Human rabies in China: evidence-based suggestions for improved case detection and data gathering

Area of Science:

• Veterinary Medicine
• Infectious Diseases
• Public Health

Background:

• Rabies remains a significant public health concern in China, despite declining reported cases.
• A disparity exists between clinically diagnosed and laboratory-confirmed human rabies cases, hindering accurate surveillance.
• This study focuses on enhancing laboratory diagnosis of rabies through specimen analysis.

Purpose of the Study:

• To analyze specimens from human rabies cases over 15 years to improve laboratory diagnosis.
• To identify optimal sample types and collection times for ante-mortem rabies detection.
• To refine the national rabies surveillance program based on diagnostic findings.

Main Methods:

• Analysis of 271 samples from 164 suspected human rabies cases (2005-2019).
• Collection of ante-mortem (saliva, CSF, serum, urine) and post-mortem (brain, skin, cornea) specimens.
• Testing specimens using reverse transcription-polymerase chain reaction (RT-PCR) and fluorescent antibody test (FAT).

Main Results:

• Saliva yielded the highest positive test results (32%) among ante-mortem fluids.
• Serum or blood specimens collected within the last 3 days of life tested positive via RT-PCR.
• Comparison of positive results across different sample types and disease stages informed sampling strategies.

Conclusions:

• Serum/blood samples from the terminal phase of illness are valuable for detecting rabies virus RNA.
• Saliva, CSF, and terminal serum/blood are suitable for ante-mortem rabies diagnosis.
• Inclusion of terminal serum sample testing enhances national rabies surveillance and laboratory diagnosis.