Smoking cessation prospects poor | Bleak outlook for foreign-owned hospitals | 500 children die of rabies every year

Smoking cessation efforts are doomed to fail in rural China unless the culture of  giving cigarettes as gifts can be broken, say researchers from the Ministry of Health in Jinan, Shandong. Their study found that although many people in rural China attempted to quit at the advice of other family members, relapses were common and few were able to quit completely because they were culturally expected to share cigarettes. The study also found that village doctors did not smoking cessation advice to all patients and there were few if any smoking cessation programs in rural areas.

Allowing foreign companies to set up and operate hospitals in China will not make much difference to overstretched health services, a leading health official says in Caxin. Lian Xinbo says the real barriers are in employment and insurance regulations which mean that foreign companies will find it difficult to attract talented doctors and also to offer services that are reimbursed by health insurers.

More than 500 Chinese children die of rabies every year, and tragically most of the deaths could have been avoided if children had received correct treatment, say clinicians from the National Institute for Viral Disease Control and Prevention in Beijing. Most of the rabies cases occur in rural areas and are due to bites by domestic or stray dogs. However, few children with rabies get the recommended treatment of post-exposure rabies injections or even adequate wound care.

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.

Tropical diseases in China: one down, ten to go

by Michael Woodhead
China has eliminated one tropical disease - lymphatic filiarisis - but has ten others that are still affecting millions of people and some of which are becoming endemic again, according to a new report.
The good news from a review of China's tropical diseases published in The Lancet Infectious Diseases is that the country is on track to eradicate five major diseases (schistosomiasis, leishmaniasis, leprosy, rabies and trachoma) in the next five to ten years.  However, the not-so-good news is that some diseases are still uncontrolled and affect millions of people in poorer provinces of the south and west. The most problematic diseases are dengue fever, food-borne parasitic diseases such as liver flukes and Echinococcosis, according to the article by researchers at the Wuxi branch of the Ministry of Health. Professor Yang Guo Jing and colleagues from the Key Laboratory for Parasitic Diseases say that lymphatic filiarisis was eliminated from China in 2007 after a long campaign to remove it from 16 provinces by using mass drug administration techniques.
Tropical diseases in the 'near-elimination' stage include schistosomiasis, which has been successfully controlled in most parts of the country and numbers reduced from 12 million to 287,000 in 2011. The disease is spread by cattle and water buffalo, and thus changes in farming techniques are needed to help eliminate the disease. Similar improvements in control have been seen for leishmaniasis, the sandfly-spread protozoal infection which used to be common around the Yangtze river basin but now affects only about 2500 people a year. The bacterial infection trachoma that causes blindness is also close to elimination due to implementation of mass campaigns that apply WHO strategies such as facial cleanliness. Rabies has also been controlled, but still causes 2000-3000 cases a year. Immunisation of 70% of dogs at risk should break the cycle of infection, but currently only about 20% are vaccinated. Leprosy was reported to affect about 6000 people in China in 2010, of which about 1300 were new cases. Better surveillance and multi-drug treatment regimens should help eradicate the infection by 2020, the report suggests.
China has has less success with soil-transmitted helminthiasis, and there are about 85 million Chinese affected by roundworm and whipworm. De-worming of schoolchildren seems to have only modest efficacy, and so new strategies such as curbs on the use of human waste as fertiliser are needed, the report says.
The most problematic tropical diseases for China include dengue fever, with outbreaks of the mosquito-borne infection rapidly emerging as a major public health problem. Climate change is worsening the problem, which requires better monitoring and mosquito management strategies as there is no drug or vaccine for the disease.
Another major problem tropical disease for China are the food-borne parasitic zoonoses, such as liver flukes, lung flukes, and other trematodes that may be transmitted by fish, snails and freshwater plants. There are tens of millions of cases in China, which has the dubious honour of having 80% of the 15 million cases globally. New programs are needed to identify high risk disease areas and to address transmission of infection through occupational risk (eg farmers) and also consumption of high risk foods.
Control of these many tropical diseases will require huge  resources to build and design  programs specific for each disease and the high risk locations and populations they affect, the authors conclude.

Rabies rise reversed in China

by Michael Woodhead
The resurgence in rabies in China that started in the 1990s is slowly being curbed, but the infection still causes more than a thousand deaths a year, a new report shows.
After a peak of almost 3500 cases in 2007, the incidence of rabies in China has since declined by about 50%, with around 1500 reported cases in 2012, according to a study from the State Key Laboratory for Infectious Disease Prevention and Control and the Chinese Center for Disease Control and Prevention, Beijing.
Most of the cases of rabies were caused by dogs and occurred in rural areas in the south west of China. In most cases of rabies infection the disease was fatal because few people received post-exposure prophylaxis treatment, the authors of the report noted. They said there was complacency and lack of awareness about rabies in China as the disease was thought to be under control and few hospitals or clinics stocked vaccine or were aware of the need to monitor for the disease.
The study found there had been almost 20,000 cases of rabies since 2005, mostly in provinces such as Yunnan, Guangxi, Guizhou, Guangdong, Hunan and Sichuan. However, while authorities had managed to curb the re-emergence in rabies with new control programs in those provinces there were signs that the disease was spreading to northern and western provinces, including Beijing.
Writing in BMC Infectious Diseases, the researchers said rabies was on the increase because of the increasing ownership of dogs and domestic animals in China.
They said there was a need for greater rabies control efforts, including inoculation of domestic animals such as dogs in high risk areas.

Rabies on the increase in China as pet dog ownership rises

by Michael Woodhead
Cases of rabies are increasing exponentially in China as more dogs are kept as pets, a study from Henan shows.
Dr Li Guowei and co-researchers from the Zhengzhou Center for Disease Control and Prevention say that rabies was unknown in Henan until the 1960s, and there were only about 10 cases a year until the year 2000. However, since then the number of cases of rabies has increased exponentially each year, with more than 100 reported in 2005 . The researchers say the rise in rabies has paralleled the increase in pet ownership as China became more wealthy. About one in four cases is in children who may have been bitten by domestic dogs, the article in Emerging Infectious Diseases notes.
Most patients died within two days of being exposed, and three patients who died had received rabies vaccine after being bitten by dogs.
The high cost of rabies vaccine and the lack of prompt treatment were related to many additional deaths, the researchers said.
“The severity of rabies and its increased incidence present a public health threat, and appropriate control strategies in Henan province are needed. A new rabies control system should be established that includes cooperation of the various health care sectors to provide protection to the public,” they conclude

Rabies epidemic spread by pet dogs in China - but it isn't crossing borders

Rabies is being transmitted across China from the south by relocation of domestic pet dogs

by Michael Woodhead
China's increasing affluence is behind an upsurge in rabies, which is being spread from southwestern provinces by wider ownership of pet dogs and longer distance travel, new research shows.
However the "massive resurgence" in rabies seen in China over the last 15 years is not spilling over into neighbouring countries, according to an in-depth  genetic analysis of rabies cases carried out by researchers at the  Chinese Center for Disease Control and Prevention, Beijing and Wuhan Institute of Virology.
The researchers analysed 3275 samples of dog brain tissue collected from dog meat markets across seven provinces of China. They found two main strains of rabies in 84 samples, and the strain appeared to have evolved form those seen in previous smaller Chinese outbreaks from the 1980s and 1990s.
However, apart from a few isolated cases of strains being picked up in neighboring countries such as Vietnam, the major strain responsible for the current Chinese epidemic has not been exported.
"Our observation of a dominant variant strain that is unique to China is significant in that it suggests that neighboring countries have not been seriously impacted by the epidemic. In spite of the increasing trade between China and other countries in South East Asia, it further suggests that current border controls remain effective at restricting the passage of infected animals … national geographical boundaries and border controls are effective at halting the spread of rabies from China into adjacent regions," they conclude.
Their genetic analysis found that the current rabies epidemic is dominated by variant strains of 'type B' rabies lyssavirus that originated in southwestern provinces such as Sichuan, and which were being translocated to provinces in eastern and northern China.
"It is the rapid economical expansion in China over the last twenty years that has probably had the most significant impact on the spread of rabies," they say.
"Prior to the plan for economic reform plan instigated by Deng XiaoPing, travel was more restricted and more commonly at the local level. Long distance travel was generally by train or bus and large scale transportation of goods only began to increase as the industrial infrastructure expanded. As the economy grew and relocation was more straightforward the population became more mobile. This likely facilitated the spread of [rabies virus] as people moved from villages to towns and cities, or between cities, transporting their dogs as part of the relocation process.
They say their theory is also supported by recent reports of rabies cases in Beijing where infected dogs were brought to the capital by migrant workers.
The researchers say dog meat markets are unlikely to be a major factor in the long distance spread of rabies as dogs are confined in living quarters and when transported to market and are not allowed to roam freely,as is the case with domestic pet dogs.
They say that domestic dogs are the main reservoir for rabies in China, and a government goal of eradicating rabies by 2020 will have to rely on widespread vaccination of domestic dogs if it is to be successful. There has already been some success seen with local dog vaccination programs against rabies in rural areas, and such programs should be extended beyond high prevalence areas and implemented nationally, they suggest.
Source: PLOS Neglected Tropical Diseases

Wuhan researchers develop oral vaccine for rabies

Affordable vaccine may help prevent rabies deaths in China

by Michael Woodhead
Researchers from Wuhan have helped develop a new vaccine for rabies that is based on the virus that causes kennel cough.
Publishing their research in the Journal of Virology, scientists from the State-key Laboratory of Agricultural Microbiology at the College of Veterinary Medicine, Huazhong Agricultural University, Wuhan say that untreated rabies virus infection is fatal and the disease causes 55,000 deaths a year. They note that vaccine and post-exposure treatment are effective in preventing rabies, but rabies vaccination and treatment have not been widely used in developing countries due to the high cost.
To try develop an effective and cost effective rabies vaccine they tried a new approach by using Parainfluenza virus 5 as a vaccine vector.  They note that Parainfluenza virus 5 is thought to contribute to kennel cough and kennel cough vaccines containing live PIV5 have been used in dogs for many years.
Therefore they tested a PIV5-vectored rabies vaccine in mice. A recombinaint PIV5 encoding RABV glycoprotein (G) (rPIV5-RV-G) was administrated to mice via intranasal (IN), intramuscular (IM) and oral inoculation. They found that  a single dose of the new vaccine was sufficient for 100% protection when administrated intranasally. The intramuscular route also provided very robust protection (90%-100%) against rabies. And intriguingly, the mice vaccinated orally with a single dose of vaccine showed a  50% survival rate, which is comparable to the 60% survival rate sen with the attenuated rabies vaccine.
"This is first report of an orally effective rabies vaccine candidate in animals based on PIV5 as a vector. These results indicate the rPIV5-RV-G is an excellent candidate for a new generation of recombinant rabies vaccine for humans and animals and PIV5 is a potential vector for oral vaccines," they conclude.
Source: Journal of Virology