Once bitten, twice shy
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When Xin Wei, a postgraduate student at the China University of Geosciences in Beijing, was given the last of four rabies shots, she finally felt a sense of relief. The 25-year-old had been scratched by a cat, which she initially thought wasn't a big deal. But she went straight to the hospital after her mom told her about the risk of rabies.
About 12-15 million Chinese get rabies vaccinations every year, costing 3.5-5 billion yuan ($554-791 million), according to the Chinese Center for Disease Control and Prevention (CDC).
In Beijing, home to 1 million registered - and many unregistered - dogs, nearly 200,000 people get rabies vaccinations annually.
Wang Chuanlin, deputy director of the emergency department at Peking University People's Hospital, says more than 8,000 are vaccinated at his hospital every year. Summer is the peak time, and he sometimes deals with up to 70 patients a day.
China is second only to India in the number of human deaths from rabies, says Tang Qing, a researcher with Institute for Viral Disease Control and Prevention of CDC.
There were 1,917 human deaths from rabies on the mainland, including five in Beijing, in 2011, CDC figures show. Most cases were in the South and Southwest, particularly in the countryside of the Guangxi Zhuang autonomous region, and Guizhou, Guangdong and Yunnan provinces.
Ministry of Health statistics from 2009 indicate dogs were responsible for 85-95 percent of rabies cases, while cats caused 4-10 percent. The rest were caused by wild animals, such as wolves and mongooses.
"High risks groups are children and the elderly. Kids like to play with dogs and may not tell if they are bitten," Wang says.
Rabies vaccines should be taken for minor scratches or abrasions, even if there is no bleeding, Wang warns.
"Rinse the wound with running water for more than 15 minutes, and take the vaccine as soon as possible," Wang says, adding immunity develops after 10-14 days. The treatment usually takes four or five injections and costs about 400 yuan ($63).
Yin Wenwu, office director of CDC's Institute for Epidemic Disease Control and Prevention, stresses healthy animals won't spread rabies and the most cost-effective way to prevent the disease is to give dogs the vaccine, which costs just 50 yuan.
It is estimated that vaccination coverage of 70 percent of the dog population can prevent 96.5 percent of rabies cases.
The vaccination coverage rate for pet dogs is low in China compared with Western countries, Tang, the CDC researcher, says.
In some foreign countries, it's legislated that dogs must be vaccinated against rabies every year. But the rules in China vary from city to city, and there is no effective monitoring system, Tang says.
In Beijing, for example, pet-owners can get free vaccinations for registered dogs. But the problem is many people don't register their dogs because of the high fee, says Liu Lang, vice-president of the Beijing Small Animal Veterinary Association.
The situation in the countryside is more serious because many people are not aware of the importance of vaccinating their dogs, Tang says.
In 2004, the government started to tackle the disease by promoting dog vaccinations, and post-exposure treatment, especially in the countryside.
In some areas, human rabies vaccinations are covered by the public healthcare system, which offers affordable medical services to rural residents.
Rabies cases rose from the mid-1990s and peaked at 3,300 in 2007 but has since dropped.
"The rabies situation is improving, but we need to do more," Tang says.
"The prevalence of rabies in dogs is due to the way we raise dogs - the irresponsibility of owners and the veterinary system. Governmental departments need to cooperate to initiate change."
Liu Lang says all dogs in Beijing should be vaccinated and be injected a chip, which stores its basic information and health record. This is done in such cities as Jiangsu's provincial capital Nanjing. At the same time, the adoption and management of homeless animals should be strengthened.
"It's the owner's responsibility to raise a pet in a proper way," Yin says. "If you love your pet you should know more about it and make sure it is regularly vaccinated."
