Survey on the current status of rabies post-exposure prophylaxis clinics construction and the surveillance of rabies-exposed individuals in China, 2022

BACKGROUND: Rabies continues to pose a significant public health challenge in China. To offer a scientific foundation for formulating rabies prevention and control strategies, this study conducted a national survey to comprehend the current status of rabies post-exposure prophylaxis (PEP) clinics construction and the surveillance of rabies-exposed individuals in China. METHODS: The Chinese Center for Disease Control and Prevention (CCDC) developed a national rabies prevention and control questionnaire, and conducted a survey across 31 provinces in Mainland China. The questionnaire was completed by the person in charge of rabies prevention and control in each provincial disease prevention and control institution. RESULTS: By the end of 2022, 24,304 PEP clinics were reported in Mainland China. The number of PEP clinics per capita in China is 1.75 per 100,000. Nationwide, 47% of PEP clinics were capable of handling category III exposures. A total of 10,770,543 PEP clinic visits were reported. East China reported the highest number of rabies exposures (4,022,265). Among category III exposures, only 35% reported using rabies immunoglobulin (RIG). 97% of rabies exposures were attacked by dogs or cats. In South China, exposures caused by cats were nearly as frequent as those caused by dogs (47% and 48% respectively). CONCLUSIONS: The distribution of PEP clinics across China is uneven. This pattern appears broadly consistent with the historical geographic distribution of rabies risk, which may reflect a risk-informed allocation of resources. We recommended implementing tiered prevention and control strategies, with emphasis on enhancing the stockpile of RIG, dogs and cats population management, and health education in regions with higher rabies exposure risks. In provinces with a high incidence of rabies outbreaks, it is essential to actively advocate for the inclusion of rabies vaccines and RIG in the reimbursement scope of the New Rural Cooperative Medical Insurance Scheme, and raise the reimbursement rate and limit. The "One Health" approach should be adopted, including mandatory immunization and surveillance management systems for dogs and cats.