Abstract
Taiwan had been free of indigenous human and animal rabies case since canine rabies was eliminated in 1961. In July 2013, rabies was confirmed among three wild ferret-badgers, prompting public health response to prevent human rabies cases. This descriptive study reports the immediate response to the reemergence of rabies in Taiwan. Response included enhanced surveillance for human rabies cases by testing stored cerebrospinal fluids (CSF) from patients with encephalitides of unknown cause by RT-PCR, prioritizing vaccine use for postexposure prophylaxis (PEP) during periods of vaccine shortage and subsequent expansion of PEP, surveillance of animal bites using information obtained from vaccine application, roll out of preexposure prophylaxis (PrEP) with vaccine stock restoration, surveillance for adverse events following immunization (AEFI), and ensuring surge capacity to respond to general public inquiries by phone and training for healthcare professionals. Enhanced surveillance for human rabies found no cases after testing 205 stored CSF specimens collected during January 2010–July 2013. During July 16 to December 28, 2013, we received 8,241 rabies PEP application; 6,634 (80.5%) were consistent with recommendations. Among the 6,501persons who received at least one dose of rabies vaccine postexposure, 4,953 (76.2%) persons who were bitten by dogs; only 59 (0.9%) persons were bitten by ferret-badgers. During the study period, 6,247 persons received preexposure prophylaxis. There were 23 reports of AEFI; but no anaphylaxis, Guillain-Barré syndrome, or acute disseminated encephalomyelitis were found. During the study period, there were 40,312 calls to the Taiwan Centers for Disease Control hotline, of which, 8,692 (22%) were related to rabies. Recent identification of rabies among ferret-badgers in a previously rabies-free country prompted rapid response. To date, no human rabies has been identified. Continued multifaceted surveillance and interministerial collaboration are crucial to achieve the goal of rabies-free status in Taiwan.
Highlights
Taiwan had been free of indigenous human and animal rabies case since canine rabies was eliminated in 1961 [1, 2], despite the lower than recommended 70% rabies vaccine coverage among dogs and cats
All vaccines and rabies immunoglobulin (RIG) were procured by Taiwan Centers for Disease Control (TCDC), and distributed to hospitals as needed
Having the experience of centralized procurement and supply of rabies postexposure prophylaxis (PEP) meant that the emergent procurement process could be pushed forward without having to seek new pharmaceutical firm collaboration, and that TCDC and hospitals already have set standard operating procedure for the distribution of these supplies
Summary
Taiwan had been free of indigenous human and animal rabies case since canine rabies was eliminated in 1961 [1, 2], despite the lower than recommended 70% rabies vaccine coverage among dogs and cats. The successful maintenance of rabies-free status was attributed to Taiwan’s relative geographic isolation as an island and strict animal importation control [2]. Human rabies remains nationally notifiable in Taiwan. Since the last locallyacquired human rabies case was confirmed in 1959, three imported cases of human rabies have been identified, including a female traveler from China (July 2002), a businessman returning from China (July 2012), and a male worker from the Philippines (May 2013), all of which occurred after dog bites outside Taiwan without receiving rabies postexposure prophylaxis (PEP) [3,4,5]. No rabies virus were found among 6,841 dog specimens tested during 1999–2012 and 322 bat specimens tested during 2008–2012 [10]
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