The occurrence of a case of human rabies in Peninsular Malaysia is reported. Despite the various control measures taken, sporadic cases of rabies have continued to occur in Peninsular Malaysia, especially in the northern states. Clinical awareness of the occurrence of rabies is therefore important and effective post-exposure prophylaxis should be instituted as soon as possible to prevent the possible occurrence of this dreaded disease.
This study evaluated rabies epidemiology in Far EastAsia. Questionnaires were sent by the OIE to Far East Asian countries and eight questionnaires were returned. Data were collected from these returns, as well as from recent publications, to gather information regarding rabies epidemiology in these countries. More than 29,000 human deaths were reported in 2006 in Far East Asia, representing more than 50% of all human rabies cases around the globe. There are only a few countries or regions from which no human rabies was reported in 2006 such as Japan, Singapore, South Korea, Malaysia, Hong Kong, and Taiwan. In many of these rabies endemic countries, the number of human rabies cases has not changed much during the past decade. The only country with a steady decline is Thailand, where the number of cases has decreased from around 200 to about 20 cases per year. The most dramatic changes were observed in China. Human rabies cases declined from around 5,000 cases per year in the 1980s to about 160 in the mid-1990s. However, these trends have since been reversed. A steady increase has been reported over the past 10 years with more than 3,200 cases reported in 2006. Although there are many factors that contribute to the epidemic or endemic nature of rabies in these countries, the single most important factor is the failure to immunize domestic dogs, which transmit rabies to humans. Dog vaccination is at or below 5% in many of these countries, and cannot stop the transmission of rabies from dogs to dogs, thus to humans. It is thus most importantforthese countries to initiate mass vaccination campaigns in dog populations in order to stop the occurrence of human rabies in Far East Asia.
A simple and rapid single-step reverse transcriptase-polymerase chain reaction (RT-PCR) was used to investigate the nucleoprotein (N) gene of 11 rabies viruses. A conserved set of RT-PCR primers was designed to amplify the most variable region in the N gene. N gene regions were amplified from 6 fixed laboratory viruses, 4 street viruses from dogs in Thailand, and a horse in Zambia. Sequences of the amplified products, together with the database of 91 additional sequences, were analyzed by using PILEUP program of the GCG package. The rabies viruses grouped into at least 9 distinct clusters by < 90% nucleotide similarity of the N gene region: I (4 isolates, USA), II (2 isolates, South America), III (3 isolates, Africa), IV (52 strains, Europe, Middle East, Africa and South America), V (16 isolates, North America and Arctic), VI (17 isolates, Africa), VII (1 isolate, Africa), VIII (6 isolates, Thailand and Malaysia) and IX (1 isolate, Sri Lanka). A unique group of rabies viruses from Thailand and clusters of isolates corresponding to their geographic origin also were determined. The simple and rapid single-step RT-PCR proved to be useful for identifying rabies viruses, and for grouping the viruses into clades by sequence analysis.
Rabies is still a major public health problem in Asia. The incidence of known annual human cases in India alone has recently been revised from 20,000 to 30,000, and over 500,000 patients are given some form of postexposure rabies treatment. Only China, Peninsular Malaysia, Singapore, and Thailand are reporting a significant decrease in the prevalence of this disease in humans. Over 150,000 courses of postexposure treatment (PET) are given in Thailand every year. To determine remaining barriers to further reduction of the number of human rabies deaths, we carried out a questionnaire study of government hospitals throughout the Kingdom.
This study was aimed at determining the molecular epidemiology of rabies virus (RABV) circulating in Vietnam. Intra vitam samples (saliva and cerebrospinal fluid) were collected from 31 patients who were believed to have rabies and were admitted to hospitals in northern provinces of Vietnam. Brain samples were collected from 176 sick or furious rabid dogs from all over the country. The human and canine samples were subjected to reverse transcription-polymerase chain reaction analysis. The findings showed that 23 patients tested positive for RABV. Interestingly, 5 rabies patients did not have any history of dog or cat bites, but they had an experience of butchering dogs or cats, or consuming their meat. RABV was also detected in 2 of the 100 sick dogs from slaughterhouses. Molecular epidemiological analysis of 27 RABV strains showed that these viruses could be classified into two groups. The RABVs classified into Group 1 were distributed throughout Vietnam and had sequence similarity with the strains from China, Thailand, Malaysia, and the Philippines. However, the RABVs classified into Group 2 were only found in the northern provinces of Vietnam and showed high sequence similarity with the strain from southern China. This finding suggested the recent influx of Group 2 RABVs between Vietnam and China across the border. Although the incidence of rabies due to circulating RABVs in slaughterhouses is less common than that due to dog bite, the national program for rabies control and prevention in Vietnam should include monitoring of the health of dogs meant for human consumption and vaccination for workers at dog slaughterhouses. Further, monitoring of and research on the circulating RABVs in dog markets may help to determine the cause of rabies and control the spread of rabies in slaughterhouses in Vietnam.
WHO recommends that 70% of dogs in a population should be immunized to eliminate or prevent outbreaks of rabies. This critical percentage (pc) has been established empirically from observations on the relationship between vaccination coverage and rabies incidence in dog populations around the world. Here, by contrast, we estimate pc by using epidemic theory, together with data available from four outbreaks in urban and rural areas of the USA, Mexico, Malaysia and Indonesia. From the rate of increase of cases at the beginning of these epidemics, we obtain estimates of the basic case reproduction number of infection, R0, in the range 1.62-2.33, implying that pc lies between 39% and 57%. The errors attached to these estimates of pc suggest that the recommended coverage of 70% would prevent a major outbreak of rabies on no fewer than 96.5% of occasions.
A fulminating extension of rabies-which has been enzootic in northern Malaya since 1924-occurred in Kuala Lumpur in April 1952. The outbreak was suppressed by the compulsory mass vaccination of dogs, stringent legislation, and intensive stray-dog destruction. Similar measures are being employed in the current campaign, the aim of which is the complete eradication of the disease.From an average annual incidence of 112 confirmed canine cases prior to 1952-when a total of 198 cases was reported-the incidence fell to 15 cases (all in unvaccinated dogs) for the period January-November 1953, during the last 5(1/2) months of which no case in either animals or man was reported. It is considered that the extensive publicity campaign and strict enforcement of the control measures have contributed measurably to the present improved position.Statistics relating to confirmed cases in dogs previously vaccinated with (a) phenolized 20% brain-tissue suspension vaccine (buffalo origin) and (b) chicken-embryo vaccine (Flury strain) are quoted and their probable significance in favour of the latter under Malayan conditions is discussed. The hypothesis that the development of rabies may, in many instances, have been blocked by the vaccine is advanced.The plan for a pan-Federation compulsory vaccination campaign in 1954, to consolidate the 1952-3 improvements, is outlined.
There have been three major rabies epidemics in China since the 1950s. To gain more insights into the molecular epidemiology of rabies viruses (RVs) for the third (the current) epidemic, we isolated RV from dogs and humans in major endemic areas, and characterized these isolates genetically by sequencing the entire glycoprotein (G) gene and the G-L non-coding region. These sequences were also compared phylogenetically with RVs isolated in China during previous epidemics and those around the world. Comparison of the entire G genes among the Chinese isolates revealed up to 21.8% divergence at the nucleotide level and 17.8% at the amino acid level. The available Chinese isolates could be divided into two distinct clades, each of which could be further divided into six lineages. Viruses in clade I include most of the Chinese viruses as well as viruses from southeast Asian countries including Indonesia, Malaysia, the Philippines, Thailand, and Vietnam. The viruses in the other clade were found infrequently in China, but are closely related to viruses distributed worldwide among terrestrial animals. Interestingly, most of the viruses isolated during the past 10 years belong to lineage A viruses within clade I whereas most of the viruses isolated before 1996 belong to other lineages within clades I and II. Our results indicated that lineages A viruses have been predominant during the past 10 years and thus are largely responsible for the third and the current epidemic in China. Our results also suggested that the Chinese RV isolates in clade I share a common recent ancestor with those circulating in southeast Asia.