Epidemiology of animal bite injuries in North of Fars province in Iran

Objective:To investigate the epidemiological situation of animal bites in Rostam city of Fars province.Methods:This is a cross-sectional study.Cases of animal bites registered in health centers of Rostam city of Fars province from the beginning of 2014 to 2020 were analyzed using the census method.The tool for collecting information was the portal of the Ministry of Health and the registration offices of people who were referred to the rabies center.Results:A total of 628 cases of animal bites registered in health centers of Rostam city of Fars province from the beginning of 2014 to 2020.The mean age of the injured was(31.3±20.2)years.Of the total injured cases,414(65.9%)were male,and 491(78.2%)lived in villages.Most of the cases were bitten by dogs(n=420,66.8%)and the upper limb was involved in 280(55.2%)cases.In addition,an increasing trend was observed in the incidence of animal bites from 2015 to 2020.Conclusions:The incidence of animal bites in Rostam City is high,and most of the cases occur in rural areas.Considering the injuries caused by animal bites,the risk of rabies transmission,and the high costs of vaccination and serum therapy,it is necessary to hold control,educational,and vaccination programs.

Non-Communicable Diseases During the COVID-19 Pandemic and Beyond

1.Introduction The coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has swept the globe as a pandemic[1].As of 1 April 2021,there were about 129.5 million confirmed cases of COVID-19,and 2.8 million deaths attributable to COVID-19[2].While some countries have suppressed COVID-19,most governments worldwide are still mobilizing available resources to contain the spread of SARS-CoV-2 in communities,facilitate COVID-19 treatments in hospitals,expand COVID-19 vaccination,and accelerate drug and vaccine development[3].

Epidemiological patterns of animal bites in Abadeh district of central Iran from 2012 to 2018: A cross-sectional study

Objectives:To investigate the epidemiology of animal bites and associated factors in Abadeh district(central Iran)from 2012 to 2018.Methods:In this cross-sectional study,1407 individuals with animal bites who were referred to the Abadeh Rabies Treatment Center were investigated by using the census method from 2012 to 2018.The variables included the victim's demographic information(age,gender,occupation),the type of biting animals(dog,cat,and other animals),the domesticated and wild animals,the time of biting based on year and month,the residence location(urban or rural),the treatment status,and the anatomical location of the wounds.Results:The annual incidence rate of animal bites was 189.62 per 100000 population.Totally 83.4%of the victims were male.The average age was(33.66±18.97)years and individuals in the age range of 36-50 years were greater at risk.Most of the animal bites were from dogs(77.8%).About two thirds(62.1%)of the bites were from household animals.A total of 57.1%of individuals lived in urban areas.Most victims were engaged in farming and animal husbandry.The highest prevalence of animal bites(37.4%)happened in the summer.None of the patients had any clinical signs of rabies.Conclusions:To reduce the incidence of animal bites,high-risk groups including farmers and ranchers should be educated about bite prevention,and it should be ensured that they are managed correctly.

Epidemiological patterns of animal bites in Yazd Province (central Iran) between 2013 and 2017

Objective:To investigate the epidemiological pattern of animal bites in Yazd Province,central Iran.Methods:In this cross-sectional study,8 545 individuals with animal bites who were referred to the Yazd Province Rabies Treatment Center were investigated using the census method from April 2013 to March 2017.The variables included:demographic information,household living condition,the type of biting animals,the domesticated and wild animals,the time of biting based on year,the residence location (urban or rural),and the treatment status.Data were analyzed by descriptive statistics using Excel 2013,SPSS version 25 and Arc GIS 14.1 Software.Results:A total of 8 545 cases of animal bites were reported in Yazd province from 2013 to 2017.The most animal bites (with 4 253 case of bites) and the lowest animal bites (with 121 case of bites) occurred in Yazd and Bahabad district,respectively.The incidence of animal bites was 168.4 per 100 000 people during the five-year period.Most of cases (73.9%) occurred in urban areas.Dog and cat bites accounted for 47.6% and 47.4% of all cases,respectively.Most of animal bites were reported in the summer (29.4%).Sixty percent of the cases received incomplete treatments,while 40% of them received complete treatments.During this study,three positive cases of fatal rabies from dog bites were reported.Conclusions:The incidence of animal bites is high in Yazd province,and more patients are bitten by dog and cat.Hence,educational,preventive,and informative programs are required to reduce the incidence of animal bites.

High prevalence of soil-transmitted helminths in Southern Belize-highlighting opportunity for control interventions

Objective:To assess prevalence and intensity of soil-transmitted helminths(STH) in school age children of two southern districts as baseline information prior to implement a deworming program against intestinal parasites as part of an integrated country development plan.Methods:Children randomly selected from urban and rural schools in Southern Belize provided one stool sample each,analysed by the Kato-Katz method to assess prevalence and intensity of STH infections.Epi Info software was used for data analysis;Chi-square test and Fischer exact test were applied to compare group proportions;P<0.05 was considered of statistical significance;descriptive statistics were expressed as percentages.Results:A total of 500 children from 10 schools participated in the study from May to December2005.Prevalence of STH ranged between 40%and 82%among schools,with a median of 59.2%;the majority of light intensity,and with 2.2%high intensity infection.Trichuris and Axaris infections presented similar frequency in children aged from 6 to 9 years old;hookworm infections tended to be more frequent in the older group 10 to 12 years old.Statistical significances(P≤0.01)were found in children in rural schools infected with any species of STH,in moderate Trichuris infections,in hookworm infections in rural areas with strong Mayan presence and in Ascaris infections in children of Mayan origin.Conclusions:High prevalence of STH in Southern Belize provided sound ground for implementing an integrated deworming control program.

Determining endemic values of cutaneous leishmaniasis in Iranian Fars province by retrospectively detected clusters and receiver operating characteristic curve analysis

Objective: To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29 201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic(ROC) curve. SPSS version 22, Arc GIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters(P<0.05) resulted in finding seven significant and accurate endemic values(P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.

Establishment of an early warning system for cutaneous leishmaniasis in Fars province, Iran

Objective:To establish an early warning system for cutaneous leishmaniasis in Fars province,Iran in 2016.Methods:Time-series data were recorded from 29 201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models.Different models were compared via Akaike information criterion/Bayesian information criterion statistics,residual analysis,autocorrelation function,and partial autocorrelation function sample/model.To decide on an outbreak,four endemic scores were evaluated including mean,median,mean+ 2 standard deviations,and median+ interquartile range of the past five years.Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included,and there were no exclusion criteria.Results:Regarding four statistically significant endemic values,four different cutaneous leishmaniasis space-time outbreaks were detected in 2016.The accuracy of all four endemic values was statistically significant(P<0.05).Conclusions:This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps:(i)to define endemic values based on which we could verify if there is an outbreak,(ii)to set different time-series models to forecast cutaneous leishmaniasis in future,(iii)to compare the forecasts with endemic values and decide on space-time outbreaks,and(iv)to set an alarm to health managers.

Causes of delay in offering rabies post-exposure prophylaxis services in Abadeh district of Iran

Objective:To identify the reasons for delayed reception of post-exposure prophylaxis(PEP).Methods:In this cross-sectional study,a total of 1407 individuals with animal bites who were referred to the Abadeh Rabies Treatment Center were investigated using the census method from January 2012 to December 2018.The patients were divided into two groups based on their delay times to referral and receive PEP:timely referral(less than 48 h after the bite)and delayed referral(equal to or longer than 48 h after the bite).Frequency,Chi-square,and logistic regression tests were used.Results:.The average delay time was(16.33±11.37)h.Low level of education(OR:3.87;95%CI:1.19-12.54;P=0.02),active economic age(21-35 and 36-50 years-old,OR:12.81;95%CI:3.16-51.97;P<0.001 and OR:3.83,95%CI:3.83-58.61;P<0.001 respectively),occupation(OR:9.16;95%CI:1.89-44.29;P=0.006),long distance from the rabies treatment center(OR:3.41;95%CI:2.03-5.72;P<0.001),bites by household and domestic animals(OR:12.22;95%CI:2.29-65.18,P=0.003),superficial injuries(OR:4.51;95%CI:1.38-14.73;P=0.01),and residence in rural area(OR:12.74;95%CI:6.58-24.66;P<0.001)had significant correlations with delayed referral of victims.Conclusions:To reduce the delay time,the high-risk groups should be informed about the importance of timely referral via educational measures.Furthermore,rabies treatment services should be rendered at the nearest possible center.

First molecular identification of Leishmania species in a new endemic area of cutaneous leishmaniasis in Lorestan,Iran

Objective:To identify Leishman{u using PCR.Methods:This studs was conducted from April2009 to March 2011 in order to identify Leishmania species in a new endemic area of CL in Lorestan.Iran.Samples were taken from 62 patients that referred to the health centers in different cities of Lorestan province,the presence of Leishmcania was confirmed using direct smear and then grown in NNN media and mass cultured in RPM!1640 medium supplemented with 10%heat-inactivated fetal bovine serum.DNA was extracted from cultured promastigotes and used in P15-PCR.Results:45(72.6%)samples out of 62 showed a hand in the range of 485 hp and 17(27.4%)with a hand in the range of 626 hp which were similar to standard strains of Leichmania tropica(L.tropical and Leishnrania major(L.major),respectively.50(65.80%)of samples were collected from people with no history of travel in at least a year prior to the onset which shows that indigenous source of infection.Conclusions:Since the vector and reservoir of the two species are different.so precise and extensive control and prevention methods should be designed and earned out.

Correlation between Load of HPV 16 DNA in Cervical Cancer and HPV 16 DNA in Lymph Nodes

OBJECTIVE To determine the association between viral loadof human papillomavirus 16 (HPV16) DNA in the primary focusof cervical carcinoma and HPV16 DNA in pelvic lymph nodes.METHODS The HPV16 DNA load was measured by fluorescentquantitation polymerase chain reaction (FQ-PCR) in 17 primaryfoci. HPV16 DNA was detected by polymerase chain reaction(PCR) using HPV16 type-specific primers in 296 pelvic lymphnodes which were from 17 cases of cervical cancer.RESULTS The viral load of HPV16 DNA showed statisticallysignificant differences between tumors with a diameter of < 4cm and ≥ 4 cm (P < 0.05). Seven of 17 cervical cancer cases hadHPV16 DNA positive lymph nodes, designated as the positivegroup, while the remaining 10 without positive lymph nodes wasdesignated the negative group. The average load of HPV16 DNAshowed no significant difference between the 2 groups (P > 0.05).The load of HPV16 in the primary lesion was not associated withthat in the lymph nodes. There were 38 HPV16 DNA positivenodes in the total 296 nodes. The rate of positivity of HPV16 DNAin lymph nodes showed statistically significant differences inconsideration of maximum tumor diameter, tumor differentiation,histologic type, depth of myometial infiltration and the metastaticstatus of the nodes, respectively (P < 0.05).CONCLUSION Viral load of HPV16 in the primary cancer focuscorrelated with the quantity of tumor cells in the primary focusbut not with the existence of HPV DNA positive lymph nodes.Detection of HPV DNA may help to find the early metastases thatcannot be evaluated histopathologically, but the prognostic valueof HPV positive lymph nodes needs further examination.

Number of Daily Doses Does Not Affect Compliance with Flucloxacillin Prescriptions

Objective: To achieve optimal effect with beta-lactam antibiotics, regimens with frequent dosages have been found necessary. However, if compliance is negatively influenced by more frequent dosages, this might hamper the effect of the treatments. Therefore, we have studied whether the numbers of daily dosages influence the compliance with prescribed flucloxacillin regimens. Design: A prospective interview study of patients with different dosing regimens of flucloxacillin. Setting: In the study, 200 patients with different dosing regimens of flucloxacillin underwent structured telephone interviews in order to reveal their compliance with the medication. Of these, 13 were prescribed twice-daily doses, 163 three times daily and 24 patients four times daily regimens. Results: There were no statistically significant differences between missed doses and prescribed numbers of daily doses. There was, however, a significant difference in the number of daily doses and experiences associated with the medication. Conclusions: This study shows that patients comply well with regimens of up to four daily doses of flucloxacillin, despite experiencing increasing difficulties with regimens of more frequent dosages.

Evaluation on Common Hand, Foot and Mouth Disease Treated by Integrative Traditional Chinese Medicine and Western Medicine

Objective To evaluate the efifcacy and safety of traditional Chinese medicine (TCM) combined with Western medicine in the treatment of patients with common hand, foot and mouth disease (HFMD) by conducting a prospective, controlled, and randomized trial. Methods A total of 452 patients with common HFMD were randomly assigned to receive Western medicine alone (n=220) or combined with TCM (Reduning or Xiyanping injections) (n=232). The primary outcome was the incidence rate of rash/herpes disappearance within 5 days, while secondary outcomes included the incidence rate for fever, cough, lethargy, agitation, and vomiting clearance within 5 days. Results The rash/herpes disappearance rate was 45.5% (100/220) in Western medicine therapy group, and 67.2% (156/232) in TCM and Western medicine combined therapy group, with significant difference (P<0.001). Moreover, TCM remarkably increased the incidence rate of secondary disappearance, which was 56.4%in Western medicine therapy group and 71.4%in TCM and Western medicine combined therapy group (P=0.001). No drug-related adverse events were observed. Conclusions It’s suggested that the integrative TCM and Western medicine therapy achieved a better therapeutic efficacy. TCM may become an important complementary therapy on relieving the symptoms of HFMD.

Does prospective permutation scan statistics work well with cutaneous leishmaniais as a high-frequency or malaria as a low-frequency infection in Fars province, Iran?

Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis(CL) or for malaria in Fars province, Iran in 2016. Methods: Using time-series data including 29 177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software. Results: A total of 5 359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied timeseries models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria(Pv was set to 0.1). The results indicated two significant prospective spatial-temporal outbreaks for CL(P<0.5) including Most Likely Clusters, and one non-significant outbreak for malaria(P>0.5) in the area. Conclusions: Both CL and malaria follow a space-time trend in the area, but prospective permutation scan modeling works better for detecting CL spatial-temporal outbreaks. It is not far away from expectation since clusters are defined as accumulation of cases in specified times and places. Although this method seems to work better with finding the outbreaks of a high-frequency disease; i.e., CL, it is able to find non-significant outbreaks. This is clinically important for both high-and low-frequency infections; i.e., CL and malaria.

Hepatitis C virus among blood donors and general population in Middle East and North Africa:Meta-analyses and meta-regressions

BACKGROUND Despite the Middle East and North Africa(MENA)Region reported to have the highest prevalence of hepatitis C virus(HCV)globally,HCV infection levels in the majority of MENA countries remain inadequately characterized.Blood donor data have been previously used as a proxy to assess levels and trends of HCV in the general population,however,it is unclear how comparable these populations are in MENA and whether blood donors provide an appropriate proxy.AIM To delineate HCV epidemiology among blood donors and the general population in the MENA.METHODS The data source was the systematically gathered MENA HCV Epidemiology Synthesis Project Database.Random-effects meta-analyses and meta-regressions were conducted.For comparison,analyses were conducted for Europe,utilizing the Hepatitis C Prevalence Database of the European Centre for Disease Prevention and Control.RESULTS One thousand two hundred and thirteen HCV antibody prevalence measures and 84 viremic rate measures were analyzed for MENA.Three hundred and seventyseven antibody prevalence measures were analyzed for Europe.In MENA,pooled mean prevalence was 1.58%[95%confidence interval(CI):1.48%–1.69%]among blood donors and 4.49%(95%CI:4.10%–4.90%)in the general population.In Europe,pooled prevalence was 0.11%(95%CI:0.10%–0.13%)among blood donors and 1.59%(95%CI:1.25%–1.97%)in the general population.Prevalence in the general population was 1.72-fold(95%CI:1.50–1.97)higher than that in blood donors in MENA,but it was 15.10-fold(95%CI:11.48–19.86)higher in Europe.Prevalence was declining at a rate of 4%per year in both MENA and Europe[adjusted risk ratio:0.96(95%CI:0.95–0.97)in MENA and 0.96(95%CI:0.92–0.99)in Europe].Pooled mean viremic rate in MENA was 76.29%(95%CI:67.64%–84.02%)among blood donors and 65.73%(95%CI:61.03%–70.29%)in the general population.CONCLUSION Blood donor data provide a useful proxy for HCV infection in the wider population in MENA,but not Europe,and could improve HCV burden estimations and assess progress toward HCV elimination by 2030.

Effect of Integrated Chinese and Western Medicine Therapy on Severe Hand, Foot and Mouth Disease: A Prospective, Randomized, Controlled Trial

Objective: To evaluate the efficacy and safety of Chinese medicine(CM) plus Western medicine(WM) in the treatment of pediatric patients with severe hand, foot and mouth disease(HFMD) by conducting a prospective, controlled, and randomized trial. Methods: A total of 451 pediatric patients with severe HFMD were randomly assigned to receive WM therapy alone(224 cases, WM therapy group) or CM [Reduning Injection(热毒宁注射液) or Xiyanping Injection(喜炎平注射液)] plus WM therapy(227 cases, CM plus WM therapy group) for 7–10 days, according to a web-based randomization system. The primary outcome was fever clearance time, which was presented as temperature decreased half-life time. The secondary outcomes included the rate of rash/herpes disappearance within 120 h, as well as the rate for cough, runny nose, lethargy and weakness, agitation or irritability, and vomiting clearance within 120 h. The drug-related adverse events were also recorded. Results: The temperature decreased half-life time was 40.4 h in the WM therapy group, significantly longer than 27.2 h in the CM plus WM therapy group(P<0.01). Moreover, the rate for rash/herpes disappearance within 120 h was 43.6%(99/227) in the CM plus WM therapy group, significantly higher than 29.5%(66/224) in the WM therapy group(P<0.01). In addition, the rate for cough, lethargy and weakness, agitation or irritability disappearance within 120 h was 32.6%(74/227) in the CM plus WM therapy group, significantly higher than 19.2%(43/224) in the WM therapy group(P<0.01). No drug-related adverse events were observed during the course of the study. Conclusions: The combined CM and WM therapy achieved a better therapeutic efficacy in treating severe HFMD than the WM therapy alone. Reduning or Xiyanping Injections may become an important complementary therapy to WM for relieving the symptoms of severe HFMD.

A Case of New Variant COVID-19 First Emerging in South Africa Detected in a Security Guard at the Isolation Point—Shenzhen,China,January 23,2021

On January 22,2021,a 34-year-old male,who served as a security guard at the isolation point in Shenzhen,tested positive for coronavirus disease 2019(COVID-19)during the every-three-day routine test.After the nasopharyngeal swab was further confirmed as positive for COVID-19 by Shenzhen CDC,the patient was transferred to the Third People’s Hospital of Shenzhen and was diagnosed as a COVID-19 asymptomatic infection.On January 25,2021,Shenzhen CDC identified the 20H/501.Y.V2(B.1.351)variant,which was a variant of COVID-19 virus first emerging in the South Africa.

Genetic diversity of Plasmodium vivax revealed by the merozoite surface protein-1 icb5-6 fragment

Background:Plasmodium vivax remains a potential cause of morbidity and mortality for people living in its endemic areas.Understanding the genetic diversity of P.vivax from different regions is valuable for studying population dynamics and tracing the origins of parasites.The PvMSP-1 gene is highly polymorphic and has been used as a marker in many P.vivax population studies.The aim of this study was to investigate the genetic diversity of the PvMSP-1 gene icb5-6 fragment and to provide more genetic polymorphism data for further studies on P.vivax population structure and tracking of the origin of clinical cases.Methods:Nested PCR and sequencing of the PvMSP-1 icb5-6 marker were performed to obtain the nucleotide sequences of 95 P.vivax isolates collected from Zhejiang province,China.To investigate the genetic diversity of PvMSP-1,the 95 nucleotide sequences of the PvMSP-1 icb5-6 fragment were genotyped and analyzed using DnaSP v5,MEGA software.Results:The 95 P.vivax isolates collected from Zhejiang province were either indigenous cases or imported cases from different regions around the world.A total of 95 sequences ranging from 390 to 460 bp were obtained.The 95 sequences were genotyped into four allele-types(Sal I,Belem,R-III and R-IV)and 17 unique haplotypes.R-III and Sal I were the predominant allele-types.The haplotype diversity(Hd)and nucleotide diversity(Pi)were estimated to be 0.729 and 0.062,indicating that the PvMSP-1 icb5-6 fragment had the highest level of polymorphism due to frequent recombination processes and single nucleotide polymorphism.The values of dN/dS and Tajima’s D both suggested neutral selection for the PvMSP-1icb5-6 fragment.In addition,a rare recombinant style of R-IV type was identified.Conclusions:This study presented high genetic diversity in the PvMSP-1 marker among P.vivax strains from around the world.The genetic data is valuable for expanding the polymorphism information on P.vivax,which could be helpful for further study on population dynamics and tracking the origin of P.vivax.

Whole-Genome Sequences Analysis Displays Relationship of SARS-CoV-2 Delta Variant Between Four Local Cases and Passengers of a Flight from South Africa—Shenzhen City,Guangdong Province,China,June 2021

On June 14,2021,a customs officer(Case A)went to the infirmary at Baoan International Airport in Shenzhen due to a runny nose and fever.He was admitted to the Central Hospital of Baoan immediately.This patient preliminarily tested positive for coronavirus disease 2019(COVID-19)infection,caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),using a quantitative realtime reverse transcription polymerase chain reaction(qRT-PCR)method in this hospital.Then,a mixed specimen of nasopharyngeal swab.

Four COVID-19 Cases of New Variant B.1.351 First Emerging in South Africa in Chinese Passengers on Same Flight-Shenzhen,China,January 2021

At 04∶50 on January 1,2021,a 36-year-old Chinese project manager(Case A),a 29-year-old Chinese worker(Case B),and a 53-year-old Chinese businessman(Case C)returned from Africa(Case A and B from South Africa and Case C from Lesotho)on the same flight and tested coronavirus disease 2019(COVID-19)RNA positive by real-time polymerase chain reaction(PCR)by Baoan District People’s Hospital.Shenzhen CDC received their oral nasopharyngeal swabs packages from the hospital and retested COVID-19 RNA positive at 09∶50.Meanwhile,Case D.

Epidemiological Characteristics of Human Rabies——Shandong Province,China,2010-2020

Introduction:Rabies is a viral zoonotic disease that causes progressive and fatal inflammation in the brain.Rabies has caused more than 5,000 human deaths in Shandong Province since 1955.This study aimed to analyze the epidemiological characteristics of human rabies in Shandong Province from 2010 to 2020 and to provide a scientific basis for policy changes.Methods:The data of reported human rabies cases from 2010 to 2020 were obtained from China’s National Notifiable Disease Reporting System,and data related to exposure and post-exposure prophylaxis(PEP)of the cases were acquired through case investigation.Results:A total of 414 human rabies cases were reported in Shandong Province from 2010 to 2020.Out of the 414 total cases,87.20%were primarily farmers;83.10%were over 40 years old.70.29%(265/377)belonged to categoryⅢexposure;and 96.67%(377/390)were exposed to the virus through infected dogs.The vaccine inoculation rate of these cases after exposure was only 8.85%;1.03%(4/390)had been vaccinated with rabies immunoglobulin,developing the disease 11 to 13 days after categoryⅢexposure.Conclusions:Dogs were still the primary animal hosts.Most rabies patients died due to no or inadequate post-exposure prophylaxis.Vaccine inoculation rates for dogs should reach the target of 70%as soon as possible.Health departments should improve the accessibility and quality of PEP;and improve the health literacy of the elderly in rural areas.