背景:狂犬病仍然是全球公共卫生的严重威胁,危害着人们的健康和公共卫生安全。在中华人民共和国,多部门和全面的预防和控制策略旨在广泛遏制人类狂犬病传播。这里,我们研究了中国狂犬病感染的现状,探索为响应世卫组织“到2030年零狂犬病死亡”的雄心而采取的战略干预措施,并严格评估在中国消除狗介导的狂犬病的制约因素和可行性。
方法:本研究从五个角度分析和评估了中国犬介导狂犬病的消除过程:人类,狗,政策,挑战,和前景。关于中国狗介导狂犬病消除进展的循证数据来自许多来源;使用PubMed进行了文献检索,WebofScience和CNKI数据库,来自中国公共卫生科学数据中心的人类狂犬病病例分布数据以及政策和文件数据均来自中国相关部委的官方网站。
结果:自2007年以来,中国狂犬病病例的发病率呈逐年下降趋势。实行政府主导,到2020年,多部门“一个健康”的方法已经将全国狂犬病死亡总数降至200人左右。报告人类狂犬病病例的省级行政区划(PLAD)数量在2020年也减少到21个,其中13个报告的病例少于10个。此外,在过去的二十年中,寻求狂犬病暴露后预防的门诊病人数量急剧增加,需求比最初高15倍。然而,仍然存在,中国不同地区狂犬病消除结果存在显著差距。迄今为止,尚未达到达到>75%的犬狂犬病疫苗接种率的目标。在欠发达城市和农村地区,狗的狂犬病免疫接种和狗管理的挑战需要与更有效的动物监测和野生动植物和牲畜的狂犬病风险一起解决。
结论:中国政府主导,多部门“一个健康”的方法来打击狂犬病,并在过去十年取得了重大进展。制定和采用更具成本效益的“一个健康”战略可以实现更多有益于全国的狂犬病消除结果。“到2030年狂犬病零死亡”的宏伟目标可以通过狗大规模疫苗接种运动在狗中建立持久的群体免疫力来实现,狗种群管理,流行病学监测和大规模口服狂犬病疫苗的应用,以消除野生动物中的狂犬病,并部署具有成本效益的人类暴露后预防,和社区教育。
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.