Eurosurveillance - Volume 10, Issue 11, 01 November 2005

Europe continually encounters the serious threat posed from zoonotic diseases including ancient bacterial agents such as Mycobacterium tuberculosis. The largest threat, however, is from RNA viruses such as the SARS-CoV, the Heninipah viruses, avian influenza viruses and emerging lyssaviruses.

Rabies is still present in Europe in 2005. Its incidence in humans remains limited (fewer than 5 human cases per year) through the application of strict prophylactic measures (anti-rabies treatment) and by means of veterinary rabies control measures in the domesticated and wild animal populations. The main indigenous animal reservoirs are: the dog in eastern European countries and on the borders with the Middle East; the fox in central and eastern Europe; the racoon dog in northeastern Europe; and the insectivorous bat throughout the entire territory. Finally, each year, cases of animals with rabies imported from enzootic areas are reported, showing the permeability of borders and traveller’s lack of consideration of the rabies risk. These importations constantly threaten the rabies-free status of terrestrial animals in western European countries and complicate the therapeutic decisions taken by physicians in the absence of information regarding the biting animal.

Rabies due to two independent and different genotypes of lyssaviruses - European bat lyssaviruses (EBLV) type 1 and type 2 - is present in many European countries. Infection is usually seen in bats, the primary reservoirs of the viruses but a few spillover infections have been seen in three other species: stone martens, sheep and humans. Spillover infections (with the exception of the two human cases) were EBLV-1 only. No EBLV-2 spillover cases have been reported in terrestrial animals. The disease is fatal in humans and has been described in Europe following a bat bite. We have studied in the available literature EBLV rabies cases across Europe in bats and humans, and have also carried out an analysis of recommendations for rabies prevention and treatments in humans. Rabies pre-exposure vaccination and post-exposure treatment is recommended for occupationally exposed persons. Some European countries have already adopted recommendations through specific protocols. Treatment of international travellers after bat bites is also recommended. The promoting of research programmes on bat rabies in Europe is underway. Bats are listed as protected species across Europe.

Fox rabies was first recorded in France in March 1968, and remained a problem until 1998. In the course of the first two decades and despite the control measures applied, rabies expanded both in terms of the enzootic surface area and number of cases. The measures applied consisted of actions aimed at reducing fox population density, the mandatory vaccination of domestic carnivores in the officially infected areas, and use of human prophylaxis. Following the large scale implementation of oral vaccination of foxes, starting 1989-1990, the rabies front was pushed back and yearly incidence decreased until rabies was eliminated at the end of 1998. The comparison of results obtained during both periods of applying various strategies is spectacular. France remains exposed to the risk from bat rabies on one hand, and from accidental cases of canine rabies imported from enzootic countries, on the other.

In August 2004, a case of rabies was diagnosed in a puppy that had been illegally imported from Morocco to Bordeaux (France). Because a great number of people and animals were thought to have come into contact with the puppy, extensive tracing measures were implemented, and an international alert was launched to trace and treat the contacts at risk. One hundred and eighty seven people received post-exposure treatment, eight of whom also received serovaccination, and 57 animals known to have been exposed to the puppy were tested. Six months after the death of the rabid animal, none of the people treated showed any signs of rabies, nor was any secondary animal case reported. The management of this crisis highlights the importance of the role of a rapid alert system at European level. Strict application of sanitary control regulations is essential for animals introduced into EU countries, and all necessary information must be made available to EU residents travelling to rabies enzootic areas.

A young male Austrian tourist, aged 23 years and unvaccinated against rabies, was bitten by a dog in Morocco in July 2004. One month later he was hospitalised in Ceuta with symptoms compatible with rabies. He died on 23 September in an Austrian hospital after a diagnosis of rabies was confirmed by FAT, IHC and RT-PCR (including sequencing) of the neck skin and the RT-PCR (including sequencing) of the pharyngeal swab. This Austrian case of laboratory confirmed rabies highlights the urgent need for reinforcement of the international recommendations for travel vaccinations.

This paper describes recent changes in the epizootical and epidemiological situation of rabies in Poland. Analysis of routine surveillance data on animal cases and human post-exposure treatment was performed in order to examine the impact of introduction of cell culture vaccine for human use and the implementation of the fox immunisation programme. The success of the immunisation programme for wild animals has become evident during the past 3 years, as a 9-fold decrease in animal rabies cases has been observed. To date, however, the downward trend in animal rabies cases has had no effect on the frequency of administration of the post-exposure treatment for humans. Moreover, two cases of locally acquired human rabies have occurred in patients who did not receive post-exposure vaccination. These cases prove that rabies should be still considered a public health concern in Poland.

In comparison with conventional methods of wildlife rabies control, oral rabies vaccination of foxes (ORV) is without doubt the most (cost-) effective method in wildlife rabies control. As a result of ORV, several European countries have become rabies-free. Although rabies had been eliminated from much of Germany, there still exists a residual rabies focus in the border triangle of Hesse, Baden-Württemberg and Rhineland Palatinate. Corrective actions have been initiated to eliminate this last remaining rabies hotspot in Germany.

Recent animal rabies data from Lithuania are of great concern, as cases are increasing. To gain insight into the risk for public health, we can investigate the number of people who have visited a rabies control centre since 1996 after contact with an animal suspected to be infected with rabies