OIE/OMS, Paris, 2007

EPIDEMIOLOGY AND PROPHYLAXIS OF RABIES IN HUMANS IN FRANCE.

EVALUATION AND PERSPECTIVES OF A TWENTY FIVE YEAR SURVEILLANCE

PROGRAM.Y. ROTIVEL, M. GOUDAL A. SIMONS DE FANTI D. VAN

DER VLIET AND FRENCH RABIES TREATMENT CENTRES.

Centre National de Référence pour la RageInstitut Pasteur

Centres de Traitement Antirabique

OIE/OMS, Paris, 2007

…towards the elimination of rabies in Eurasia!

• Thanks to the many experts and reference books, we all know now that rabies has been a known disease for more than 40 centuries.

• Moreover, rabies has been and is still the usual companion of our pets, especially dogs, in many parts of the world

• Elimination of rabies in pets, primarily dogs, and even in terrestrial wild fauna has proven to be possible, but difficult and costly.

• But, bats, seem to be currently an inexhaustible reservoir.

This is why our primary goal should be the elimination of rabies in humans.

And this can only be done globally.

OIE/OMS, Paris, 2007

21 antennes

66 centres

Rabies treatment centers and antennas in France

OIE/OMS, Paris, 2007

« Bulletin about epidemiology and prophylaxis of rabies in humans »

• Demand from the Health Authorities• Sent to Health Authorities, RTC, Veterinary

Authorities, local veterinary laboratories, vet schools…

• Data from the RTC• Collected and analyzed by the NRC for Rabies• Direct entry of the data on the Internet• Direct access to the data to authorized persons

thanks to Voozanoo®

OIE/OMS, Paris, 2007

Rabies in humans in France• No autochtonous cases• Exposures during long

stays in rabies enzootic countries (mostly northern and sub saharian african countries)

• 18/20 cases from Africa• 2 tourists (Mexico and

India)• Dogs (17), Cat (1), ? (1)• 10 children (<10 years old) • 18 males, 2 females

Year Sex Age Country Animal Incub Disease PET Diag PETII COM.

1970 M 3 Niger Cat 10d 9d SMB PM

1973 M 10 Gabon Dog 11 mor 15d

20d AM

1976 M 5 Gabon Dog 45d 1m AM

1976 M 18 Algeria Dog ? 23d AM 1

1976 M 28 Morocco ? ? 1m PM

1976 M 10 Algeria Dog 1 m 18d AM

1977 M 2 Gabon Dog 18d 1d SMB PM 5

1977 M 4 Morocco Dog 1m 2d SMB PM 25

1979 F 57 Egypt Dog 2 m 10d PM 12

1979 M 36 Egypt CG 1 m 15d PM 128

1980 M 4 Tunisia Dog 2,5m 3d AM 66

1982 M 40 Senegal Dog 122 ? 30d PM ?

1990 M 28 Mexico Dog 47d 10d PM 1

1992 M 3 Algeria Dog 1m 3w AM 143

1994 M 46 Mali Dog 3m 11d PM 36 HIV+

1996 M 3 Madagascar Dog 2m 6d AM 290

1996 M 60 Algeria Dog 2m 5d PM 45

1996 M 71 Algeria Dog 40d 3d PM 35 +1 DC

1997 F 50 India Dog 12d 56d PCEC AM 36 Chloro

2003 M 3 Gabon Dog +2m 10d AM 100

OIE/OMS, Paris, 2007

A few data from the RTC and the NRC for Rabies…

• Domestic animals(90%)• Dogs: 65%!• Sex ratio (M/F): 0.54• Age : 30%<20y, 20<60%<60,

11%>60• Category III exposure : 70%

Stability of the caracteristics of the population who receives PET along the years

OIE/OMS, Paris, 2007

Data about PET

• Vaccine : – 1982 -1989 : mostly HDCV + FBKV – 1990-2003 : PVRV – 2004 : mostly PVRV+ PCECV

• Regimens– Essen (5 doses)– Mostly Zagreb (2-1-1, 4 doses)

• RIG : HRIG

OIE/OMS, Paris, 2007

Rabies in France1982-2004

Cases in animals and PET

262528702009246222132225

42122983

21641214

261994017 2 4 1 5 4 3 2 7 50

2000

4000

6000

8000

10000

12000

14000

16000

18000

82 84 86 88 90 92 94 96 982000

2002

2004

PositiveanimalsPatients

PET

BatsBatsImported petsImported pets

Last autochtonous terrestrial cases

OIE/OMS, Paris, 2007

PET after rabies cases in humansFrance

1991-2003• Mexico-Nice, 1991 : 44• Mali, 1994 :36• Madagascar-La Réunion, 1996 : 290• Algeria-Nice, 1996 : 45• Algeria-Marseille, 1996 : 35• India-Bretagne, 1997 : 50• Gabon-Lyon, 2003 : 142

Mean PET: 92Without the 2 rabies cases in children (Lyon and La

Réunion): 42

OIE/OMS, Paris, 2007

PET after exposures to bats or monkeys

-50

0

50

100

150

200

82 85 88 91 94 9720

0020

0320

06

MonkeysBatsLinˇaire (Bats)Linˇaire (Monkeys)

OIE/OMS, Paris, 2007

Number of PET according to the status of the animal towards

rabies

0

500

1000

1500

2000

2500

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

Positive LaboClinically PNegative LaboClinically N

OIE/OMS, Paris, 2007

Percentage of PET after exposure during travel

France

02468

101214161820

Pasteur Institute : 40% in 2006

OIE/OMS, Paris, 2007

Conclusions

• No autochtonous case in humans• Education of the public

– Risk from imported animals– Rabies exposure while traveling– Diversity of animal species : bats!

• Training– RTC– Travel clinics– Occupational medicine

OIE/OMS, Paris, 2007

Thank you for your attention!

• Medical team of the NRC for Rabies, M. Goudal, A. Simons de Fanti, D. Van der Vliet

• Rabies Treatment Centers