Mapping rabies distribution in China: a geospatial analysis of national surveillance data

Objectives: Dog-mediated human rabies remains an important public health problem in China. In this study, we aimed to understand the spatiotemporal variation of rabies and examine its nonmedical eco-logical factors. Methods: In this study, we used the annual incidence data for rabies at the province level in China to describe the incidence trends for the period 2004-2019 and used a Bayesian hierarchical spatiotemporal model to determine the impacts of environmental, economic, and demographic factors. Results: From 2004 to 2019, there were 26,593 cases reported in 31 provinces in Mainland China, and the annual incidence increased from 0.02 per 10 0,0 0 0 in 20 04 to 0.14 in 2007, substantially decreased in 2008, and was gradually declining thereafter. Guizhou, Guangxi, Hunan, and Hainan were four high-risk provinces, and Yunnan and Anhui provinces showed an increased risk in 2018 and 2019. Temperature and per capita gross domestic product were significantly positively correlated with the disease risk. The stan-dardized morbidity ratio of rabies is likely to increase by 28% (relative risk: 1.28, 95% credible interval: 1.13-1.36) for every 1 degrees C rise in temperature, and 17% (relative risk: 1.17, 95% credible interval: 1.01-1.34) for every 10,0 0 0 yuan increase in per capita gross domestic product. Conclusion: In most provinces in China, the risk of rabies has been reduced to a persistently low level. However, the progress of rabies control in six provinces have been less than satisfactory. The study high-lights interventions, such as enhancing animal vaccination need to be implemented in these priority areas. (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Automated summary

This study aimed to understand the spatiotemporal variation and nonmedical ecological factors of rabies in China. The annual incidence data from 2004 to 2019 revealed an increasing trend followed by a gradual decline in most provinces. Guizhou, Guangxi, Hunan, and Hainan were identified as high-risk provinces, while Yunnan and Anhui showed an increased risk in recent years. Temperature and per capita gross domestic product were significantly correlated with the disease risk. The study suggests the need for interventions, especially in the six provinces with unsatisfactory control progress.