Un chiot importé illégalement du Maroc révèle la rage en France;
Bulletin épidémiologique mensuel de la rage animale en France,Vol.32,N¡4-5-6,
Laboratoire d'étude et de recherche sur la rage et la pathologie des animaux sauvages, Agence Française de Sécurité Sanitaire des Aliments
Source: Mahendra Hospital, Dang, and news published in
Kantipur Daily News paper, Kathmandu, Nepal.
4 cas de morts humaines dûes à la rage au Népal
Le 9 Décembre 1998, 4 personnes sont mortes de rage (hydrophobie) dans la
région de Dang, à l'ouest du Népal.
Elles avaient toutes été mordues par des chiens enragés quelques mois
auparavant. Dans cette région, 1000 personnes ont étéŽ mordues cette année.
Elles avaient toutes reçu un traitement par vaccins antirabiques produits
sur cerveau de mouton (Semple) pendant 10 jours .
Apr&eagrave;s la fin de cette série de vaccinations, 4 personnes sont décédées.
Cela signifie qu'il y a un problème d'efficacité du vaccin.
C'est le deuxième épisode d'échec dû à ce tupe de vaccin. Il y a quelques
mois, une personne est morte de rage dans les mêmes conditions à
Kathmandu.
Dr.D.D.Joshi
Kathmandu
Date: 09 October 1998
Source: MMWR, Vol. 47 / No. 39,
Via: Dr. James Chin,CDPC-mail jchin@cdpc.com
Animal rabies, Denmark - Bat virus causes rabies in sheep
On 24 August, rabies was diagnosed by the Danish Veterinary Institute
for
Virus Research in a sheep in western Jutland. Further characterization of
the isolated virus strain performed by the Central Veterinary Laboratory
(United Kingdom) revealed that it was bat rabies virus type EBL-1a, which
is identical to the bat rabies virus isolated sporadically from Danish
bats. No animal may leave the holding in which the case occurred without
a
permit from the Danish Veterinary Service. No other animal has shown any
clinical signs of rabies.
[WER] Editorial note: In western Europe, there are 2 distinct rabies
reservoirs, in which the virus is maintained by permanent transmission:
one
comprises terrestrial wildlife species (mainly foxes), and the other bats.
Infection of other susceptible species (including humans) is an
epidemiological dead-end, as the virus is usually not further propagated.
No outbreaks of bat rabies in wildlife have been detected. This is the
first case of rabies in a terrestrial animal caused by a bat-related rabies
virus.
date: 29 Juin 1998
Source: Ivan Kuzmin
Rabies group, Institute for Natural Foci Infections,
Prospekt Mira, 7, Omsk, 644080, Russia
e-mail:kuzmin@home.omsk.su
human rabies case in Russian Siberia
Man, 51 years old was attacked by wolf in Norilsk district of Krasnoyarsk
region (near 69 degrees N) at the end of March 1998. Multiple wounds of
head, face, shin and hand finger took place. Concentrated rabies vaccine
(Rabivac, Vnukovo-32) was injected on days 0, 3, 7, than the patient declined
the immunization himself. RIG was unavailable because the territory was
free of rabies during many years. The patient felt ill on day 25 after incident
and died 6 days later with classical
rabies symptoms.
The virus strain was isolated from human brain using the mice inoculation
test in our laboratory. Mice brain impressions were studied with antinucleocapsid
monoclonal anti-bodies. Bright fluorescence obtained with MAb P-41 (Germany
Federal Res. Inst. Anim. Vir. Dis.; courtesy of Dr. L.Schneider) was typical
for rabies. The arctic fox strain from Yakutia was used as positive
control and the fox strain from Western Siberia as negative. The reactivity
pattern with Wistar MAbs (Wistar Inst., USA; courtesy of Drs. H.Koprowski,
C.Rupprecht) was very similar to arctic fox strains.
No human rabies cases were registered in Krasnoyarsk region since 1955
(earlier data are unavailable at the moment). Only 5 animal rabies cases
(dogs) were reported during last 2 decades: 1981 - 3, 1990 - 1, 1994 - 1.
By the way, the North of the region is ter-ritory of high density of arctic
fox, the species known as main host of arctic rabies.
Source:
Rabies Bulletin Europe, 4/97, WHO Collaborating Center for Rabies Surveillance
and Research.
Imported human rabies cases in France
Y. Rotivel*, H. Bourhy*, S. Wirth*, M. Goudal**, H. Tsiang*
*Unitéde la Rage, Centre National de Référence pour
la Rage, Institut Pasteur
**Centre Antirabique, Institut Pasteur
The last indigenously acquired human rabies case occurred in France in
1924.
Particularly, no indigenously acquired human case have been reported since
the beginning of the vulpine epizooty in 1968. Simultaneously, 14 imported
rabies cases occurred from 1977 to 1993. Since 1994, 5 cases have been reported
mostly in French residents returning for holidays in their country of origin
or even in tourists.
- Case 1
In December 1994, a 46 years old man native from Mali but resident in Créteil,
died from rabies. He had been bitten by a rabid dog in Mali in september
1994 and had received one injection of an unknown vaccine. He returned
to France at the end of September and was hospitalized mid december for
loss of weight and fever. He was agitated, confused and hydrophobic when
he arrived at the hospital. Rabies was suspected and he was isolated. Samples
of saliva, a skin biopsy and CSF were taken for diagnosis and found negative.
Meanwhile, he was found to be HIV positive.
He died 12 days after being hospitalized. Rabies antigen was found on brain
and skin biopsies using direct immunofluorescence test, Elisa, and isolation
on neuroblastoma cells. 36 postexposure treatments (PET) were applied in
family members and hospital staff.
- Case 2
In march 1995, a 3 years old boy, died from rabies in the French Island
La Réunion. He had been bitten in Madagascar during holidays in
his family in January. Nobody saw the biting dog, but the family members
thought it was one of the known stray dogs. The child did not receive any
PET as the dog was thought to be still alive until 3 weeks after the bite.
Back home, he died within one week showing anxiety, agitation and hydrophobia.
Rabies virus antigen was found on brain and skin biopsies. 299 PET were
applied in hospital staff, family members and school mates of the child.
- Case 3
A 71 years old man was bitten in Algeria by his own dog in his village
while on vacation. He did not seek any PET treatment. He died 40 days later,
back in France. Hydrophobia was reported. A woman bitten by the same dog
died in Algeria at the same period. 35 PET were applied in close contacts.
Rabies antigen was found on brain and skin biopsies.
- Case 4
A 60 years old man was bitten in Algeria. He died 2 months later, when
he was back in France. Hydrophobia was present. Rabies antigen was found
on brain biopsies. 45 PET were applied in family members and hospital staff.
- Case 5
A 50 year old woman was bitten by a rabid dog during a holiday trip in
India. The wounds were deep and multiple, located on the legs. The wounds
were cleaned and sutured on the same day at the local hospital and she
received one dose of rabies vaccine intramuscularly (PCEC, Behring). The
second dose was given 3 days later in India. Back to France, she received
3 more doses of Verorab according to the Essen schedule. 12 days after
the bite, she began to complain of paresthesia at the site of the wounds.
She developed a paralytic form of rabies and died 50 days after the bite.
50 PET were applied in family members and hospital staff. Rabies virus
antigen was found intra-vitam on skin biopsy and post-mortem on brain biopsies.
Rabies virus RNA was found intra-vitam in the saliva by RT-PCR.
Imported rabies is still a danger for travellers, especially for European
travellers who have forgotten the risk of rabid animals. Information on
rabies should be part of the pre-travel information given in travel clinics
as well as by general practitioners. Moreover, cell culture or duck embryo
rabies vaccines and rabies immunoglobulin are not available easily everywhere.
Rabies preexposure vaccination is therefore useful for residents in canine
enzootic countries, as well as children and travellers in remote areas.
Rabies PET in previously vaccinated individuals is greatly simplified.
Two vaccines injections are given 3 days apart. No rabies immunoglobulin
is necessary. An anamnestic response is elicited and high antibody titers
are rapidly obtained.
January 16, 1998/Vol.47/No01
Rage Humaine, Texas et New-Jersey, 1997
Les 19 et 23 Octobre 1997, deux patients, l'un au Texas et l'autre au
New-Jersey sont morts de rage.
Ce rapport résume quelques caractéristiques cliniques de ces
cas ainsi que les aspects épidémiologiques. Le département
de la santé du Texas et celui de l'état du New-Jersey, indiquent
qu'une souche variante du virus de la rage (chauve-souris) est responsable
de l'infection dans les deux cas.
- Cas 1:
Le 3 Octobre, un homme de 71 ans originaire du Texas fait un malaise,
est atteint d'anorexie avec des douleurs à l'oreille. Après
des études approfondies, la rage est suspectée le 12 Octobre.
Il tombe dans le coma le 16 Octobre et décède le 17 Octobre.
Son épouse rapporte qu'il avait eu un contact récent avec
une chauve-souris : le 03 Aout, pendant son sommeil, l'homme a été
réveillé par une chauve-souris qui s'était posée
sur son épaule gauche, mais l'absence de morsure détectable
fait qu'aucun traitement n'a été pratiqué.
- Cas 2:
Le 12 Octobre, un homme de 32 ans, originaire du New-Jersey, présente
une douleur dans son épaule droite et dans son nez. Ces symptomes
persistent et s'aggravent, entrainant des vomissements, des frissons et
une gorge douloureuse l'amenant à consulter un médecin le
13 Octobre. La rage est suspectée le 17 Octobre et des tests montrent
que le patient est infecté par le virus rabique.Il décède
le 23 Octobre. Ce patient avait lui aussi été en contact
avec des chauve-souris à deux reprises en Juillet sans souvenir
d'avoir été mordu.
- Note :
Dans le courant de l'année 1997, il y a eu 4 cas de rage humaine
aux Etats-Unis incluant les deux cas ci-dessus.Depuis 1971, c'est le premier
cas de rage humaine au New-Jersey et le douzième au Texas.Depuis
1980, des 36 personnes mortes de rage aux Etats-Unis, 21 l'ont été
à la suite de contact avec des chauves souris avec un seul cas de
morsure avérée.
Cette situation illustre l'importance grandissante des chauves-souris
dans la transmission de la rage à l'homme aux Etats-Unis.Elle est
préoccupante car en l'absence de morsure, les patients ne se présentent
pas forcément chez un médecin pour un traitement antirabique
comme c'est le cas pour une morsure par un chien ou un animal sauvage.
04 Décembre 1997
Source:
Oral Rabies Vaccination Program (ORVP)
Texas Department of Health
Two rabies epizootics (epidemics in animals) began in Texas in 1988.
The canine rabies epizootic (carried by coyotes and dogs) in South Texas
and gray fox rabies epizootic in Central Texas have expanded to include
21 counties in South Texas and 48 count s in Central Texas.
Since 1990, five human lives have been lost to rabies in Texas. In South
Texas alone, 2 people have died from canine rabies and over 2,500 people
have taken postexposure injections of rabies vaccine after being exposed
to a potentially rabid animal.
If the rabies epizootics were not halted, rabies postexposure health
care costs in humans would have reached $63 million by the year 2004.
In February 1995, the Texas Department of Health (TDH) initiated a cooperative
program, known as the Oral Rabies Vaccination Program (ORVP), assisted by
the Texas Animal Damage Control Program; Texas National Guard; Merial Limited;
Van Kampen Group, Inc. Ontario Ministry of Natural Resources; Queen's University
at Kingston - Ontario; U.S. Army Veterinary Laboratory - Fort Sam Houston;
David Johnston - Ontario, Canada; Hill's Pet Nutrition, Inc.; U.S. Department
of Agriculture (USDA) Animal and Plant Healt Inspection Service; Centers
for Disease Control and Prevention; Texas A&M University System; U.S. Air
Force; USDA Predator Research Facility -Logan, Utah; National Wildlife Research
Center; and Texas Parks and Wildlife Department. The goals of the program
were to create zones of vaccinated coyotes and gray foxes along the leading
edges of the epizootics and to halt the spread of the rabies virus and the
expansion of the epizootics.
During the February 1995 program, 850,000 doses of oral rabies vaccine
in an edible bait (dog food or fish meal) were aerially distributed by Canadian
Twin Otter aircraft over 15,000 square miles of South Texas. The January
1996 program was enlarged to include the expanding gray fox rabies epizootic
in Central Texas and involved the distribution of 2.5 million doses of vaccine
over 41,000 square miles of South and Central Texas, becoming the world's
largest single distribution of an oral rabies vaccine. The January 1997
program included the distribution of 2.6 million doses of vaccine ove
The programs through 1997 have demonstrated substantial success based
on 3 areas of evaluation:
(1) Case surveillance - there has been a significant reduction in reported
cases in the treated area. Reported cases of canine rabies in South Texas
have dropped from 166 in 1994 (before the first year of the coyote program)
to 75 in 1995, 15 in 199 and 3 as of October 1997. Reported cases of gray
fox rabies have demonstrated a similar decline from 188 cases in 1995 (before
the first year of the gray fox program) to 57 in 1996, and 16 as of October
1997. (Note: case surveillance data for the program begins in mid-March
of each year.)
(2) Tooth analysis - identification of a marking agent in the baits
has determined that, of a sample of animals from the treated area, 87%
of coyotes from South Texas tested since the program began in 1995 and
47% of gray foxes from Central Texas te ed in 1997 had eaten a bait(s).
(3) Serology - evidence of vaccination immunity in a sample of animals
from the treated area indicated that 82% of coyotes from South Texas tested
since the program began in 1995 and 84% of gray foxes from Central Texas
tested in 1997 showed an immu response.
During the 1998 program, there will be 2.6 million doses of oral rabies
vaccine distributed over approximately 42,000 square miles of South and
Central Texas.
For additional information, contact Dr. Gayne Fearneyhough or Guy Moore
of TDH's Zoonosis Control Division at (512) 458-7255 or the Web site at
http://www.tdh.state.tx.us/zoonosis/orvp.
Le 19 octobre 1997, un chiot provenant de la région d'Agadir (Maroc)
a été importé en Suisse par une touriste du canton
de Zurich. Le 21 octobre, ce chien a manifesté des changements de
comportement et a mordu sa nouvelle propriétaire. L'animal a ete
euthanasié le 27 octobre et la rage diagnostiquée par immunofluorescence
au Centre Suisse de la Rage le 29 octobre.
Le chien a été retrouvé dans la région d'Agadir
le 15 octobre 1996 par un couple (non identifié) et amené
au camping de Taghazout. Il s'agissait de deux ressortissants autrichiens
probablement de Vienne (ages de 35 ans environ) qui d'après les informations
disponibles sejournent encore dans leur caravane dans les environs de Taghazout.
Le chiot enragé a eu des contacts avec plusieurs personnes et des
animaux domestiques (chiens, singe) se trouvant dans le camping et a finalement
été amené par la ressortissante suisse. Vu l'apparition
des premiers symptômes le 21 Octobre, il est possible que le chiot
ait déja excreté le virus de la rage avant son importation
en Suisse.
Toute personne qui est entrée en contact avec ce chiot et a été
exposée au risque de transmission du virus (morsure, griffure, contact
de la salive avec les muqueuses), à Taghazout, dans les aéroports
d'Agadir et de Casablanca ou dans l'avion au retour d'Agadir via Casablanca
(vol AT 934 Casablanca Zurich du 19 Octobre 1997), devrait bénéficier
au plus vite d'un traitement postexpositionnel complet.
Depuis juillet 1997, aucun cas de rage de sérotype 1 n'a été
observé en France, ce qui correspond à 9 mois sans rage vulpine
en France.
Source : Bulletin Epidémiologique Mensuel de la Rage Animale
en France (juillet 1997)
En Suisse, aucun cas de rage depuis un trimestre n'a été
diagnostiqué en 1997. Le dernier cas de rage vulpine remonte à
plus d'un an.
Source : Rapport trimestriel de l'Institut de Virologie Vétérinaire
de Berne (Premier trimestre 1997)
RABIES IN GERMANY
A german fellow spent 4 weeks in Sri Lanka where he was bitten by a dog.
He did not receive antirabies vaccination. After returning to Dusseldorf,
this fellow was hospitalized with an unclear clinical picture almost one
month after the bite. The patient died 16 days after onset of the clinical
signs. Rabies was confirmed by laboratory diagnosis. Antirabies treatment
was given to 46 persons were.
Rabies Builltetin europe (april-june 1996)
LYSSAVIRUS IN AUSTRALIA
A strain of lyssavirus (lyssavirus 7), new to Australia has been isolated
in a fruit bat (flying foxe). The virus has produced illness and coma in
a woman who was scratched by a sick bat in Queensland. Investigations show
that five isolates are genetically identical. The samples come from 2 species
of fruit bats : black fruit bat (Pteropus alecto) and the Little Red Fruit
Bat (Pteropus scapulatus). show thInvestigations suggest the virus to be
present in Australia for at least one year.
Dorothy Preslar
Australian Media Report (11 nov. 1996)
Peter Thornber
12 nov. 1996
An rabies outbreak is reported in Sierra Leone (12 deaths and 40 hospitalized)
by stray dogs. The number of stray dogs had increased as rebels were cleared
from surrounding villages and the number of dog bites has increased 10 times.
Angela Lee
Media Report (13 nov. 1996)
A case of human rabies in England.
A 19 year-old patient returning to England from Nigeria developed rabies
and died from the disease. The virus was identified and post-exposure treatment
was given to all persons considered at risk.
No indigenous case of human rabies occurred in the UK since 1902 but
20 imported cases were reported since 1946.
From PHLS (vol. 6, Number 42, 18 october 1996)
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