Rabies 2020 and 2021
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, it should be examined by a veterinary. If the suspicion cannot be dismissed, the veterinarian notifies the Danish Veterinary and Food Administration who then provides further instructions.
In other parts of the world, rabies is more widespread and the Department of Infectious Disease Epidemiology and Prevention annually processes hundreds of enquiries concerning possible exposure to rabies following travels. Transmission occurs through the penetrating bite or scratching 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 human rabies immunoglobulin (HRIG), please read here.
In 2020 and 2021, a total of 110 and 54 persons, respectively, received prophylactic rabies treatment after having been bitten by animals suspected of having rabies. Among these, a total of seven and six persons, respectively, had received PrEP.
Post-exposure prophylaxis given after exposure in Denmark in 2020 and 2021
In 2020 and 2021, a total of 28 and 21 persons, respectively, received prophylactic rabies treatment after possible rabies exposure in Denmark. In 2020, 24 persons received post-exposure prophylaxis in Denmark because of a bat bite. In 2021, the number was 14.
In 2020, two persons initiated rabies treatment following bites from illegally imported puppies from non-rabies-free countries. 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.
Post-exposure prophylaxis given after exposure abroad in 2020 and 2021
In 2020, a total of 82 Danes were possibly exposed to rabies abroad. In 2021, the corresponding number was 33. In 2019, the number was 261.
Figure 1 shows that the period from 2008 to 2019 and particularly the period since 2010 has witnessed a considerable increase in the number of persons who have seen a doctor after possible rabies exposure abroad. Following the COVID-19 lockdown and ensuing reduced travelling activity, 2020 and 2021 have recorded a steep decline.
In 2020, a total of 34 (41%) and in 2021 a total of 23 (70%) persons who had possibly been exposed to rabies abroad were treated with HRIG. Among these, 19 persons (56%) in 2020 and 21 persons (91%) in 2021 received HRIG only after returning to Denmark.
A total of 16 persons (20%) were not vaccinated until after returning to Denmark in 2020. The corresponding number was 12 (36%) in 2021.
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.
In 2020 and 2021, dogs caused 47 (57%) and 17 (52%), respectively, of the cases of possible exposure abroad. Additionally, in 2020 a total of 21 persons were possibly exposed by monkeys and 11 by cats. Similarly, in 2021 seven persons were possibly exposed by cats and four by bats.
Overall, in 2020 two persons were possibly exposed by coatis, one person by a horse, one person cut themself on material while dismantling a rabies laboratory, and one person was bitten by an unidentified animal. In 2021, one person was possibly exposed by a horse, and two persons initiated PEP due to bites by unidentified animals.
Among all of those exposed abroad in 2020, only four persons had received PrEP before embarking on their journey. In 2021, no persons had received PrEP.
Among all of those exposed in Denmark in 2020, three persons had received PrEP prior to their exposure. All three persons had been vaccinated in connection with their work. In 2021, five persons had received PrEP prior to their exposure, and three of the five persons had been vaccinated in connection with their work.
Rabies in animals
Rabies is caused by virus of the lyssavirus family. The virus is most frequently caused by classic rabies virus or European bat lyssavirus (EBLV type 1 and 2), also known as bat rabies virus.
Classic rabies remains endemic to large parts of the world, including part of Eastern Europe but has been eradicated in Western Europe. Illegal import of pets from Eastern Europe continues to pose a problem; and cases of rabies are regularly reported in dogs and cats imported illegally into the EU. Classic rabies virus is endemic in Greenland, where Arctic foxes occasionally transmit the infection to other mammals. The latest case of classic rabies in Arctic foxes was reported in 2021.
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 most recent case was EBLV of type 1 detected in a serotine bat in 2009, whereas EBLV of type 2 was detected in a saliva sample from a Daubenton’s bat in 2015.
In 2020 and 2021, a total of 15 and 25 animals, respectively, from Denmark were tested for classic rabies and/or bat rabies through passive monitoring, all of which tested negative by PCR, Table 1.
In 2020 and 2021, a total of four specimens were submitted for rabies testing from Greenland, Table 2. In 2020, no rabies was detected in the submitted polar foxes, but in 2021, classic rabies was detected in one of the two submitted polar foxes. The tests were conducted by the OIE Collaborating Centre for Zoonoses in Europe, the reference laboratory at the Friedrich-Loeffler-Institut (FLI) in Germany as agreed with Statens Serum Institut.
This report is also described in EPI-NEWS 10-11/22.