Risk for Rabies Importation from North Africa

Abstract

A retrospective study conducted in France indicated that a large proportion of patients injured by potentially rabid animals while in North Africa did not seek pretravel advice, and some had not received proper rabies postexposure prophylaxis while in North Africa. As a result, imported human rabies cases are still being reported, and the need for postexposure prophylaxis after exposure in North Africa is not declining. Tourists are generally unaware of the danger of importing potentially rabid animals and of the rules governing the movement of pets. In France, for example, rabid dogs have frequently been imported from Morocco to France through Spain. This situation imposes heavy social and economic costs and impedes rabies control in Europe. Rabies surveillance and control should therefore be reinforced in North Africa, and travelers to North Africa should receive appropriate information about rabies risk and prevention.

Rabies in Europe: what are the risks?

“…In 2013, two imported cases occurred in France and in Spain, both originating in Morocco [18]. Such illegal importations generally result in the administration of high numbers of post-exposure treatments [3]. Moreover, such imported cases pose a threat of rabies reintroduction into rabies-free areas.…”

“…It should be noted that a number of travel-related and autochthonous rabies cases are neither reported nor published [3,12]. From 1990 to 2012, a total of 210 human fatalities due to rabies were reported in Europe [9] with around 10 cases per year.…”

“…The virus is excreted in the saliva of infected animals and is usually transmitted to a susceptible host through biting [1]. The annual rabies burden is around 60,000 deaths annually [2], with 99% of them occurring in Africa and Asia through dog transmission [3], but the true incidence of this neglected disease is greatly underestimated due to a lack of systematic surveillance and reporting by most developing countries [4].…”

Regional Variation in Travel-related Illness acquired in Africa, March 1997–May 2011

“…However, the paucity of reported bites and need for rabies PEP at GeoSentinel sites among travelers returning from sub-Saharan Africa may in part reflect that travelers to sub-Saharan Africa were more often travelers VFR or long-term travelers, who may be more likely than tourists to Northern Africa to seek treatment at the time of exposure ( 14 ). …”

Integrating the landscape epidemiology and genetics of RNA viruses: rabies in domestic dogs as a model

“…The European colonisation of Africa is thought to have led to the introduction and subsequent expansion of canine rabies across the continent (Bourhy et al 2008; Talbi et al 2009; Lemey et al 2010); increasingly frequent records of re-introductions into countries where rabies has been eliminated have been recorded (Zanoni and Breitenmoser, 2003; Weiss et al . 2009; Gautret et al 2011;), and canine rabies has recently emerged on several previously rabies-free islands in Indonesia via fishermen importing incubating dogs (Windiyaningsih et al 2004; Susilawathi et al . 2012).…”