[Epidemiological trends and spatiotemporal distribution of rabies in China, 2010-2024]

Objective: To characterize the temporal trends and spatiotemporal distribution of human rabies in China from 2010 to 2024, and provide evidence for identification of priority control areas, detection of emerging epidemic areas, and development of targeted prevention strategies. Methods: The incidence data of rabies were collected during 2010-2024 from Infectious Disease Reporting Information Management System of Chinese Disease Prevention and Control Information System.Temporal trend was analyzed by using Joinpoint regression 4.9.1 software. Spatial autocorrelation at the county level was evaluated by using software ArcGIS 10.8. Spatiotemporal clustering was identified by using software SaTScan 9.3, and seasonal pattern was analyzed by using circular distribution method. Results: A total of 10 958 rabies cases were reported in China during the study period with a mean annual incidence rate of 0.05/100 000. The incidence of rabies declined markedly (average annual percent change=-7.55%, t=-5.36,P<0.001). The rabies incidence exhibited clear seasonality, with 5 398 cases (49.26%) occurring between July and November, and a noticeable delay in incidence peak and epidemic period was observed during 2019-2024. Men (7 743 cases) were mainly affected compared with women (3 215 cases), the difference was significant (χ²=111.06, P<0.001). The majority of cases were aged 15-64 years (63.16%), the proportion of the cases in those aged ≥65 years increased substantially from 17.75% to 39.29% with a peak of 44.36%. The majority of the cases were farmers (71.47%). The top three provinces in terms of cumulative cases were Guangxi Zhuang Autonomous Region (1 428 cases), Hunan Province (1 109 cases), and Guangdong Province (1 049 cases). In 2024, up to 90.98% (111/122) of the affected counties were historical epidemic areas. Spatial autocorrelation analysis revealed significant clustering (Moran's I: 0.05-0.28, P<0.001), the hotspots were mainly in southwestern and southern China, showing a northward expansion. Spatiotemporal scanning analysis identified six statistically significant clustering areas, mainly located in interprovincial border areas. No new clustering areas were detected after February 2016. Conclusions: From 2010 to 2024, the human rabies incidence in China declined substantially, with a change of wide transmission to low-level sporadic pattern. High-risk areas shifted northward, with more transmission in historical epidemic areas. Middle-aged and older male farmers remained the most affected population, indicating that it is necessary to target the areas and populations at high risk and improve the resource allocation based on current comprehensive prevention and control measures to further reduce the incidence of rabies.