Prevention of human rabies: a challenge for the European Union and the European Economic Area

Abstract

Rabies is enzootic in over one hundred countries worldwide. In the European Union/European Economic Area (EU/EEA), the vast majority of human rabies cases are travellers bitten by dogs in rabies-enzootic countries, mostly in Asia and Africa. Thus, EU/EEA travellers visiting rabies enzootic countries should be aware of the risk of being infected with the rabies virus when having physical contact with mammals. They should consider pre-exposure vaccination following criteria recommended by the World Health Organization and if unvaccinated, immediately seek medical attention in case of bites or scratches from mammals. As the majority of the EU/EEA countries are free from rabies in mammals, elimination of the disease (no enzootic circulation of the virus and low number of imported cases) has been achieved by 2020. However, illegal import of potentially infected animals, mainly dogs, poses a risk to public health and might threaten the elimination goal. Additionally, newly recognised bat lyssaviruses represent a potential emerging threat as the rabies vaccine may not confer protective immunity. To support preparedness activities in EU/EEA countries, guidance for the assessment and the management of the public health risk related to rabies but also other lyssaviruses, should be developed.

Tackling the Threat of Rabies Reintroduction in Europe

“…In Europe, the chiropteran rabies cycle is independent from the terrestrial rabies cycle ( 24 ). In 2019, the surveillance data confirmed five cases in animals in Europe, the highest proportion of the cases being in red foxes (two in Romania and one in Poland), followed by one case in a cow and in a wild boar, also in Romania ( 68 ). In the early 1960s, red fox rabies emerged in many European countries ( 13 , 25 ).…”

New global targets for NTDs in the WHO roadmap 2021–2030

“…Although human deaths associated to dog-mediated rabies (95% of all-deaths from rabies) are estimated at around 23,500 to 59,000 per year, mostly children younger than 15 years living in Asia and Africa, elimination was achieved in Canada, Western Europe (in 2019, only Poland and Romania were reporting cases in European Union), USA, Japan, and substantial decrease in Latin American countries [25][26][27]. The highly committed "Zero by 30" global strategic plan to eliminate dog-mediated rabies is now in place, with the aim of guiding effective use of vaccines, medicines, and technologies, and generating both evidence-based guidance and highquality data for control [28].…”

Zoonotic Risk: One More Good Reason Why Cats Should Be Kept Away from Bats

“…The best-known disease that may pass on from bats to cats and eventually humans is rabies, a zoonosis that causes 590,000 human deaths per year and affects >100 countries worldwide [ 49 ]. Human contagion is caused by contact with saliva of an infected animal.…”

“…Contacts between domestic cats and rabid Eptesicus serotinus bats were reported for the Netherlands [ 55 ]. Most recently, a cat in Central Italy died after biting humans and tested positive for another lyssavirus, the West Caucasian bat lyssavirus [ 49 ], previously isolated in the Miniopterus schreibersii from South-Eastern Europe [ 56 ]—a partly migratory species also occurring in Italy [ 57 ]. Isolates of the African Mokola virus (genus Lyssavirus ) are also retrieved in domestic cats and might result from predation over a bat or rodent natural reservoir [ 58 ].…”