The impact of anthropogenic and environmental factors on human rabies cases in China

Human rabies is a public health problem in Asia, especially in less-developed regions where the disease is under-reported because of a lack of epidemiological surveillance. To address this gap, we collected data on human rabies in Yunnan Province, China, between 2005 and 2016. Using statistical mapping techniques, we correlated the occurrence of human rabies to environmental (elevation, precipitation, normalized difference vegetation index [NDVI], temperature and distance to the nearest main rivers) and anthropogenic (human and dog population density, distance to the nearest main roads and gross domestic product [GDP]) factors. We used a performance score, the average area under the receiver operator characteristic curve (0.88), to validate our risk model. Using this model, we found that environmental factors were more strongly associated with human rabies occurrence than anthropogenic factors. Areas with elevation below 2000 metres, GDP per capita between $750 and $4500/year and NDVI below 0.07 were associated with greater risk of human rabies. Rabies control in China should specifically target these areas.