy.

Agile and reactive rabies vaccination techniques in countries with low and middle incomes

Rabies are still a major public health risk in low-and middle-income nations,endangering both human and animal health.Rabies is caused by rabies virus(RABV)from the Rhabdoviridae family of the genus Lyssavirus.The infection affects the central nervous system,mainly the brain and spinal cord,causing acute encephalitis,which has the highest case fatality rate ever recordednearly 100%.Although all mammals can be infected by RABV,dogs are thought to be the main source of infection.Dog bites cause 95%of human cases of rabies,but in endemic areas,this number increases to 99%(Harischandra,Gunesekera et al.2016).

Eco-Epidemiological Characteristics of Human Rabies in Côte d’Ivoire, 2012-2017

Introduction: Human rabies is a major public health problem in many African countries, including Côte d’Ivoire. The present work aims at describing the eco-epidemiological characteristics of human rabies cases recorded in Côte d’Ivoire. Methods: This was a retrospective and prospective cross-sectional descriptive study based on epidemiological surveillance data that ran from september 2014 to december 2017. The clinical data were extracted from the database of the human rabies epidemiological surveillance management service of the National Institute of Public Hygiene’s rabies centre. These data cover the period from 1 January 2012 to 31 December 2017. Results: Human rabies is endemic in Côte d’Ivoire, with most people exposed in the south and especially in the west of the country. There was no association between any of the climatological parameters (temperature, humidity, rainfall) and the occurrence of human rabies during the months of exposure to rabies infection. Conclusion: Ultimately, effective prevention and control of human rabies requires a thorough understanding of the links between climatological parameters and rabies. Health authorities must take ownership of these results if we are to achieve our goal of eliminating rabies by 2030.

Study of Factors Associated with Knowledge, Attitudes and Practices Regarding Rabies in the Commune of Niakhéne in Senegal, in 2022

Introduction: Rabies is a serious disease, as it is always fatal, but it can be prevented by sero-vaccination. It is a neglected tropical disease endemic in Asia and Africa. The aim of this study was to assess knowledge, attitudes and practices regarding rabies and to determine the factors associated with them among people aged 18 and over in the commune of Niakhène. Methods: This was a cross-sectional, descriptive and analytical survey of subjects aged 18 and over living in the commune of Niakhène. A sample of 300 individuals was drawn from a two-stage cluster survey stratified by age and sex. Bivariate analysis was performed using association tests. Results: The mean age of respondents was 35.3 ± 16.9 years. It was noted that 67% (201) of respondents had a good knowledge of rabies. The results showed that 7.3% (22) of respondents owned a dog. Of the 278 people who did not own a dog, 78.4% (218) said they would have vaccinated their dog if they had had one. It should be noted that 83.7% (251) of respondents said they would go to a health facility if an animal bit them. None of the dog owners had vaccinated their dogs against rabies. Of the 41 people exposed to rabies, 39% went to a health facility. The age and education of the respondents had statistically significant associations with knowledge of rabies. Respondents’ age and education were statistically significantly related to whether they had vaccinated a domestic dog. The age, education and economic well-being quintile of respondents’ households had statistically significant associations with the use of a health facility in the event of being bitten or scratched by an animal vector. The education of respondents who had been bitten by an animal vector was statistically significantly associated with the use of a health facility. Conclusion: It would be imperative for human and animal health authorities to collaborate in a “One Health” approach in order to increase knowledge and promote the adoption of good practices in rabies prevention.

Rabies by Dog Bites in Benin: Determinants of Good Knowledge of the Rabies Risk among Subjects Exposed in the Plateau Department in 2023

Rabies, a viral zoonosis, is one of the neglected tropical diseases (NTDs) that mainly affects poor and vulnerable populations. Human rabies is endemic in Benin. Although listed among the notifiable diseases, it nevertheless remains a neglected and under-reported disease. The objective of this study was to investigate the determinants of knowledge of rabies risk among subjects exposed to human rabies by dog bites in the Plateau department of Benin. Methods: This was a cross-sectional study with an analytical aim which involved a sample of 900 people aged at least 18 years old chosen randomly and residing in the Plateau department for at least six months. A pre-tested and validated digital questionnaire served as a data collection tool. Data analysis was done with R 3.4.1 software. The prevalence ratio was used as a measure of association. The confidence threshold was set at 5%. We carried out a multiple logistic regression using the likelihood ratio (top-down approach) in order to identify the main factors which influenced the good knowledge of human rabies in the population of Plateau. Results: In the study population, 80.89% of the subjects surveyed lived in a rural area. The sex ratio (Male/Female) was 1.11. The average age of the subjects was 40.24 ± 14.52 years. The prevalence of dog bites was 4.11% (95% CI = [3.00;5.63]) or 37 subjects bitten. After evaluation of knowledge of rabies risk in the study population, the main factors which positively influenced good knowledge of human rabies were age (p linear trend 0.01), residence of the subject in the municipality of Pobè (ORa = 8.34;95% CI = 0.83 - 1.23;p < 0.01), individual dwelling (ORa = 17.95;95% CI = 13.12 - 49.58;p < 0. 01), educational level of at least secondary (ORa = 5.53;CI 95 = 3.06 - 10.15;p = 0.01), the existence of a veterinary center (ORa = 3.66;CI 95 = 1.07 - 12.43 p = 0.01) and knowledge of a dog bites victim (ORa = 6.55;95% CI = 2.73 - 8.25;p < 0.01). Conclusion: This population study confirms that human rabies remains a public health problem with a need to raise awareness among populations on good prevention practices against human rabies after a dog bite in the Plateau department. This could help to improve strategies surveillance for the control and eradication of human rabies through the implementation of the One Health approach.

Effectiveness of Implementing an Integrated Care Management Program for Rabies Vaccination Patients

Objective:To analyze the effect of implementing a comprehensive nursing management program for rabies vaccination patients.Methods:100 cases of rabies vaccination patients were selected as observation objects from January 2022 to December 2023,and after enrollment,they were grouped according to the different nursing management programs,with 50 cases in each group.The control group was only given routine nursing management,and the observation group was combined with comprehensive nursing management on the basis of routine nursing management.The completion rate of vaccination,the rate of adverse reactions,and the satisfaction rate were assessed,comparing the clinical effects of different nursing management programs.Results:The completion rate of the 5th shot of rabies vaccination in the observation group was 82.00%higher than 64.00%in the control group(χ^(2)=4.1096,P<0.05);the rate of adverse reaction of vaccination in the observation group was 4.00%lower than 18.00%in the control group(χ^(2)=5.0051,P<0.05);the vaccination satisfaction in the observation group was 98.00%higher than 86.00%in the control group(χ^(2)=4.8913,P<0.05).Conclusion:The application of comprehensive nursing management program can help rabies vaccination patients to improve the completion rate of vaccination and reduce the incidence of adverse reactions to vaccination,with clear effects.

Update on Canine and Human Rabies in a Rabies Endemic Situation in the Republic of Guinea

Each year, rabies kills nearly 60,000 people worldwide. Asia and Africa are the most affected. It is a public health problem because of the number of stray dogs in these nations. In Guinea, rabies is endemic and cases are often under-reported. The objective of this study was to determine the prevalence of rabies among human and animal exposures in Guinea. This was a retrospective analytical study from 2019 to 2021 conducted in the country’s human and veterinary health divisions and, primarily focused on rabies épidémiologique surveillance. The selection was based on human contact with an animal causing behavioural disorders, as well as animals put under observation following aggression on humans. The data were analysed using Epi Info version 21 software. Qualitative variables were expressed as proportions with 95% CIs, quantitative variables as mean ± standard deviation. The chi2 test and the Fischer exact test were used to compare proportions. A total of 85 veterinary facilities were visited and 100 animals registered, of which 93% were reported cases of exposure to canine rabies. One thousand five hundred and thirty-one (1531) people exposed to rabies were recorded between 2019 and 2021. During the period, the prevalence of human rabies was 0.533% [0.042 - 0.064] at 95% CI and that of canine rabies was 0.55% [0.039 - 0.061] at 95% CI. The biting animal was the dog in 97.2% of cases. Subjects over 45 years of age (57.7%) were the most affected. The prevalence of canine rabies was 0.5% compared with 0.533% for human rabies between 2019 and 2021. This low prevalence does not reflect the true extent of the phenomenon in Guinea, as few people consult health structures in the event of dog bites. Regular surveillance of the human and dog population is necessary for better rabies control in Guinea.

Rabies Virus Neutralizing Activity,Safety,and Immunogenicity of Recombinant Human Rabies Antibody Compared with Human Rabies Immunoglobulin in Healthy Adults

Objective Preliminary assessment of rabies virus neutralizing activity,safety and immunogenicity of a recombinant human rabies antibody(NM57)compared with human rabies immunoglobulin(HRIG)in Chinese healthy adults.Methods Subjects were randomly(1:1:1)allocated to Groups A(20 IU/kg NM57),B(40 IU/kg NM57),or C(20 IU/kg HRIG).One injection was given on the day of enrollment.Blood samples were collected on days-7 to 0(pre-injection),3,7,14,28,and 42.Adverse events(AEs)and serious AEs(SAEs)were recorded over a period of 42 days after injection.Results All 60 subjects developed detectable rabies virus neutralizing antibodies(RVNAs)(>0.05 IU/mL)on days 3,7,14,28,and 42.The RVNA levels peaked on day 3 in all three groups,with a geometric mean concentration(GMC)of 0.2139 IU/mL in Group A,0.3660 IU/mL in Group B,and0.1994 IU/mL in Group C.At each follow-up point,the GMC in Group B was significantly higher than that in Groups A and C.The areas under the antibody concentration curve over 0-14 days and 0-42 days in Group B were significantly larger than those in Groups A and C.Fifteen AEs were reported.Except for one grade 2 myalgia in Group C,the other 14 were all grade 1.No SAEs were observed.Conclusion The rabies virus neutralizing activity of 40 IU/kg NM57 was superior to that of 20 IU/kg NM57 and 20 IU/kg HRIG,and the rabies virus neutralizing activity of 20 IU/kg NM57 and 20 IU/kg HRIG were similar.Safety was comparable between NM57 and HRIG.

Current Status of Canine Rabies in China

Abstract The number of human rabies cases acquired from dog bites constitutes a high proportion of the total rabies cases in China, although the number of human rabies cases has gradually decreased in recent years. The pivotal role of dogs in the spread of rabies indicates that controlling and preventing canine rabies could be a key step in eradicating human rabies in China. The primary aims of this review are to discuss the properties and pathogenesis of the rabies virus, the clinical signs and diagnosis of canine rabies, threshold host density and vaccination of dogs, and the prevention and control of canine rabies in China.

Recovery from rabies,a universally fatal disease

Background:Rabies is a zoonosis transmitted via the bites of various mammals,primarily dogs and bats.Known since antiquity,this disease may have the deadliest human fatality rates and is responsible for approximately 65,000 deaths worldwide per year.Case presentation:We report the case details of a 13-year-old boy from India belonging to a South Asian ethnicity,who presented with altered sensorium one month following a dog bite.He did not receive the active rabies immunization and was managed with supportive therapy.The patient had extensive T_2 weighted(T_2W)/fluid attenuation and inversion recovery(FLAIR) hyper intensities involving the deep gray matter of the cerebral hemispheres,hippocampus,brainstem,and cerebellum.The diagnosis was confirmed by the demonstration of the rabies antigen from a nuchal skin biopsy and a corneal smear.The patient had a slow but significant recovery over four months and was discharged from the hospital in stable condition with severe neurological sequelae.Conclusion:We report a unique case of survival after infection with a universally fatal disease.

Immunizing Vulnerable Populations Like Rag Pickers, Garbage Collectors, Municipality Workers and Newspaper Hawkers against Rabies in Shimla Municipality, HP, India

Background: Rabies is a zoonotic disease and many vulnerable sections like rag pickers and municipality workers neglect animal bites due to ignorance of their potential deadly outcomes. Stray dogs abound in garbage pits and this population is exposed to their attacks. It should be a mandate for municipalities to help protect their sanitary workforce, especially rag pickers, from deadly infectious diseases such as Rabies, Hepatitis-B, HIV, Tetanus etc. Objectives: Objective of this study was to study methods to provide pre-exposure Rabies vaccination for such highly exposed populations by engaging them and understanding their perception of this disease through a constant dialogue with them. Methods: We started by engaging with the rag pickers to know how best to entice them to get themselves immunized. We then attempted to search literature for the most practical methods likely to succeed in reducing risk of rabies deaths in this population. Results: WHO approved 3 injections of 0.1 ml tissue culture vaccine on days 0, 7 and 21 were tried but were shown to result in many dropouts among rag pickers for repeat injections. We then followed a method where 0.1 ml of rabies vaccine was injected at 4 different anatomical sited in one setting. This proved acceptable and relatively inexpensive. A small number of subjects were studied by determination of neutralizing antibody by RFFIT, which proved immunogenic having anamnestic response on boosters given single IM or at 4 sites ID subsequently, implying that short schedule rabies pre-exposure vaccination can be done in high risk groups and may save lives if applied to the poorest that are highly exposed.

Eliminating dog-mediated rabies: challenges and strategies

Rabies is an acute encephalitis caused by a lyssavirus. It is primarily transmitted through bites of infected dogs which results in the worldwide death of an estimated 59000 humans every year. The disease is preventable through the application of post-exposure prophylaxis (PEP) and its elimination has been demonstrated in many countries by applying multiple interventions simultaneously. Nonetheless, rabies is still widespread in many developing countries, primarily due to the poor implementation of intervention strategies that include inadequate dog-bite wound management practices, unavailability/unaffordability of PEP by the communities, failure to control the disease in free-roaming dogs and wildlife, improper dog population management, weak surveillance and diagnostic facilities and a lack of a One Health approach to the disease. In this review, strategies to control dog-mediated rabies through a One Health approach were discussed. We recommend applying multiple interventions against the disease by involving all the concerned stakeholders in selected urban and rural areas of the countries where rabies is endemic. An empirical demonstration of disease freedom in the selected areas through a One Health approach is needed to convince policymakers to invest in rabies prevention and control on the national level. This multifaceted One Health control model will enhance the likelihood of achieving the goal of global rabies eradication by 2030.

Breaking the Barriers to Access a Low Cost Intra-Dermal Rabies Vaccine Through Innovative “Pooling Strategy”

Background: In India every year an estimated 20,000 patients die of Rabies. Major reason for poor compliance to anti-rabies prophylaxis is the high cost of anti-rabies vaccine being prescribed intramuscularly (IM) as a routine i.e. 44.5 USD per course of five injections. In 1992 WHO recommended low cost intra-dermal rabies vaccination (IDRV), which costs only 7.5 USD or less per animal bite course. Methods: Interviews with doctors revealed that they were not prescribing intra-dermal anti rabies vaccination as they were either not aware or were not confident of this route of rabies vaccination. Also the vaccine vial did not have the label for “intra-dermal use”. These barriers were removed by advocacy efforts with policy makers & drug companies, credit sharing & team building, which led to starting of first intra dermal anti-rabies clinic of North India on 2nd August 2008. Results: Within a month of start of intra-dermal rabies vaccination clinic, i.e. by 2nd September, 2008, there was an increase in the hospital patient load by 2.8 times, and poor patients load by 3.2 times. In just less than two-year time, 200,000 USD of poor patients were saved and 5769 patients vaccinated. Each patient was asked to bring one vial on first visit & rest of doses were given “free” by pooling strategy. Pooling strategy involved distribution of one vial of vaccine among four persons and keep the three vials for use one by one by all the four patients on subsequent three visits. Another offshoot of the strategy was to prevent wasting of even few drops of vaccine that used to remain in each vial of 1 ml after distribution among four patients (0.2 mL or less). Out of more than 5000 vials utilised, every time we would transfer the left out drops of vaccine to the next new vial and use it immediately on a new pool of patients waiting for vaccination. We would, however, discard the unused vaccine after eight hours of reconstitution at the end of the day. The vaccine so saved turned to be a stock of more than 100 vials in less than two years that we were able to give free to more than 225 rag pickers, garbage collectors and newspaper hawkers on World Rabies Day, Sep 28, 2010. Conclusions: With intra-dermal clinic, we were able to successfully introduce the new cost effective intra-dermal method of rabies vaccination despite all odds & vested interests of companies & old mindset of doctors that had blocked this technique till now. This will go a long way in reducing the burden of disease & death due to rabies from India.

Molecular Characterization of Viral G Gene in Emerging and Re-emerging Areas of Rabies in China, 2007 to 2011

In recent years (2007 to 2011), although the overall number of rabies cases in China has decreased, there is evidence of emerging or re-emerging cases in regions without previous rabies cases or with low incidence of rabies. To investigate the origin and the factors affecting the spread of rabies in China, specimens were collected from 2007 to 2011 from provinces with emerging and re-emerging cases and tested for the presence of the rabies virus. Positive specimens were combined with sequences from GenBank to perform comparisons of homology and functional sites, and to carry out phylogenetic analyses. Out of these regions, five provinces had 9 positive specimens from canine and cattle, and 34 canine or human specimens were obtained from previously high-incidence provinces. Complete sequences of G gene were obtained for these samples. Homology of the sequences of these 43 specimens was 87%-100% at the nucleotide level and 93.7% -100% at the amino acid level. These G gene sequences were combined with reference sequence from GenBank and used to construct a phylogenetic tree. The results showed that 43 specimens were all assigned to China clade I and clade II, with all specimens from emerging and re-emerging areas placed within clade I. Specimens isolated from Shanxi and Inner Mongolia in 2011 were distinct from previously-isolated local strains and had closer homology to strains from Hebei, Beijing and Tianjin whereas new isolates from Shanghai were tightly clustered with strains isolated in the 1990s. Finally, Shaanxi isolates were clustered with strains from adjacent Sichuan. Our results suggest that the rabies cases in emerging and re-emerging areas in China in the last 5 years are a consequence of the epidemic spreading from of neighboring provinces and regions experiencing a serious epidemic of rabies.

Analysis on Factors Related to Rabies Epidemic in China from 2007-2011

To analyze features of the rabies epidemic in China between 2007 and 2011, identify factors influencing the epidemic and to provide a scientific basis for further control and prevention of rabies, Descriptive epidemiological methods and statistical analysis was used on data collected from the National Disease Reporting Information System between 2007 to 2011 and the National Active Surveillance System between 2007 and 2010. Our analysis shows that while the number of human rabies cases decreased year by year, the number of districts reporting cases did not show significant change. The situations in Guangdong, Guangxi, Guizhou and Hunan provinces clearly improved over the period but they remain provinces with high-incidence, and consequently influence the epidemic situation of surrounding provinces and possibly the whole country. Summer and autumn were high-incidence seasons. Farmers, students and pre-school children represent the high-risk populations, and rates of cases in farmers increased, those for students decreased, and pre-school children remained unchanged. Provinces with active surveillance programs reported a total of 2346 individual cases, of which 88.53% were associated with canines. Postexposure prophylaxis （PEP） of rabies cases was not significantly improved, whereas PEP in post-exposure population was good. In rural regions of China, canine density was reduced somewhat, and the immunization rate increased slightly. Finally we show that while the epidemic decreased 2007 to 2011 in China, cases continued to be diffused in certain regions. Lack of standardization of PEP on rabies eases was the main reason of morbidity. The high density and low immunization of dog in rural areas and the defective situation of PEP are still continuous occurrences in China and remain a cause for concern.

The Full-length Genome Analysis of a Street Rabies Virus Strain Isolated in Yunnan Province of China

The epidemic of rabies has rapidly increased and expanded in Yunnan province in recent years. In order to further analyze and understand the etiological reasons for the rapid expansion of rabies in Yunnan, a strain of rabies virus CYN1009D in Yunnan was isolated, and the complete genomic sequencing was carried out, and the bioimfomative analysis on genes/encoded proteins and phylogeny with reference to sequences in GenBank was performed. The complete genome of CYN1009D was 11923 nt in length and belonged to genotype I. The genes encoding different structural proteins were all conserved in their lengths, in comparison to other strains in China. The amino acid sequence was conserved at different antigen sites of NP, but the variation was detected at the secondary phosphorylation site of position 375; variations were also detected in the phosphorylation sites at positions 63-63 and 162 of PP; the sites playing important roles in virus synthesis, budding and viral morphology in MP were conserved; two glycosylation sites were detected at Asn37 and Ash319 in GP, the neutralizing antigen sites in GP were conserved; the initial amino acid of LP （ML） was different from that of most of the strains in China （MM）; the variations in G-L region in the intergenic region were significant. The phylogenic tree showed that CYN1009D has a closer genetic relationship to the strains in Southeast Asia, indicating that prevention and control on rabies in borderland areas should be reinforced meanwhile efforts are made to control rabies in China.

Establishment and Preliminary Application of a Rapid Fluorescent Focus Inhibition Test (RFFIT) for Rabies Virus

The World Health Organization (WHO) standard assay for determining levels of the rabies virus neutralization antibody (RVNA) is the rapid fluorescent focus inhibition test (RFFIT), which is used to evaluate the immunity effect after vaccination against rabies. For RFFIT, CVS-11 was used as the challenge virus, BSR cells as the adapted cells, and WHO rabies immunoglobulin (WHO STD) as the reference serum in this study. With reference to WHO and Pasteur RFFIT procedures, a micro-RFFIT procedure adapted to our laboratory was produced, and its specificity and reproducibility were tested. We tested levels of RVNA in human serum samples after immunization with different human rabies vaccines (domestic purified Vero cell rabies vaccine (PVRV) and imported purified chick embryo cell vaccine (PCECV)) using different regimens (Zagreb regimen and Essen regimen). We analyzed the levels of RVNA, and compared the immune efficacy of domestic PVRV and imported PCECV using different immunization regimens. The results showed that the immune efficacy of domestic PVRV using the Zagreb regimen was as good as that of the imported PCECV, but virus antibodies were generated more rapidly with the Zagreb regimen than with the Essen regimen. The RFFIT procedure established in our laboratory will enhance the comprehensive detection ability of institutions involved in rabies surveillance in China.