EPIDEMIOLOGY AND PROPHYLAXIS OF RABIES IN HUMANS IN FRANCE. EVALUATION AND PERSPECTIVES OF A TWENTY FIVE YEAR SURVEILLANCE PROGRAM.

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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

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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.

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Rabies treatment centers and antennas in France
21 antennes
66 centres
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 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

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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 (lt10 years old)
• 18 males, 2 females

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A few data from the RTC and the NRC for Rabies

• Domestic animals(90)
• Dogs 65!
• Sex ratio (M/F) 0.54
• Age 30lt20y, 20lt60lt60, 11gt60
• Category III exposure 70
• Stability of the caracteristics of the population
  who receives PET along the years

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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

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Rabies in France1982-2004Cases in animals and
PET
Last autochtonous terrestrial cases
Bats Imported pets
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PET after rabies cases in humansFrance1991-2003

• 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

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PET after exposures to bats or monkeys
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Number of PET according to the status of the
animal towards rabies
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Percentage of PET after exposure during
travelFrance
Pasteur Institute 40 in 2006
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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

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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