Progress towards dog-mediated rabies elimination in PR China:a scoping review

Background Rabies continues to be a serious threat to global public health endangering people’s health and public health safety.In the People’s Republic of China,multi-sectoral and comprehensive prevention and control strategies have aimed to extensively curb human rabies transmission.Here,we examine the current state of rabies infection in China,explore strategic interventions put in place in response to WHO’s ambition of“Zero rabies deaths by 2030”and critically assess the constraints and feasibility of dog-mediated rabies elimination in China.Methods This study analyzed and evaluated the process towards dog-mediated rabies elimination in China from five perspectives:namely,human,dog,policy,challenge,and prospects.Evidence-based data on progress of dog-mediated rabies elimination in China was derived from a number of sources;a literature search was undertaken using PubMed,Web of Science and CNKI databases,distribution data for human rabies cases as derived from the Data-center of the China Public Health Science and policy and document data were obtained from official websites of the relevant China ministries and commissions.Results The incidence of human rabies cases in China have shown a downward trend year-on-year since 2007.Implementation of a government-led,multi-sectoral“One Health”approach to combating rabies has driven down the total number of rabies deaths nationwide to around 200 in 2020.The number of provincial-level administrative divisions(PLADs)reporting human cases of rabies has also decreased to 21 in 2020,13 of which reported less than 10 cases.Furthermore,the number of outpatient visits seeking rabies post-exposure prophylaxis has risen dramatically over the past two decades,with demand being 15 times higher than it was initially.There remain however,significant gaps in rabies elimination outcomes across the different regions of China.To date the target of achieving a canine rabies vaccination rate of>75%has not been met.The challenges of rabies immunization of dogs and dog management in underdeveloped cities and rural areas need to be addressed together with more effective animal surveillance and rabies risk from and too wildlife and livestock.Conclusions The Chinese government-led,multi-sectoral“One Health”approach to combating rabies and has made significant progress over the past decade.Development and adoption of more cost-effective One Health strategies can achieve more nationally beneficial rabies elimination outcomes.The ambitious target of“Zero rabies deaths by 2030”can be met through establishment of long-lasting herd immunity in dogs by means of dog mass vaccination campaigns,dog population management,epidemiological surveillance and the application of large-scale oral rabies vaccine to eliminate rabies in wild animals coupled with deployment of cost-effective human post-exposure prophylaxis,and community education.

Determining the spatial distribution of environmental and socio-economic suitability for human leptospirosis in the face of limited epidemiological data

Background:Leptospirosis is among the leading zoonotic causes of morbidity and mortality worldwide.Knowledge about spatial patterns of diseases and their underlying processes have the potential to guide intervention efforts.However,leptospirosis is often an underreported and misdiagnosed disease and consequently,spatial patterns of the disease remain unclear.In the absence of accurate epidemiological data in the urban agglomeration of Santa Fe,we used a knowledge-based index and cluster analysis to identify spatial patterns of environmental and socioeconomic suitability for the disease and potential underlying processes that shape them.Methods:We geocoded human leptospirosis cases derived from the Argentinian surveillance system during the period 2010 to 2019.Environmental and socioeconomic databases were obtained from satelite images and publicly available platforms on the web.Two sets of human leptospirosis determinants were considered according to the level of their support by the literature and expert knowledge.We used the Zonation algorithm to build a knowledge-based index and a clustering approach to identify distinct potential sets of determinants.Spatial similarity and correlations between index,clusters,and incidence rates were evaluated.Results:We were able to geocode 56.36%of the human leptospirosis cases reported in the national epidemiological database.The knowledge-based index showed the suitability for human leptospirosis in the UA Santa Fe increased from downtown areas of the largest cities towards peri-urban and suburban areas.Cluster analysis revealed downtown areas were characterized by higher levels of socioeconomic conditions.Peri-urban and suburban areas encompassed two clusters which differed in terms of environmental determinants.The highest incidence rates overlapped areas with the highest suitability scores,the strength of association was low though(CSc r=0.21,P<0.001 and ESc r=0.19,P<0.001).Conclusions:We present a method to analyze the environmental and socioeconomic suitability for human leptospirosis based on literature and expert knowledge.The methodology can be thought as an evolutive and perfectible scheme as more studies are performed in the area and novel information regarding determinants of the disease become available.Our approach can be a valuable tool for decision-makers since it can serve as a baseline to plan interventionmeasures.