Abstract
The epidemiology of rabies in France and western Europe has changed during the past 22 years. In France, rabies in non-flying terrestrial mammals was declared to be eliminated in 2001, and the risk of rabies is now limited to contact with bats, rabid animals illegally imported from rabies-enzootic countries and traveller exposure in enzootic areas. We analysed the epidemiology of rabies in France from 1995 to 2016, describing and analysing data on human rabies surveillance as well as data on post-exposure prophylaxis (PEP) collected from the network of French antirabies clinics. Over the study period, seven individuals were diagnosed with rabies in France, all of whom were infected outside mainland France. PEP data analysis revealed an expected overall decrease in PEP administration for individuals exposed in mainland France, but there was still overuse of anti-rabies drugs, given the very low epidemiological risk. On the other hand, a significant increase in PEP delivered to individuals exposed abroad was evidenced. These epidemiological trends indicate that clear guidelines should be provided to support physicians’ efforts to adjust rabies risk assessment to the evolution of the epidemiological situation.
Highlights
Rabies is a zoonotic disease caused by a neurotropic virus of the Lyssavirus genus
The low numbers suggest that the antirabies clinic network is effective on the management of individuals who sought advice on postexposure prophylaxis (PEP) in mainland France before 2001, and of individuals exposed to bats in France or to any animal species in enzootic countries during the study period
The risk of being infected is extremely low or even negligible in mainland France and rabies is perceived as a threat only if exposure takes place outside western Europe
Summary
Rabies is a zoonotic disease caused by a neurotropic virus of the Lyssavirus genus. All mammals are susceptible to rabies, but only a few species are important as reservoirs for the disease (dogs, some other carnivores and bats) [2]. The rabies virus reaches the brain by centripetal propagation mediated by retrograde transneuronal transfer, and once clinical signs appear the disease almost invariably progresses to fatal encephalitis [6]. Rabies still causes tens of thousands of deaths worldwide every year, mostly in the developing world where control measures in dogs are not implemented and the majority of the population do not have access to PEP [9,10,11,12,13,14]
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