China’s estimated 80 to 200 million domestic dogs represent a substantial reservoir for rabies transmission, with canine-mediated infections accounting for approximately 95% of human rabies cases (7). Our surveillance findings confirm that dogs remain the predominant rabies vector across central, eastern, and southern China, responsible for the majority of human bite exposures requiring post-exposure prophylaxis. However, current animal rabies surveillance systems suffer from significant limitations, operating through passive reporting mechanisms that result in substantial underreporting. This surveillance gap becomes evident when comparing human and animal case detection: while human rabies cases were documented in 101 counties across 17 PLADs during 2023 (8), only 28 animal rabies cases received laboratory confirmation from 12 counties in 4 PLADs during the same period. This dramatic disparity — with human cases outnumbering confirmed animal cases by nearly 4∶1 — highlights critical deficiencies in animal surveillance infrastructure, as only a small fraction of aggressive or suspect animals undergo diagnostic testing. Multiple factors contribute to this underreporting, including limited regional diagnostic capacity, inconsistent compliance with sample submission protocols, inadequate reporting awareness among veterinary professionals, and substantial logistical barriers in remote and resource-constrained areas. Consequently, our confirmed case numbers likely represent a significant underestimate of the true animal rabies burden across China.
Although China harbors an estimated 80–200 million dogs, canine rabies continues to pose a substantial public health threat, accounting for approximately 95% of human rabies cases (7). Our surveillance data confirm that dogs remain the predominant rabies vector across central, eastern, and southern China, responsible for the majority of human bite exposures. However, wildlife rabies — particularly among foxes — has emerged as an increasingly significant concern in northern border PLADs (IMAR, XUAR, and Heilongjiang Province), creating substantial spillover risks to livestock populations. Red foxes now represent the primary wildlife reservoir, while recent rabies detections in raccoon dogs and badgers suggest an expanding host range. This epidemiological pattern aligns with global trends, where wildlife rabies has resurged in numerous countries despite successful canine vaccination programs implemented across Europe and North America (9). Although rare, human rabies cases linked to wildlife exposures are increasingly documented throughout China. Since 2012, sporadic cases have been attributed to ferret badgers (Jiangxi, Anhui, and Zhejiang provinces), bats (Jilin Province), and foxes (XUAR, 2016) (10–11). Most notably, the first confirmed badger-mediated human rabies case occurred in Xilingol League (IMAR) in 2020 (12). These incidents underscore the critical need for enhanced wildlife rabies surveillance, particularly in northern border regions where cross-species transmission to livestock occurs frequently. Unlike canine rabies, which can be effectively controlled through mass vaccination campaigns, wildlife serve as natural RABV reservoirs with extensive movement ranges that complicate large-scale vaccination efforts. Wildlife rabies, therefore, requires alternative control strategies, including comprehensive surveillance programs and oral rabies vaccination (ORV) campaigns targeting foxes and other reservoir species. Europe’s successful elimination of fox-mediated rabies through ORV programs provides a proven model for implementation in China (13). To contain viral circulation within these natural foci and prevent spillover into human and domestic animal populations, establishing robust immune barriers in surrounding areas remains essential. This objective can be achieved through enhanced canine vaccination campaigns in and around identified endemic regions, where high vaccination coverage will create protective buffers that interrupt transmission chains at the wildlife-domestic animal-human interface.
To effectively address animal rabies challenges in China, comprehensive strategies must be implemented within a One Health framework that combines enhanced surveillance, targeted wildlife vaccination programs, and strengthened cross-sector collaboration: 1) Improve both passive and active surveillance systems to significantly reduce underreporting of animal cases. 2) Strengthen cross-border and cross-sector collaboration while implementing real-time data sharing between animal health, forestry, and public health agencies to enhance outbreak response capabilities. 3) Establish species-specific wildlife vaccination strategies by developing oral rabies vaccines tailored for foxes, raccoon dogs, and badgers, building upon existing ORV technologies (13). 4) Conduct comprehensive ecological studies to map wildlife movement patterns and optimize bait distribution strategies for maximum vaccination coverage. 5) Establish a rabies-free pilot region across Hainan Province as a national demonstration model, leveraging its low dog rabies prevalence and natural island geography that provides an effective barrier against rabies transmission from China.