The first report of rabies was in 1907; since then, 200-800 cases were reported every year and it occurred continuously until 1945. Since then, 3-91 cases occurred per year until the 1970s. Subsequently, outbreak increased every year; in 1984, there was only 1 case; following the institution of the vaccination program and abandoned dogs prevention policy by the government, there was no outbreak until 1992. However, in September 1993 in Gangwon-do and Cheorwon-gun, rabies occurred in dogs and occurred continuously every year. Recently, 2 cases in dogs, 1 case in a cow, and 4 cases in raccoon dogs were confirmed in 2012; there have been 2 cases (cat and cow) and 4 cases (dog) in 2013. Rabies occurred more frequently in January, November, December, February, and April; the highest frequency according to seasonal outbreak was in the winter (December to February) (Table 1) [5].

In the 1960s, there were nationwide rabies outbreaks; in the 1970-1980s, rabies occurred in most of the regions except in Chungcheongnam-do and Jeju. In 1993, there were cases in Gangwon-do and Cheorwon-gun, which is in proximity to the military border, and in regions such as Gyeonggi-do, Yeoncheon-gun, Paju-si, and Pocheon-si. Outbreak was more frequent in regions such as Gangwon-do, Inje-gun, Yanggu-gun, and Cheorwon-gun. After 2002, rabies tended to occur in the northern regions of Gangwon-do (29 cases in Goseong-gun) and Gyeonggi-do (27 cases in Yeoncheon-gun, 25 cases in Paju-si, and 25 cases in Yangju-si). In 2005, there was continuous outbreak: 2 cases from Gimpo-si, the southern area of the Han River, and 1 case from Yangpyeong-gun [6].

Recently,wild raccoon dogs moved to new habitats due to development of an industrial complex in the Sihwa Lake region, Hwaseong-si, Gyeonggi-do. These movements increased the possibility of contact with rabies-infected animals and transmission of rabies infection to other animals or humans.In fact, after 2 cases (raccoon dog) in Goyang-si, Gyeonggi-do and 1 case in Eunpyeong-gu, Seoul (raccoon dog) in 2006, the outbreak of the rabies after 7 years in 2012 in Suwon-si and Hwaseong-si, Gyeonggi-do was significant because rabies was considered to have "escaped" from the rural and mountain areas and transmitted to high-population urban areas (Table 2) [7].

In domestic outbreak, rabies usually occurred in cows, dogs, and raccoon dogs. There was a clear tendency for the increase or decrease of outbreak to be similar in cows and dogs. In farms that bred both cows and dogs, rabies was detected in both species. Since 1997, the year the government began investigating rabies infection in wild animals, the raccoon dog was assumed to be the main transmitter of rabies to breeding live stock (Table 3) [7].

Hydrophobia was entered into official records from 1962; the first outbreak was a case in 1984. Before 1999, there were no reports of hydrophobia in humans in Korea. The aspect of outbreak between hydrophobia in humans and rabies in animals was not directly proportional. However, their epidemiologic characters shared considerable similarity, and geographic analysis also revealed similarities in their outbreak [8].

Immune serum therapy and vaccination enabled the prevention of hydrophobia in a person who had been bitten by an infected animal. However, there were reports of death in people who did not undergo treatment after being bitten. Hydrophobia, which occurred continuously, was not reported from 2004 until 2013 (Table 4) [1,2].

Rabies, which mainly occurred in areas close to the military demarcation line, exhibited a tendency to move south over time. The rabies control strategy required remodeling because the rabies outbreak had changed. It was known that the outbreak of rabies had moved gradually to urban areas (high-population areas) as compared to the past, where rabies mainly occurred in rural areas (low-population areas).

Analysis of species outbreak determined that it mainly infected in cows, dogs, and raccoon dogs, and it was presumed that the main transmitter in the Gyeonggi-do and Gangwon-do regions was the raccoon dog. According to seasonal outbreak, distribution was most frequent in the winter. There was also outbreak in the spring, autumn, and summer, in that order. Consensus was that this was when the raccoon dog, the main rabies transmitter, was most active [9].

Analysis of rabies outbreak location and environmental terrain condition found that about 85% of the places where the rabies occurred were the foot of mountains, valleys, and around rivers, which were areas where contact possibility with wild animals was high. Raccoon dog habits such as fishing and territorial range appeared to support this.

Rabies can be prevented by vaccination. The application of focused vaccination to dogs and cows is important. The government supports the annual supply of rabies vaccine under the Livestock Disease Prevention Plan. Governors around the country assign quantities of rabies vaccine supply according to the situation of rabies outbreak in livestock. Mayors and heads of district order vaccinations and provide public information under the Prevention of Contagious Animal Diseases Act. The government appoints a veterinary hospital to provide vaccinations, or direct vaccinations of livestock are undertaken by vaccination agents (veterinary inspectors, public veterinarians, vaccination assistants). Subsequently, the government issues a certificate of vaccination to the owner (Table 5) [10].

Rabies serum analysis has been performed on a number of dogs and cows from the Si, Gun, and nearby Si and Gun areas in Gangwon-do and Gyeonggi-do every year from 2002. Blood collection was carried out through a cooperative effort between the Animal and Plant Quarantine Agency and the Livestock Disease Prevention Agency. The agents visit each farm directly and collect blood from the animals. Serum analysis is performed using a neutralizing peroxidase-linked assay by the Animal and Plant Quarantine Agency (Tables 6, 7).

The bait vaccine strategy for raccoon dogs, an important mediator of concern, has been the main method for providing wild animals with immunity against rabies from 2001. The bait vaccine uses the direct scattering method, where it is scattered by the hand.

Transmission of rabies is influenced by the population density of susceptible animals in the area [11]. Depopulations of suspected animals have been used to decrease number of outbreak of the disease. However, there was low efficiency in many cases because wild animal populations were resilient. For example, foxes were culled, or hunted in Europe in the past, however this did not decrease the population of fox and the number of outbreak of rabies. The method including decreasing of susceptible animal population and vaccination in parallel was executed from 1999 in Canada and it was effective on reducing rabies outbreak in raccoon dogs [12].

To prevent rabies, the bait vaccine, an oral vaccine has been developed. Since Switzerland applied the bait vaccine for the first time in 1978, it has been considered an effective method and used in multiple European nations [13]. To achieve optimal vaccination result, vaccination time, coverage area for vaccination, effective method for bait scattering and potential number of wild animals should be considered. The years of when each country has been started to apply the vaccine are as follows: Switzerland (1982), Germany (1983), Italy (1984), Austria, Belgium, France, Luxembourg (1986), and Finland, the Republic of Czechoslovakia (1988), Canada (1989), the United States of America (1991), and the Republic of Korea (2001) [14]. The United States of America defined their bait vaccine scattering area to intercept rabies caused by the raccoon dog. In Europe, application of the bait vaccine resulted in the successful extermination of rabies from the Netherlands, Italy, Switzerland, France, Belgium, Luxembourg, and the Republic of Czechoslovakia [12].

Before 1975, when a person was bitten by a wild animal suspected of having rabies, immunotherapy was used to inhibit replication of the virus, the number of incidences in Alaska, USA, was 104.8 per 100,000 people every year. From 1975, the Alaskan government initiated a project for comprehensive rabies prevention with cooperation of the medical health, veterinarian public health, and livestock departments. The key concept of this project was improvement of the rabies vaccination coverage and electronic management of vaccination records. Despite the fact that wild animals were important transmitters of rabies infection, dogs were more common transmitter in human infection caused by bites. Comparing the aspects of disease prevention management, dogs were more manageable than wild animals. Certain programs to improve the rabies vaccination coverage were carried out in the rural regions, which had low accessibility to veterinary public service. First, the government supplied rabies vaccine by establishing a budget in the state public health department. Second, the owner paid only the vaccination fee if vaccination was performed at a private veterinary clinic. Third, the government educated and trained lay vaccinators to vaccinate animals without charge in regions with low accessibility to clinics. These veterinarians or vaccinators reported to the government and managed the vaccination records [15].

At March 1997, the first outbreak of raccoon dog rabies in Ohio, Mahoning occurred, and then number of rabies outbreak rapidly increased. After 1997, the government carried out a complex program that linked the bait vaccine scattering project, the wild raccoon dog capture and analysis program, rabies diagnosis program of infection-suspected animals, and a public information plan. In 2000, there was no report of raccoon dog rabies. After 2001, 1-2 cases of raccoon dog rabies were reported from around the border with Pennsylvania within a 1.6-km area every year. With the cooperation of nearby states, the state government established a bait vaccine zone (buffer zone) to prevent the spread of rabies. It prevented the spread of raccoon dog rabies from Pennsylvania, which was a rabies outbreak area, West Virginia, and Virginia, to Ohio, which is in the west, Kentucky, and Tennessee injection [11,16].

Ontario, Canada, which possesses a vast natural area, adopted the main strategy of a rabies prevention plan based on research on wild animals. Rabies outbreak in red fox and skunks in the eastern and southwest parts of Ontario was a problem. After development of a bait vaccine suitable for wild animals, the vaccine was distributed via air scattering using aircraft. From 1992, rabies was almost eradicated in this area as a result of the program. The state also had a rabies research unit under the Ministry of Nature and Resource to protect wild animals from wild-type rabies. This unit monitored worldwide outbreaks of rabies and analyzed type of rabies viruses isolated from brain samples of rabies-positive animals in various countries. Urban areas such as Toronto adopted the trap-vaccinate-release (TVR) method as a rabies protection plan. Wild animals were trapped, vaccinated, and released to same area where they were caught. According to statistical records, 60-70% of skunks and raccoon dogs that lived in urban areas were vaccinated from 1987 to 1992. The border between Canada and the United States of America contained a disease prevention area in which a combined vaccination plan that included bait vaccine scattering and TVR was executed. The rabies infection situation was monitored through analysis of wild animal corpses within these areas under international cooperation between the United States of America and Canada [12,17].

The Bavarian model that was initially used in the Bavaria region of Germany was used to prevent fox rabies. This program was performed by hunters who volunteered. Each hunter was charged with one sector on the map. They scattered the bait vaccine in the sector to be ingested by the target animal. After scattering the bait vaccine, the hunters monitored whether the vaccine was ingested. Lastly, serum antibody analysis was performed to estimate the antibody-positive rate of the target animal. Subsequently, many European countries used this method for rabies prevention campaigns and produced good results for rabies prevention [18].

Rabies prevention using the bait vaccine in Belgium was executed initially in 1986. Before the bait vaccine was instituted, there were >500 rabies cases every year. 2 years after using the bait vaccine, the outbreak of rabies decreased by around 50%. However, there were 515 and 842 cases in 1989 and 1990, respectively. This was the highest number of outbreaks since 1983. To decrease rabies outbreak, a 30-km bait vaccine scattering area (buffer zone) was established, and then expanded to 50-70 km. According to an investigation that compared the rabies antibody-positive rate of the red fox in 1994, the average antibody-positive rate of animals living in the area where the bait vaccine had been scattered was 25-86%. Bait vaccine aerial scattering was carried out in March and July, and in the fall in 1995; the scattering quantity was 15.7-17.2/km², and an additional 5 bait vaccines were scattered near every red fox habitat. The entire scattering area spanned 8,700 km², but 213 rabies cases occurred. Bait vaccine scattering was not carried out in France and the German border area; it required an international cooperative effort. To confirm bait vaccine intake, 15 foxes per 100 km² were analyzed. The scattering method was similar to that used in 1996, but increased quantities of the bait vaccine were used. Tetracycline analysis of the animals' teeth revealed that the number of animals that took up the bait vaccine had increased. After 1998, rabies did not occur in red foxes; the last outbreak of rabies, which occurred in a cow, was in 1999. From 1966 to 2000, approximately 7,000 of 29,000 samples were rabies-positive, among which around 4,000 cases were related to red foxes. According to the OIE data, Belgium was classified as a rabies non-outbreak nation after 2001 [19].

The bait vaccine method is known as a proper effective plan among several presented rabies prevention methods. The approach had high efficiency with small input as compared to other plans. There are some weaknesses to the bait vaccine, which can be observed in current rabies prevention strategy [17].

The most important element for the determination of bait quantity was the density of the wild raccoon dog, which was the target animal. The major reason that rabies occurred continuously in Gangwon-do and did not occurred for several years in Gyeonggi-do is the insufficient supply of bait vaccine as compared with the demand. Gangwon-do has a high density of raccoon dogs and a higher proportion of mountain terrainas compared with Gyeonggi-do, but the determination of the bait vaccine quantity did not consider these points. Currently, such points are considered and supply follows the raccoon dog density. However, there still appears to be insufficient supply of bait vaccine when the actual condition of each local government is considered. As this supply quantity short fall is compensated by additional purchases within the local government budget, it depends on the financial ability of each local government. Therefore, there is a gap in the rabies prevention system of each local government. This means that there is a need to research determination of the quantity of bait vaccine to be scattered, followed by the density of raccoon dogs to prevent rabies successfully.

The bait vaccine is of a square brown solid shape 3-cm wide and 3-cm long. It confers immunity to wild animal after it is ingested together with the bait, such as fish cake or chicken meat dough. However, according to consultant interviews, some reported that the raccoon dog ate only the food parts (the surface of the bait vaccine) instead of the entire bait vaccine. The instructions were not issued clearly to the person scattering the bait vaccine, or scattering by the agents was inadequate, avoiding the optimal planned position. To monitor some projects, evaluation after scattering is required. There were many opportunities for untargeted animals to acquire the bait vaccine. Furthermore, the antibody-positive rate of target animal after scattering should be surveyed.

Direct inoculation of the rabies vaccine to abandoned animals (dogs and cats) is not easy. Inoculation in fierce dogs is also difficult. Oral vaccine methods for rabies prevention are more appropriate for such animals. Consequently, the less effective bait vaccine could be applied to dogs and cats.

In the companion animal (dog and cat) section, the government purchases rabies vaccine and syringes, and supplies these to local governments every spring and autumn. The local government distributes the vaccine and syringes to local veterinary clinics. Pet owners visit these clinics for rabies vaccination, and bear certain operation expenses. For dog vaccinations, education and public information are well established, and most companion dog owners have tried injecting their dogs with rabies vaccine. For cat vaccinations, however, despite the cat being an included animal inthe Prevention of Contagious Animal Diseases Act, insufficient public information has resulted in many cat owners not knowing that cats also require rabies vaccination. For vaccination timing, current policy involves a low-efficiency method with fixed terms (spring, autumn) and periods (2 weeks) every year. To prevent rabies, first inoculation is immediately provided in 3-month-old puppies. Subsequently, boosting inoculation is executed at an appropriate time under veterinarian control. However, there is the possibility of missing additional inoculation with current system of spring and autumn all-vaccination approach. Furthermore, owners attempt to vaccinate their pets during the campaign period to derive economic benefit, and it is possible that blank immunity elevation could occur, or the owner could give up on the vaccination due to the relatively short inoculation period. It means that the current policy could be relatively inefficient.

The operation expenses for clinics when rabies vaccine inoculations are executed require considerable adjustment to actual situations. When one animal comes to the hospital, outside of veterinarian labor cost, the expense of additional labor (if it is a large dog), disinfection, etc., should be expected. Inoculation side effects or being attacked are also outside of the responsibility and support of the government; the veterinarian is solely accountable. From July 1, 2011, value-added tax was added to the operation expense, reducing clinic expenses further. Then again, the distribution of rabies vaccine supply may also require adjustment. Without consideration of the size of the animal hospital or the number of clients, applying a uniform calculation for supply is an inefficient method.

In the farm animal (cow) section, rabies vaccine injections are performed after the vaccine is supplied to each farm directly. However, most farmers dislike cow rabies vaccinations. It is believed that one of the reasons for this is the possibility of live vaccine side effects. Farms in rabies-occurring regions are supplied inactivated vaccines, but farms in rabies non-outbreak regions are supplied live vaccines. In addition, farmers tend to neglect rabies vaccination, although they receive government compensation if a cow dies from vaccine side effects. It is also possible that the rate of rabies vaccination is low because the rabies vaccination certificate is not necessary for trade, unlike that for bovine brucellosis, and because the rabies vaccine is not essential for cows.

In the guard dog, hunting dog, and the others section, guard dogs that live in or around rabies outbreak regions to guard factories or farms are a rabies vaccination blind spot. Factory owners tend not to care about vaccinating these animals, and factory workers tend to be unconcerned about guard dog health. In hunting dogs, most large-scale breeders of hunting dogs focus on rabies vaccination, but small-scale breeders are not concerned about rabies vaccination for various reasons. Dogs initially bred for hunting that are retired and then released or abandoned into the wild become feral dogs that are more vulnerable to rabies and can infect humans. Applying regulations is difficult when it comes to abandoned dogs. An abandoned dog that has become feral is difficult to distinguish from a wild animal.

If an animal is not vaccinated, the owner can be charged and fined under the current prevention of contagious animal diseases Act Article 15 and Article 60. The enforcement decree of Article 16 of the Act states that first, second, and subsequent violations are liable for fines of $500, $2,000, and $5,000. However, cases in which offenders are actually fined by the government are rare.

Currently, there is no independent organization that bears exclusive responsibility for the rabies outbreak. In particular, rabies is not easy to be prevented by short-term plans. Therefore, an organization that executes rabies prevention plans continuously should be established.

The important transmitter animal is the wild raccoon dog, which spreads rabies to other animals. Research of the raccoon dog gene map has been performed using mitochondrial single-nucleotide polymorphisms (SNP). Based on nationwide analysis, this research has established that there are regional differences in raccoon dogs. However, additional research to create regional detailed gene maps is necessary. In addition, to analyze the gene map of the virus and target animals, it is necessary to request that central organizations such as the Animal and Plant Quarantine Agency analyze confirmed rabies samples in cooperation with other organizations.

In a short-term strategy for rabies prevention, the prevention of spread from outbreak to non-outbreak regions is important. Intensive execution of the rabies prevention plan is necessary to prevent diffusion and additional outbreak in recent outbreak regions.

A short-term prevention strategy is insufficient for exterminating rabies; a long-term prevention strategy should be implemented to control rabies. The OIE determines a rabies-free state based on no rabies outbreak in humans and animals over 2 years. It is necessary to aim for a rabies-free base condition and to maintain the control system over 2 years to acquire the status of a rabies-free state by 2018. The 10 southeast Asian countries have announced a rabies free-state declaration and aim to be declared rabies-free states by 2020.

As most rabies outbreaks occur around the DMZ, there are rabies infections in North Korea. Therefore, joint research between South and North Korea would promote epidemic rabies preventative activity. To accomplish this, international institutes such as the World Health Organization (WHO), Food and Agriculture Organization (FAO), and OIE strongly recommend research to North Korea.