Transcript EPIDEMIOLOGY AND PROPHYLAXIS OF RABIES IN HUMANS IN …

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 Rage
Institut 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
Rabies treatment centers and antennas in France
21 antennes
66 centres
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
OIE/OMS, Paris, 2007
Year Sex Age Country
Animal Incub Disease PET
1970 M
3
Niger
Cat
10d
1973 M
10
Gabon
Dog
AM
1976 M
5
Gabon
Dog
11 m 20d
or 15
d
45d 1m
1976 M
18
Algeria
Dog
?
23d
AM 1
1976 M
28
Morocco
?
?
1m
PM
1976 M
10
Algeria
Dog
1m
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
2m
10d
PM
12
1979 M
36
Egypt
CG
1m
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
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
9d
Diag PETII COM.
SMB PM
AM
36
AM 100
HIV+
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 France
1982-2004
Cases in animals and PET
18000
16000
Last autochtonous terrestrial cases
14000
Positive
animals
Patients
PET
12000
10000
8000
6000
OIE/OMS, Paris, 2007
04
7 5
20
02
4 3 2
20
00
1 5
20
98
96
94
92
90
88
82
0
86
2000
84
4000
4212
2983
2870 2462
2625
2225
2164
2009 2213
1214
261 99 40 17 2 4
Bats
Imported pets
PET after rabies cases in humans
France
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: 92
Without the 2 rabies cases in children (Lyon and La
Réunion): 42
OIE/OMS, Paris, 2007
PET after exposures to bats
or monkeys
200
150
Monkeys
Bats
Linˇaire (Bats)
Linˇaire (Monkeys)
100
50
0
82
-50
85
88
OIE/OMS, Paris, 2007
91
94
97 000 003 006
2
2
2
Number of PET according to the
status of the animal towards
rabies
2500
2000
Positive Labo
Clinically P
Negative Labo
Clinically N
1500
1000
500
OIE/OMS, Paris, 2007
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
0
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
18
16
14
12
10
8
6
4
2
0
Percentage of PET after
exposure during travel
France
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
OIE/OMS, Paris, 2007