Rabies surveillance and control in China over the last twenty years

Globally, rabies remains a serious threat to public health. In particular, large number of cases continue to be detected in Africa and Asia. China has experienced three major outbreaks with the current epizootic starting in 1990s, peaking in 2007 with 3,300 cases, and consistently decreasing since this point. A key factor of the success in keeping the rabies outbreak under control is the National Public Health Reporting Program that was introduced to coordinate surveillance at provincial and regional levels. Through this program, it is possible to obtain an integrated overview of how rabies was spreading and how various factors were contributing to the outbreak. At the same time, samples have been collected from suspected rabies cases and a subset of positive samples selected for sequencing. In this way, it is possible to investigate the outbreak from a phylogenetic perspective, providing the comprehensive description of a rabies outbreak to date. In this work, we review rabies control efforts over the last 20 years, and show how this integrated approach has led to a deeper characterization of the outbreak and a better understanding of the factors driving the spread of the disease