Rabies - Annual Report 2018

Rabies 2018

In Denmark, being bitten by a bat is normally 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 destroy the animal if necessary and will arrange for further investigation for rabies.
In other parts of the world, rabies is more widespread. Transmission occurs through the penetrating bite of an animal that may have become infected with rabies or, on rare occasions, through direct contact between infected saliva and mucous membranes or wounds.

For Post-Exposure Prophylaxis (PEP), Pre-Exposure Prophylaxis (PrEP) and information about dispensing of rabies vaccines and HRIG in the on-call period, please read here.

Post-exposure prophylaxis given to Danes in 2018

In 2018, a total of 263 persons were given treatment against rabies after having been bitten by animals suspected of having the condition. Six of these persons had received PrEP.

In 2018, bat bites were the reason why 22 persons received post-exposure prophylaxis in Denmark. Three bats were submitted for testing for bat rabies virus, European Bat Lyssa Virus (EBLV). All three tested negative, and the treatment was discontinued.

A total of 241 Danes were possibly exposed to rabies abroad. For four persons, the treatment was discontinued because the animal was alive ten days after exposure.

Figure 1 shows that in the period from 2000 to 2018 and particularly since 2010, a considerable increase has been seen in the number of persons who have seen a doctor following possible exposure abroad.

Figure 1. Number of persons initiating prophylactic therapy following possible exposure to rabies in  Denmark and abroad, 2000-2018

In 2018, a total of 106 (44%) persons who had possibly been exposed to rabies abroad were treated with human rabies immunoglobulin (HRIG). Among these, 68 persons (64%) only received HRIG after returning to Denmark, Table 1.
A total of 56 persons (23%) were not vaccinated until after returning to Denmark, Table 1.

Table 1. Number of persons initiating prophylactic therapy with HRIG and the initial rabies vaccination, respectively, by geographic area, 2018

Dogs were the cause of possible exposure abroad in 131 (54%) cases. Furthermore, 60 persons were possibly exposed by monkeys, 37 by cats and three by bats. Furthermore, four were possibly exposed by rats, two by racoons, one by a tapir and a donkey, respectively, and in two cases the animal species was not stated.

Among all of those exposed in 2018, only six persons had received PrEP before embarking on their journey.

(A.H. Christiansen, S. Cowan, Department of Infectious Disease Epidemiology and Prevention)

Rabies in animals

Rabies is caused by virus of the lyssavirus family. Two types exist: classic rabies virus and European Bat Lyssavirus (EBLV), also known as bat rabies virus. Classic rabies is endemic to most of Eastern Europe but has been eradicated in Western Europe. Nevertheless, illegal import of pets from Third-World countries to Europe continues to pose a problem; and cases of rabies are now and then reported in dogs and cats imported from North Africa to Southern Europe.
Classic rabies has not been observed in Denmark since 1982, while bat rabies, which is considered endemic, was detected for the first time in 1985. The latest case of bat rabies was detected in a bat in 2009.

In 2018, a total of 22 animals from Denmark were tested for classic rabies and/or bat rabies, all of which tested negative, Table 2. Classic rabies virus is endemic to Greenland, where Arctic foxes frequently transmit the infection to other mammals. In 2018, classic rabies virus was detected in three Arctic foxes from Greenland, Table 2.

Table 2. Rabies tests performed on animals in Denmark, 2018

(Senior Researcher Thomas Bruun Rasmussen, National Veterinary Institute, Technical University of Denmark, Lindholm)

This report is also described in EPI-NEWS 6/19.