Background
Human rabies is a significant public health concern in mainland China. However, the neglect
of rabies expansion and scarce analyses of the dynamics have made the spatiotemporal
spread pattern of human rabies and its determinants being poorly understood.
Methods
We collected geographic locations and timeline of reported human rabies cases, rabies sequences
and socioeconomic variables for the years 2004-2013, and integrated multidisciplinary
approaches, including epidemiological characterization, hotspots identification, risk
factors analysis and phylogeographic inference, to explore the spread pattern of human rabies
in mainland China during the last decade.
Results
The results show that human rabies distribution and hotspots were expanding from southeastern
regions to north or west regions, which could be associated with the evolution of the
virus, especially the clade I-G. A Panel Poisson Regression analysis reveals that human rabies
incidences had significant correlation with the education level, GDP per capita, temperature
at one-month lag and canine rabies outbreak at two-month lag.
Conclusions
The reduction in the overall human rabies incidence was accompanied by a westward and
northward expansion of the circulating region in mainland China. Higher risk of human rabies
was associated with lower level of education and economic status. New clades of rabies,
especial Clade I-G, played an important role in recent spread. Our findings provide
valuable information for rabies control and prevention in the future.