No 10/11 - 2022

Report on rabies testing in Denmark in 2020 and 2021

for a detailed description of post-exposure prophylaxis (PEP) and animals tested for rabies in Denmark in 2020 and 2021, please see the annual report.

Decline in the number of PEP following a COVID-19-related decline in travelling activity

From 2010 to 2019, the number of Danes who were vaccinated abroad following possible exposure to rabies more than doubled. In 2019, the number had reached 261. Following the COVID-19 lockdown and ensuing reduced travelling activity, 2020 and 2021 have recorded a steep decline to 82 and 33 persons, respectively.

In 2020 and 2021, exposure abroad constituted 75% and 61%, respectively, of all exposed cases.

The number of bites in Denmark, primarily bat bites, seems to have followed an increasing trend until 2019 when a total of 28 persons initiated treatment following bat bites. 2020 and 2021 recorded a decline to 24 and 14 persons, respectively. As bat bites is by far the most frequent cause of PEP, 2020 and 2021 saw a steep decline in the total number of persons who initiated prophylactic treatment following exposure to rabies in Denmark, Figure 1.



In 2020 and 2021, a total of 110 and 54 persons, respectively, received treatment on suspicion of rabies after having been bitten by animals. The overwhelming majority (82 in 2020 and 33 in 2021) initiated treatment after having been bitten by animals abroad.

The majority of those who initiated rabies PEP following bites abroad in 2020 had become exposed in Thailand or India. In 2021, the most frequently observed country of exposure was Turkey.
Nobody developed the disease.

Three new rabies cases following bat bites in the US

From September to November 2021, three persons died in the US following bat bites. None of the three persons had been seen by the healthcare authorities. If they had, they could probably have been saved, as they would have been offered PEP. In the US, bat rabies is classic rabies which is different from the types of bat rabies found in Europe.

Dogs from the Ukraine

Due to the terrible situation there, we expect that Denmark will receive a number of war refugees from the Ukraine; some of whom may bring their dogs. Not all Ukrainian dogs have received rabies vaccination. Rabies occurs endemically among mammals in the Ukraine. Cats and ferrets that have not been vaccinated may also have rabies. Therefore, it is important to follow the guidelines of the Danish Veterinary and Food Administration.

Illegally imported puppies

In 2020, two persons initiated rabies treatment following bites from illegally imported puppies. In 2021, the corresponding number was six persons. In 2021, a total of five persons had been bitten by the same puppy, which had been imported illegally from Rumania. The remaining puppies were also from Eastern Europe. Parts of Eastern Europe still record a high occurrence of rabies in dogs.

Cats in Denmark have a low rabies risk

Statens Serum Institut occasionally receives information about cats that have changed behaviour, including showing CNS symptoms, and have bitten their owners. The risk that a cat in Denmark has rabies is very low, but cats are occasionally affected by encephalitis, meningitis, etc., which may produce rabies-like symptoms.

In cases in which cats are suspected of rabies and submitted for testing, normally no indication exists for initiation of PEP treatment before a test result is available.

In cases in which a cat has been imported illegally or has been bitten by an illegally imported animal (dog/cat/ferret), the person who has been bitten/scratched should initiate PEP without delay.

Rabies in animals

Classic rabies has not been observed in Denmark since 1982, whereas European bat rabies (EBLV) is considered to occur endemically in Danish bats.

In 2020 and 2021, a total of 15 and 25 animals from Denmark were tested for classic rabies and/or bat rabies, all of which tested negative by PCR.

Classic rabies virus is endemic in Greenland where Arctic foxes occasionally transmit the infection to other mammals. In 2020 and 2021, a total of four foxes from Greenland were tested. In one of the four foxes, classic rabies virus was found. The rabies-positive fox was from 2021.

(A.K. Hvass, S. Cowan, Department of Infectious Disease Epidemiology and Prevention, T. B. Rasmussen, Department for Virus and Microbiological Special Diagnostics)

16 March 2022