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Update on human rabies in a dog- and fox-rabies-free country.
Med Mal Infect. 2014 Jul; 44(7):292-301.MM

Abstract

Rabies is responsible for 50,000 deaths per year worldwide. Mainland France has been officially freed from rabies in non-flying animals since 2001.

METHOD

We wanted to provide an update on the French situation, using published data, and describe possible options since official guidelines are lacking.

RESULTS

Post-exposure prophylaxis (PEP) (early and careful cleaning and dressing of the wound, vaccination, and in case of high-risk exposure, injection of specific anti-rabies immunoglobulins) is known to be efficient except in rare cases. It is recommended after grade II contact (+specific immunoglobulins in immunodepressed patients), or grade III contact (vaccination+immunoglobulins).

DISCUSSION

Mainland France being rabies-free, 3 options may be considered in case of bite by a dog or a cat that cannot be monitored in France: (a) consider the risk of rabies as null, so no PEP should be administrated, whatever the severity of bites; (b) consider there is a weak but lethal risk, so the international recommendations should be applied, using immunoglobulins in some cases; (c) consider that the risk is extremely low but cannot be excluded, and that the patient should be vaccinated to be protected, but without adding immunoglobulins (whether in case of grade II or III bites).

CONCLUSION

There are no national guidelines for rabies in France, and so the physician managing the patient is the one who will decide to treat or not.

Authors+Show Affiliations

Maladies infectieuses et centre antirabique, CHU, BP 217, 38043 Grenoble, France. Electronic address: jpstahl@chu-grenoble.fr.Centre antirabique, CHU Nord, 13915 Marseille, France.Centre national de référence sur la rage, Institut Pasteur, 75015 Paris, France.Groupe Courlancy, cabinet d'infectiologie, clinique Saint-André, 51100 Reims, France.Service des maladies infectieuses et centre antirabique, hôpital la Milétrie, 86021 Poitiers, France.Centre antirabique, CHU Ponchaillou, 35033 Rennes, France.SLB JsBio, laboratoire espace santé du Golfe de Saint-Tropez, 83580 Gassin, France.Service des admissions et des urgences, centre antirabique, centre hospitalier, 55107 Verdun, France.Centre national de référence sur la rage, Institut Pasteur, 75015 Paris, France.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25011930

Citation

Stahl, J-P, et al. "Update On Human Rabies in a Dog- and Fox-rabies-free Country." Medecine Et Maladies Infectieuses, vol. 44, no. 7, 2014, pp. 292-301.
Stahl JP, Gautret P, Ribadeau-Dumas F, et al. Update on human rabies in a dog- and fox-rabies-free country. Med Mal Infect. 2014;44(7):292-301.
Stahl, J. P., Gautret, P., Ribadeau-Dumas, F., Strady, C., Le Moal, G., Souala, F., Maslin, J., Fremont, B., & Bourhy, H. (2014). Update on human rabies in a dog- and fox-rabies-free country. Medecine Et Maladies Infectieuses, 44(7), 292-301. https://doi.org/10.1016/j.medmal.2014.05.002
Stahl JP, et al. Update On Human Rabies in a Dog- and Fox-rabies-free Country. Med Mal Infect. 2014;44(7):292-301. PubMed PMID: 25011930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Update on human rabies in a dog- and fox-rabies-free country. AU - Stahl,J-P, AU - Gautret,P, AU - Ribadeau-Dumas,F, AU - Strady,C, AU - Le Moal,G, AU - Souala,F, AU - Maslin,J, AU - Fremont,B, AU - Bourhy,H, Y1 - 2014/07/08/ PY - 2014/04/15/received PY - 2014/04/29/revised PY - 2014/05/22/accepted PY - 2014/7/12/entrez PY - 2014/7/12/pubmed PY - 2015/4/14/medline KW - Anti-rabies immunoglobulins KW - Immunoglobulines antirabiques KW - Post-exposure prophylaxis KW - Prophylaxie post exposition KW - Rabies KW - Rage SP - 292 EP - 301 JF - Medecine et maladies infectieuses JO - Med Mal Infect VL - 44 IS - 7 N2 - UNLABELLED: Rabies is responsible for 50,000 deaths per year worldwide. Mainland France has been officially freed from rabies in non-flying animals since 2001. METHOD: We wanted to provide an update on the French situation, using published data, and describe possible options since official guidelines are lacking. RESULTS: Post-exposure prophylaxis (PEP) (early and careful cleaning and dressing of the wound, vaccination, and in case of high-risk exposure, injection of specific anti-rabies immunoglobulins) is known to be efficient except in rare cases. It is recommended after grade II contact (+specific immunoglobulins in immunodepressed patients), or grade III contact (vaccination+immunoglobulins). DISCUSSION: Mainland France being rabies-free, 3 options may be considered in case of bite by a dog or a cat that cannot be monitored in France: (a) consider the risk of rabies as null, so no PEP should be administrated, whatever the severity of bites; (b) consider there is a weak but lethal risk, so the international recommendations should be applied, using immunoglobulins in some cases; (c) consider that the risk is extremely low but cannot be excluded, and that the patient should be vaccinated to be protected, but without adding immunoglobulins (whether in case of grade II or III bites). CONCLUSION: There are no national guidelines for rabies in France, and so the physician managing the patient is the one who will decide to treat or not. SN - 1769-6690 UR - https://www.unboundmedicine.com/medline/citation/25011930/Update_on_human_rabies_in_a_dog__and_fox_rabies_free_country_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0399-077X(14)00149-8 DB - PRIME DP - Unbound Medicine ER -