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 veterinarian. 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 2022, a total of 183 persons received treatment on suspicion of rabies exposure after having been bitten by animals (PEP). Among these, three persons had previously received PrEP, two had possibly become exposed abroad and one had possibly become exposed in Denmark
Post-exposure prophylaxis given after exposure in Denmark in 2022
In 2022, a total of 49 persons received prophylactic treatment after potential rabies exposure in Denmark (PEP). In Denmark, bat bites were the reason why 19 persons were initiated PEP treatment.
A total of 16 persons received rabies treatment due to dog bites. Fifteen of these people had been bitten by dogs imported from non-rabies-free countries, of whom eight had been bitten by dogs from Ukraine. In one case, a person was bitten by two dogs from Ukraine. Seven persons were bitten by illegally imported dogs; four of whom were bitten by the same dog from Romania, two were bitten by dogs from Turkey and one was bitten by a dog from Bulgaria. The final person was bitten by a Danish dog with rabies-like behaviour but without any known rabies risk. PEP treatment was initiated on the request of the veterinarian, but the treatment was discontinued when samples from the dog’s brain tested negative for rabies.
In 2022, a total of 14 persons initiated PEP treatment following cat bites. Half of these persons were bitten by cats from Ukraine, three were bitten by the same cat. The seven persons who received PEP treatment after being bitten by a Danish cat had been bitten by four different cats.
Post-exposure prophylaxis given after exposure abroad in 2022
In 2022, a total of 134 persons received PEP-treatment after potential rabies exposure abroad.
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, which was, once more, replaced by an increase in 2022.
In 2022, a total of 81 (60%) persons who had possibly been exposed to rabies abroad were treated with human rabies immunoglobulin (HRIG). Among these, 54 persons (67%) received HRIG only after returning to Denmark.
A total of 28 persons (21%) were not vaccinated until after returning to Denmark.
The majority of those who initiated rabies PEP treatment following bites abroad in 2022 had become exposed in Thailand (29) or Turkey (27).
In 2022, dogs caused 77 (57%) of the cases of potential exposure abroad. Additionally, 31 persons (23%) were potentially exposed by cats, 15 persons (11%) were potentially exposed by monkeys, seven persons were potentially exposed by bats, one person was potentially exposed by a fox, one by a racoon, one by a donkey and one by a chipmunk.
Rabies in animals
The more frequent type of rabies is classic rabies virus or European Bat Lyssavirus (EBLV type 1 and 2), also known as bat rabies. 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 and North Africa, among others, 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.
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 2022, 22 animals from Denmark were tested for classic rabies and/or bat rabies and/or as part of the passive monitoring efforts. Ten of these cases were tested on suspicion of transmission of infection from pets due to the situation in Ukraine. All of these animals tested negative by PCR, Table 1.
In 2022, a total of nine specimens were submitted for rabies testing from Greenlandic Arctic foxes, Table 2. Classic rabies virus was detected in five of the nine submitted Arctic 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 no. 49b/2023.