Nearly 700 dead in Yunnan rabies epidemic - mass culling of dogs needed to stop spread to Lijiang and Dali

by Michael Woodhead
Yunnan is in the midst of a rabies crisis and drastic action is needed to curb the disease in dogs before it spreads to popular tourist towns such as Lijiang and Dali, Chinese researchers say

In the year 2000 there were only three cases of rabies in the whole of Yunnan, but in the following decade there was an epidemic of the disease and 663 people died. The explosion in rabies cases has mostly affected eastern parts of the province adjacent to Guizhou and Sichuan, and the rabies cases are linked to increasing ownership of dogs in rural areas - and better transport links.

In a report published in the journal Emerging Infectious Diseases this week, researchers from the Yunnan Institute of Endemic Diseases Control and Prevention say a mass culling of dogs in the province is urgently needed to curb the ongoing spread of rabies. They say many rural households have dogs that are apparently healthy but harbouring and spreading rabies. Vaccination is not practical for the tens of thousands of poorly supervised dogs in rural towns and villages, and therefore culling is the only realistic option, they say.

In their article they says that rabies had been all but eliminated from Yunnan by the late 1990s after serious outbreaks in the 1980s. In the year 2000 there were just 3 cases in one county, but since then the disease has spread to 77 counties within the province and the epidemic shows no sign of abating. The problems has become so bad that Yunnan is now the focal point for the spread of rabies not just within China but also for neighbouring counties such as Laos and Burma, they claim.

Rural families often own two to three dogs and there is little legislation to enforce vaccination, they note. In addition, better road links and increased ownership of vans and cars means that dogs are now traded over a much wider area and they are also sold to restaurants for dog meat.

They propose a four point plan for the most severely affected regions of Yunnan, which include Wenshan, Zhaotong, Qujing, and Honghe counties.

1 Domestic dogs should be confined in the household at all times.
2. All unsupervised dogs and domestic dogs within the affected villages to be killed.
3. Vaccination of all  dogs in neighboring villages as an emergency and temporary measure.
4. Provide free rabies vaccination to all susceptible people and educate local inhabitants regarding the
risk of rabies.

If these measures are not adopted immediately, rabies can be expected to spread to the tourists towns of Lijiang and Dali, they warn. In the longer term, compulsory vaccination programs for all dogs will be needed to curb rabies. However, they are pessimistic about the prospects for such a campaign.

"The greatest obstacle to removing the threat of rabies is the low level of political commitment because dogs are not regarded as economically useful animals in Yunnan Province," they conclude.

China has its first non-imported dengue outbreak in a decade

by Michael Woodhead
Last year, Yunnan experienced an explosive outbreak of  dengue fever spread by mosquitoes.

This was a strange and worrying phenomenon because Yunnan has been dengue free for many years. China has had a few outbreaks of dengue in recent years but they tend to have been in south eastern provinces such as Guangdong, and they are usually related to imported dengue fever. The infection is not endemic to Yunnan.

However, in 2013 health workers in Xishuangbanna had to deal with a huge outbreak of this often severe, life-threatening disease. There were 1245 cases of which 136 patients were hospitalised and 70 were classified as severe cases. The symptoms included severe haemorrhage (including massive vaginal and gastrointestinal bleeding), severe plasma leakage (such as pleural effusion, ascites, or hypoproteinaemia), and organ failure. Twenty of the cases  deteriorated to shock.

In an analysis of the outbreak published in the International Journal of Infectious Diseases, Dr Zhang Fuchun of the Guangzhou 8th People's Hospital say the dengue fever was caused by a new virulent strain of the virus known as serotype 3 (DENV-3). But the main reason for the severity of the outbreak was that the infection was spread  more rapidly by a different type of mosquito - Aedes. aegypti. The usual type of mosquito seen in Yunnan is known as Aedes albopictus, and dengue caused by this species tends to be milder and short lived. The researchers say the 'double whammy' of a new strain of dengue and a new strain of mosquito combined to "carries a high risk for a severe epidemic and endemicity" in an area that was until recently dengue free.

China medical news in brief

Headache and migraine a problem for one in ten Chinese children

A study of 4812 children and adolescents in Shanghai, China has found that 10% experienced a headache in the past three months. Of those who had headache, 45% were classified as having migraine. with the highest rates of migraine found at ages 14 years and 15 years. Tension-type headache accounted for 29% of headaches, while  cluster and other headache were responsible for 6.2% and 20%, respectively.
Source: Clinical Journal of Neuroscience 

Zhejiang prostitutes have high HPV rates and cervical cancer risk

Two out of three sex workers are infected with high risk subtypes of HPV putting them at increased risk of cervical cancer, a Zhejiang study has found.
Cervical samples from almost 300 female sex workers  in Huzhou, Zhejiang, showed that the prevalence of HPV was 67%, compared to 19% in the general population. Among the different types of HPV found,  HPV-16 (29%) was the most prevalent, followed by HPV-58 (24%) and HPV-52 (21%), and these were significantly associated with abnormal cervical cytology. The rate of cervical abnormalities was also higher among female sex workers (21%) than among the general population (5%). Researchers from the Huzhou Central Hospital conclude that female sex workers in the city have a greater probability of being infected with high-risk HPV, and novel vaccines against HPV-58 and HPV-52 should be developed. Using condoms could reduce the risk of infection.
Source: International Journal of Gynecology & Obstetrics 

Jiangsu simplifies medical insurance claims

Medical insurance claims can now be settled on the spot for outpatients in  Jiangsu. Outpatients from 13 cities including Changzhou, Nantong, and Wuxi can immediately settle their medical insurance if they go to see a doctor with their medical insurance cards, according to Jiangsu provincial Human Resources and Social Security Bureau.
Source: Jiangsu China.


Gay men in Yunnan have high HIV risk

More intensive HIV and STD screening and prevention campaigns are needed for gay men in Yunnan, say researchers who found a high incidence of new infections. In an 18 month study of 378 seronegative gay men in Yunnan they found that 11 became infected with HIV and 15 were infected with syphilis. Subgroups at high risk included students, retirees and minority ethnic groups, say the researchers from the No.1 Hospital of China Medical University, Nanjing.
Source: BMC Infectious Diseases.