Epidemiological Characteristics and Spatiotemporal Clustering Analysis of Human Rabies - China, 2005-2024

Rabies remains a significant zoonotic disease in China. Following comprehensive control measures implemented since 2006, annual human cases declined steadily from 2008 through 2023. However, 2024 witnessed a 36.9% increase in cases compared with 2023, indicating possible changes in transmission dynamics or control effectiveness. This study analyzes the epidemiological characteristics and spatiotemporal patterns of rabies from 2005 to 2024 to inform targeted prevention strategies.

We employed descriptive epidemiological methods to analyze the spatiotemporal distribution and demographic characteristics of rabies cases in China. Spatial clustering was assessed using global and local Moran's I statistics (P<0.05). Retrospective space-time scan analysis (2005-2024) was performed using SaTScan software to identify significant disease clusters. We conducted spatial frequency analysis by calculating the number of years each county reported at least one case during the study period; counties reporting cases in ≥10 years were classified as high-frequency areas.

Following a peak of 3,300 cases in 2007, rabies incidence declined continuously for 16 years before resurging in 2024 (167 cases, representing a 36.9% increase compared with 2023). Cases remained geographically concentrated, with 76.0% occurring in six central and southern provincial-level administrative divisions. The majority of affected counties (74%) reported only a single case. Males (70.0%), farmers (68.6%), and individuals aged 41-70 years (53.8%) comprised the highest-risk populations. Spatial analysis revealed that High-High clusters decreased in number over time. These clusters also shifted geographically: from widespread distribution across southwestern provincial-level administrative divisions (PLADs) during 2005-2014 to concentration in central agricultural zones during 2020-2024, particularly along the border regions of Henan, Hunan, Hubei, and Anhui PLADs. We identified 352 high-frequency counties. Spatiotemporal scan statistics detected seven significant clusters during 2005-2024, all located in central and southwestern regions. Outbreaks within these clusters peaked during summer and autumn months (July-November) from 2006 to 2013, with no new clusters emerging after 2014.

Our findings demonstrate that China's rabies control efforts have successfully transitioned the epidemic from widespread endemic transmission to sporadic occurrence with localized clustering. The 2024 resurgence occurred predominantly in historically endemic hotspots identified through spatial analysis. Sustaining these control achievements will require implementing precision prevention strategies specifically targeted at these persistent high-risk counties.