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. 2018 Sep;23(39):1700548.
doi: 10.2807/1560-7917.ES.2018.23.39.1700548.

The shift in rabies epidemiology in France: time to adjust rabies post-exposure risk assessment

Perrine Parize  1 , Laurent Dacheux  1 , Florence Larrous  1 , Hervé Bourhy  1 ; French network of antirabies clinics  2
Affiliations

The shift in rabies epidemiology in France: time to adjust rabies post-exposure risk assessment

Perrine Parize et al. Euro Surveill. 2018 Sep.

Abstract

The epidemiology of rabies in France and western Europe has changed during the past 22 years. In France, rabies in non-flying terrestrial mammals was declared to be eliminated in 2001, and the risk of rabies is now limited to contact with bats, rabid animals illegally imported from rabies-enzootic countries and traveller exposure in enzootic areas. We analysed the epidemiology of rabies in France from 1995 to 2016, describing and analysing data on human rabies surveillance as well as data on post-exposure prophylaxis (PEP) collected from the network of French antirabies clinics. Over the study period, seven individuals were diagnosed with rabies in France, all of whom were infected outside mainland France. PEP data analysis revealed an expected overall decrease in PEP administration for individuals exposed in mainland France, but there was still overuse of anti-rabies drugs, given the very low epidemiological risk. On the other hand, a significant increase in PEP delivered to individuals exposed abroad was evidenced. These epidemiological trends indicate that clear guidelines should be provided to support physicians' efforts to adjust rabies risk assessment to the evolution of the epidemiological situation.

Keywords: lyssaviruses; post-exposure prophylaxis; public health policy; rabies; vaccine-preventable diseases; zoonoses.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Number of humans tested annually for rabies (n = 250) and laboratory-confirmed human rabies cases (n = 7), France, 1995–2016
Figure 2
Figure 2
Annual number of individuals seeking post-exposure prophylaxis for rabies (n = 204,296) and post-exposure prophylaxis delivered by location of exposure (n = 106,233), France, 1995–2016
Figure 3
Figure 3
Percentage of prescription of rabies immunoglobulin in individuals given post-exposure prophylaxis, by location of exposure, France, 1995–2016 (n = 8,144)
Figure 4
Figure 4
Human exposures leading to rabies post-exposure prophylaxis administration, mainland France, 1995–2016 (n = 57,063)
Figure 5
Figure 5
Human exposure abroad outside mainland France and French overseas territories, given post-exposure prophylaxis for potential exposure to rabies virus, France, 1995–2016 (n = 15,000)
See this image and copyright information in PMC

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