The rabies situation presented during the meeting is summarized in . All countries represented at MEEREB reported animal rabies, and in some countries where canine rabies is prevalent, the disease still occurs in humans. Cats also play a role as a vector especially in Ukraine, where, according to the data presented, 12 out of 29 (41.4%) human rabies cases in the last 10 years were transmitted by cats, and in Turkey where the recent reappearance of the disease in this species is a concern.
| Table 1Rabies epidemiology and management in the 7 countries represented at MEEREB. |
In Croatia and Serbia, no human rabies case has been reported for over 30 years. The last case in Croatia was reported in 1964, and the last case in Serbia was in 1980:
rabid dogs caused both. Since then, there have been two-imported cases of human rabies in Croatia. The absence of cases in Serbia and Croatia can be explained by the fact that rabies is present in wildlife only, vaccination of pet dogs is mandatory, and PEP of animal bite victims is accessible free of charge. However, rabies is still enzootic in the red fox in these two countries, and sporadic cases spill over to other wild animal species and domestic animals. In each country, >1,500 animal-bite victims receive post-exposure prophylaxis (PEP) annually. Human rabies immunoglobulins (HRIG) are locally produced by the Zagreb Institute of Immunology and by the Belgrade Blood Transfusion Institute of Serbia.
The specific rabies situation in
Turkey was described; dog-mediated urban rabies predominates, with foci in the Istanbul region. However, fox rabies has been increasing since 1999, especially in the western Aegean region where the numbers of rabid dogs and foxes are approximately equal, a situation unique to Turkey. Occasional rabies cases are observed in the jackal, particularly around Istanbul. These data have also been published recently [
11]. One to two human cases are reported annually.
In Iran, rabies is the most important zoonotic disease and has spread across the country including the central desert areas; the most affected provinces are located in the north-east, east, and south. The country is spending an increasing portion of its health budget on procurement of cell culture rabies vaccines and immunoglobulins to meet the increasing demand for rabies PEP. The number of people receiving PEP in the 300 bite management centres across the country has more than doubled between 1997 and 2009, while the rabies mortality rate has decreased from 0.9 per million people in the 1980s [
12] to 0.02-0.03 per million people in recent years.
In
Egypt, animal rabies is present both in urban areas and rural settlements. Stray dogs are the main transmitters to other animals and humans. The situation has been stable for the last 10 years with an annual number of 80 human rabies cases. Among the countries reporting data at the meeting, it had the second highest human rabies incidence, following
Georgia where the number of reported admissions for PEP following exposure to potentially rabid animals has been increasing steadily (from ~10,000 in 2000 up to 28,055
PEP in 2008—with a peak of ~48,000 in 2006).
Several of the countries represented receive support from the European Union (EU) for oral vaccination of foxes (Croatia, Serbia, and Turkey) and dogs (Turkey) [
11]. Western Europe eliminated animal rabies through compulsory vaccination of dogs and oral vaccination of wildlife [
13], but the persistence of rabies in animals along borders is a permanent threat. This is illustrated by the reemergence in 2008 of animal rabies in Italy in an area bordering Slovenia, and it spread through the north-western provinces [
14,
15].
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