No 4 - 2011

Rabies prophylaxis

In Denmark, being bitten by a bat is usually the only indication for prophylactic treatment against rabies.

If, after being bitten by other animals, there is reason to suspect that the animal has rabies, the animal should be examined by a veterinary. The veterinary will, if necessary, destroy the animal and arrange further investigation.

In other parts of the world, rabies is more widespread. Transmission occurs through the penetrating bite of an animal infected with rabies, or on rare occasions through direct contact between infected saliva and mucous membranes or wounds.

Prophylactic treatment after possible exposure should be discussed with the Department of Epidemiology, and human rabies immunoglobulin (HRIG) and vaccine may be ordered by general practitioners at the expense of the National Health Service.
Pre- as well as post-exposure prophylaxis recommendations are further described in EPI-NEWS 37/10.

Post exposition prophylaxis

In 2010 a total of 113 patients received prophylactic rabies treatment following animal bites, Table 1.

A total of 64 persons were treated with HRIG in addition to vaccination.

Bat bites in Denmark were the reason that 15 persons received post-exposure prophylaxis. A bat was submitted for testing, but tested negative, after which treatment was terminated.

A total of five family members were bitten by the family's dog, which was then destroyed. Subsequently, the veterinary believed that the dog may have had rabies, and as it could not be tested, the family received treatment.
One person who was bitten by a mink, received prophylactic treatment.

In retrospect, there was no indication for treatment in the two last-mentioned cases, as rabies does not occur among dogs and mink in Denmark. One person was given prophylactic treatment after being bitten by a goat. As bat rabies was previously detected in a limited number of Danish sheep, EPI-NEWS 24/03 (pdf), the goat was submitted to tests but tested negative for rabies. The treatment was discontinued when the results were known.

An additional 18 persons were exposed to rabies in the remaining parts of Europe (incl. Turkey), 63 in Asia, seven in Africa, two in Central and South America and one in Greenland.

A total of 41 patients were treated following possible rabies exposure in Thailand, including 23 after being bitten by dogs, 16 by monkeys one by a tiger and another by a rat.

Commentary

Possible exposure to rabies abroad was the primary cause of prophylaxis, as 81 % of all prophylactically treated cases had travelled abroad, including nearly half to Thailand.

Over the past decade an increase has been observed in the number of persons who receive prophylactic treatment following animal bites in Thailand. The past four years, a total of 41-50 persons were treated annually.

When giving advice prior to foreign travel, it is important to mention the risk of rabies associated with contact to animals. Travellers should be advised to limit contact to animals and to see a physician without delay in case of a bite.

Rabies in dogs in Bali

Since September 2008, Bali has seen an outbreak among dogs. More than 100 inhabitants have died from rabies. The affected persons were bitten by dogs, but were unaware of the need to receive treatment or unable to seek treatment.

Initially, the outbreak was localised to Southern Bali, but it has now spread to the entire island and to the neighbouring island of Nusa Penida.
The authorities stride to provide sufficient amounts of vaccine, to destroy all street dogs and to vaccinate all other dogs.

In 2010, three Danish tourists received post-exposure prophylaxis following dog bites in Bali.

Commentary

No travel restrictions have been imposed for Bali or the neighbouring areas. Travellers to Bali should we aware of the risk of rabies and should avoid contact with animals.

In case an animal bite occurs, medical attention should be sought immediately with a view to initiating vaccination, etc.
Vaccination may be considered in connection with prolonged travels, EPI-NEWS 37/10.
(A.H. Christiansen, S. Cowan, Department of Epidemiology)

Rabies in animals

Since 1982 Denmark has been free of classic rabies virus.
Infection with classic rabies virus is endemic in Greenland, where Arctic foxes frequently transmit the infection to sled dogs and other mammals. In 2010, classic rabies virus was detected in six Arctic foxes from Greenland, Table 2.

Bats are a reservoir for EBLV (European Bat Lyssavirus). EBLV was first detected in bats in Denmark in 1985, and the most recent positive finding occurred in 2009.

(T. B. Rasmussen, Technical University of Denmark, Lindholm)

EPIET

Once again it is possible to apply for the two-year European training programme to become a field epidemiologist, EPIET (European Programme for Intervention Epidemiology Training). Participants will achieve skills related to monitoring and control of infectious diseases, outbreak tracing and management, applied research, communication, etc.

The programme starts in September 2011 and is completed during a two-year placement in another European country.
The deadline for application is 6 February 2011.

Further information is available at www.ecdc.eu or from Kåre Mølbak, Department of Epidemiology, Statens Serum Institut.
(Department of Epidemiology)

Individually notifiable diseases and selected laboratory diagnosed infections (pdf) 

26 January 2011