symptoms, risk countries, in France?

Worldwide, rabies kills one person every ten minutes. As soon as symptoms appear, the disease is always fatal. All cases of rabies in France originate from animals infected abroad. Symptom, country of risk, prevention in case of travel.

In the world, rabies kills one person every ten minutes, reminds the Ministry of Agriculture in a press release dated June 30, 2022. Once symptoms appear, rabies is always fatal. France regularly encounters cases of rabies associated with illegal import of pets from countries where the disease remains endemic. Means exist to prevent the introduction of the disease and its spread, and the right actions must be taken. Practical advice.

Definition: What is rabies?

Rabies is viral diseasecaused by viruses of the lyssavirus family. It is a zoonosis, that is, a disease transmitted to humans from animals. Rabies causes encephalitis, infection, and severe brain inflammation. Rabies is almost always fatal as soon as the first symptoms appearedadds Dr. Perrin Parise, deputy director of the National Rabies Reference Center at the Institut Pasteur.

Is there rabies in France?

France is free from rabies. “Ldog rabies eradicated at the beginning of the last century” tell him Dr. Perrin Parise, Deputy Head of the National Rabies Reference Center of the Pasteur Institute. All cases of rabies in France originate from animals infected abroad. Thus, France regularly faces cases of rabies associated with smuggling pets from countries where the disease remains endemic, according to the Ministry of Agriculture. For example, in February 2020 a case of rabies was found in a puppy brought from Morocco via Spain. “Each year, several bats are sent to our lab or Nancy’s Wildlife and Rabies Lab (ANSES) and are diagnosed positive for these lyssaviruses.” she adds. Thus, situations involving the risk of rabies transmission in French territory Exhibitions (bites, scratches, licks on wounds or mucous membranes) bat or illegally imported animal (without adequate rabies vaccination) from another country. The situation most at risk for French citizens is contact with an animal in a country where terrestrial mammalian rabies still occurs (worldwide except Western Europe, Japan, Australia…) while traveling.

What are the symptoms of rabies?

After infection with a rabid animal, the first signs of the disease appear on average in 1-2 months which corresponds to the incubation period. However, this period is variable and may last only a few days after the bite or several months. Rabies is responsible for encephalitis, an infection of the nervous system central. Main symptoms:

  • Belonging anomalies of consciousness with behavioral change, restlessness, agitation progressing to coma.
  • Belonging spasms : hydrophobia and / or aerophobia (spasm of the neck muscles at the sight of water or after contact with air) can be observed. These spasms are uncontrollable and characteristic of the disease. By the way, in some countries rabies is called rabies.
  • BUT dysregulation of the autonomic nervous system : it controls breathing, digestion, sweating, heart rate, blood pressure … Then patients have abnormal blood pressure, changes in heart rate, pupil anomalies, in particular hypersalivation. This sign is also very characteristic of canine rabies.

“After the appearance of the first symptoms, evolution proceeds rapidly and death usually occurs within a few days” Perrin Parise says.

According to the WHO, 99% of human rabies deaths are attributable to dog bites. “The disease is transmitted to humans by direct contact with a rabid animal, or by biting, scratching or licking a wound or mucous membrane. Most deaths occur in countries where dogs and some wild mammals can be infected with rabies, and where there is access to preventive treatments for the disease that are not available to the most vulnerable populations. Africa and Asia bear the brunt of human mortality from rabies.”promoted by a specialist. “There is no risk of human-to-human transmission of rabies, except in extremely rare cases of infection after organ or tissue transplantation,” the scientist says.

Diagnosis: what tests to pass?

The diagnosis may be carried out in an animal if a veterinarian suspects this disease (in an animal illegally imported from a country where rabies is still circulating in dogs, for example). The person has no lack of a diagnostic test for the disease before symptoms of encephalitis appear. In France, diagnoses of rabies are often suspected by resuscitators or infectious disease specialists in hospitals. “The disease is suspected because the patient’s clinical symptoms and medical history are suggestive. Has he been exposed to animal contact through bites or scratches abroad, or has he been in contact with a bat or animal smuggled into France? When all these elements are combined, the only laboratory in France authorized for human diagnosis is the CNR for rabies at the Institut Pasteur. Diagnosis is by PCR on saliva samples and skin biopsy.” explains Dr. Paris.

What are the treatments for rabies?

There is no no effective cure for rabies. We only have preventive procedures called post-exposure prophylaxis (vaccination and rabies immunoglobulin). “The only preventive measure against rabies ispost-exposure rophylaxis which should be started as soon as possible after a bite from an animal suspected of having rabies. The vaccine is 100% effective in preventing infection. In France, almost every department has rabies centers where patients bitten or scratched by an animal suspected of having rabies are treated. Only these centers are authorized to provide post-exposure prophylaxis. Treatment consists of a series of 4 or 5 injections of the vaccine and sometimes injections of rabies immunoglobulins, ie antibodies that are directed directly against rabies., lists the specialist. These drugs should be used in the first days after a bite or scratch, during the incubation period, and until symptoms appear.

Who should be vaccinated against rabies?

Rabies vaccination is not requirede in France, but recommended:

  • after contact with a suspicious animal
  • during your stay in the country of risk”especially in childrenPerrin Parise explains.
  • if there is an occupational risk of contracting rabies (veterinarians, lab workers who diagnose rabies or produce vaccines, or chiropractors who come into contact with bats)

The specialist advises discussing this with the attending physician – all doctors can do the rabies vaccination as a preventive measure – or contact the international vaccination center, where doctors specializing in travelers’ diseases inform the population.

The situation most at risk for French citizens is contact with an animal in a country where terrestrial mammalian rabies still occurs (worldwide, except Western Europe, Japan, Australia…) on the occasion travel. To protect yourself, while staying abroad in a country of risk, do not touch an unfamiliar animal and don’t take it back. An animal can become infected with rabies and transmit the disease to humans or other animals.

To travel with a pet, preliminary procedures are required (for their non-compliance, criminal liability is provided):

  • contact your veterinarian well in advance of departure (1 to 4 months depending on destination);
  • your animal must be identified and have a valid passport;
  • your pet’s vaccinations must be up to date, especially against rabies;
  • a blood test for serum rabies antibody titration is required before traveling to some countries with a risk of rabies infection.

In case of contact with a bat or illegally imported animal as a result of biting, scratching or licking in France or in case of contact with an animal abroad, it is recommended contact a rabies control center immediately. “And when you travel, I advise you to inquire about the risks before you leave with your doctor or go to an international vaccination center.”adds Perrin Parise.

Which countries are at risk for rabies?

The list of countries at risk of rabies infection was updated in March 2022 by the Ministry of Agriculture. Among them :

  • Afghanistan
  • South Africa
  • Algeria
  • Angola
  • Saudi Arabia
  • Argentina
  • Armenia
  • Azerbaijan
  • Bangladeshi
  • Belize
  • Benign
  • Butane
  • Belarus
  • Bolivia
  • Botswana
  • Brazil
  • Burkina Faso
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Chile
  • China (People’s Republic of)
  • Colombia
  • Costa Rica
  • Cuba
  • Egypt
  • USA
  • Hungary
  • India
  • Madagascar
  • Morocco
  • Mexico
  • Norway
  • Poland
  • Russia
  • Thailand
  • Tunisia
  • Ukraine
  • Venezuela
  • Vietnam

Thanks to Dr. Perrine Parise, Deputy Head of the National Reference Center (CNR) for Rabies at the Institut Pasteur. Interview in March 2021.

Source: Beware of Rabies: launch of annual awareness and prevention campaign. Press release. June 30, 2022

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