EXPANDED PRODUCTION: A worker checks new facilities at Liaoning Chengda Biotechnology Co., China's leading human rabies vaccine supplier (LI GANG)

Tian Di, a specialist at Beijing's Ditan Hospital, vividly recalls losing a young patient to rabies last year. "When Lin Hao (pseudonym) walked into the hospital last September, it was raining heavily," Tian said. "The only thing that really struck me was how tightly he had wrapped himself in a blanket. Once inside, after unwrapping himself, he seemed perfectly normal."

However, Tian soon learned the reason Lin clung so tightly to his blanket: an extreme fear of water. After a short period of observation, Lin's fear of water and light became evident and Tian knew at that point that his 20-year-old patient was suffering from rabies and would be dead within a matter of days.

"The diagnosis of rabies equals a death sentence, there is no cure and no one ever survives the disease," said Chen Zhihai, head of the Infectious Disease Ward at Ditan Hospital.

He said that in the cases he had treated, early symptoms of rabies include anxiety, delirium and insomnia while later symptoms include drooling, fear of water, light and air. Respiratory failure was the usual cause of death.

"Once a diagnosis of rabies is made, our doctors cannot do anything besides using sedatives and ventilators. Therefore, it is not unusual for patients to be taken home to die in the company of their families. This is especially common for patients from areas out of Beijing," Chen said.

As one of the most lethal zoonotic or animal-transmitted diseases in the world, rabies is nearly always fatal after its symptoms appear. The rabies virus infects domestic and wild animals and is spread to people through close contact with infected saliva via bites or scratches. Symptoms in humans may take from several days to more than a year to appear, although most people present signs of the disease within two to three months. The virus damages the central nervous system, which includes the brain and spinal cord. Dogs are the source of 99 percent of human rabies deaths.

According to the World Health Organization (WHO), more than 55,000 people die of rabies worldwide every year and more than 95 percent of human deaths occur in Asia and Africa.

In 2009, China's Ministry of Health (MOH) announced that in recent years the total number of annual deaths from rabies reported in China averaged around 2,400 and only India reported more deaths from the disease.

The WHO says that rabies takes a disproportionate toll on the young, with 40 percent of the people bitten by rabid animals being under 15 years of age.

Heavily vaccinated people

In China, rabies victims are predominantly farmers, males and often under 15 years or above 50 years of age.

Yin Wenwu, an official at the Chinese Center for Disease Control and Prevention, said that farmers accounted for 90 percent of China's rabies cases in 2010.

According to a MOH study released at the end of 2009, there was a clear increase in the prevalence of rabies across the country. The number of counties with human rabies cases surged from 120 in 1999 to 855 in 2008. The study attributed the deterioration in rabies control mainly to the increase in the population of domestic dogs and cats.

Since no tests are available to diagnose the presence of the rabies virus in humans before the onset of clinical disease, the only effective way to save the life of a person exposed to the disease is by treating the wound, injecting rabies immuno-globulin that provides fast and effective protection, and administering the rabies vaccines.

However, not everyone who needs rabies vaccines is being inoculated, as the vaccines and rabies immuno-globulin are not covered by medical insurance in most parts of China.