Abstract
BackgroundThe nonhuman primate (NHP)-related injuries in rabies-enzootic countries is a public health problem of increasing importance. The aims of this work are to collect data concerning rabies transmission from NHPs to humans; to collate medical practices regarding rabies postexposure prophylaxis (PEP) in different countries, and to provide an evidence base to support the decision to apply rabies PEP in this context.MethodologyTo retrieve information, we conducted a literature search from 1960 to January 2013. All reports of rabies in NHPs and rabies transmission to humans by infected NHPs were included. Also included were studies of travelers seeking care for rabies PEP in various settings.Data collected by the French National Reference Centre for Rabies concerning NHPs submitted for rabies diagnosis in France and human rabies exposure to NHPs in travelers returning to France were analyzed for the periods 1999–2012 and 1994–2011, respectively.Principal findingsA total of 159 reports of rabies in NHPs have been retrieved from various sources in South America, Africa, and Asia, including 13 cases in animals imported to Europe and the US. 134 were laboratory confirmed cases. 25 cases of human rabies following NHP-related injuries were reported, including 20 from Brazil. Among more than 2000 international travelers from various settings, the proportion of injuries related to NHP exposures was about 31%. NHPs rank second, following dogs in most studies and first in studies conducted in travelers returning from Southeast Asia. In France, 15.6% of 1606 travelers seeking PEP for exposure to any animal were injured by monkeys.Conclusions/significanceAlthough less frequently reported in published literature than human rabies, confirmed rabies cases in NHPs occur. The occurrence of documented transmission of rabies from NHPs to human suggests that rabies PEP is indicated in patients injured by NHPs in rabies-enzootic countries.
Highlights
Among wildlife, nonhuman primates (NHPs) are known to harbor a large diversity of zoonotic pathogens and are among the primary mammals targeted for zoonotic disease surveillance [1]
Epidemiologic studies and reports collated in this review indicate that the number of rabies case reported in NHPs are rare compared with humans
Little is currently known of the pathobiology of rabies virus shedding in primates, which implies that rabies postexposure prophylaxis (PEP) and administration of rabies immunoglobulin should be considered in patients with a possible exposure
Summary
Nonhuman primates (NHPs) are known to harbor a large diversity of zoonotic pathogens and are among the primary mammals targeted for zoonotic disease surveillance [1]. They are the principal host and sometimes an important intermediate host of many zoonotic RNA viruses. Despite evidence of rabies virus spillover in NHPs and of transmission of rabies from NHPs to humans, neither the World Health Organization (WHO) nor the United States Centers for Disease Control and Prevention (CDC) provide specific guidelines regarding rabies PEP following NHPrelated injuries. The aims of this work are to collect data concerning rabies transmission from NHPs to humans; to collate medical practices regarding rabies postexposure prophylaxis (PEP) in different countries, and to provide an evidence base to support the decision to apply rabies PEP in this context
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