The last autochthonous human rabies case identified any French territory was reported in 1924 in continental France 
. However, the risk remains of humans being exposed to the virus in enzootic countries and not seeking PEP due to ignorance of the rabies risk. Since 1970, 21 human deaths from rabies have been recorded in France 
: 20 cases were imported and 1 was transmitted by a corneal transplant. The first human rabies case diagnosed in French Guiana, in May 2008, and described herein, confirms that the risk of contracting the rabies virus there indeed exists. It was the first case subjected to molecular biology confirmation by the French National Reference Center for Rabies.
The patient's initial clinical picture was not typical and he consulted the Cayenne Hospital emergency unit 3 times before being admitted, further emphasizing the need to include rabies in the differential diagnosis of unexplained encephalitis in humans 
. Rabies was diagnosed intravitam based on RT-hnPCR–detection of viral RNA in saliva and a skin biopsy 
. The rabies virus responsible was similar to those circulating in hematophagous bats in this part of the world and closely related to those previously isolated from animals in French Guiana with <4% nucleotide divergence in the nucleoprotein gene (unpublished data). The origin of the contamination was not formally established, although an unrecognized vampire-bat bite seems by far the most likely route of transmission. However, as some cases reported in other countries 
, the source of contamination could also have been feline, because a cat reportedly died in March 2008, 2 months after having been severely bitten and wounded by a bat.
After the public was informed of this case, the number of patients consulting the CTAR increased dramatically 
, a phenomenon that had previously been observed in continental France 
. Since 2008, no other human rabies case has been reported in French Guiana.
Recent emerging zoonoses, e.g., Ebola or Marburg virus hemorrhagic fevers, Nipah virus encephalitis, severe acute respiratory syndrome (SARS), highlight the potential of bats as vectors for transmission of infectious diseases to humans. This potential was already known for rabies encephalitis, since 10 of the 11 Lyssavirus
species are transmitted by bats. Rabies control in bats remains very difficult, even though some encouraging experimental results obtained with D. rotundus
bats in captivity demonstrated the immunogenicity of the vaccinia-rabies glycoprotein 
. However, several effective methods are available to limit the access of the bat population to cattle. Furthermore, some preventive and control measures to limit the number of human deaths attributable to rabies transmitted by vampire bats have been successfully implemented 
Rabies diagnosis is a key issue. It is routinely based on clinical and epidemiological information, especially when the exposure is reported in a rabies-endemic country. Although techniques for postmortem diagnosis of rabies have been well-established for decades, tests for intravitam
diagnosis of human rabies were rarely optimal, and depended entirely on the nature and quality of the sample supplied. Over the past 3 decades, molecular biology tools have contributed to the development of these tests, resulting in more rapid detection of the rabies virus. Several molecular methods are now available that can be used to complement conventional tests for human rabies diagnosis 
. The 21st
century challenges for diagnostic test developers are 2-fold: first, to achieve internationally accepted validation of a test that will then lead to its acceptance by international organizations; second, these tests are mainly needed in developing regions the world, where financial and logistical barriers prevent their implementation 
. The question is even more important in that rapid diagnosis of rabies in suspected human cases influences PEP for potential case contacts and ensures appropriate patient management 
This first human rabies case in French Guiana means that national and local public health authorities must improve preventive and control measures for the local population and travellers. Rabies prophylaxis requires a multifaceted approach, including health education, PEP, systematic vaccination of dogs and cats, and, sometimes, selective immunization campaigns to control transmission among wild animals, e.g. foxes and hematophagous bats 
. Since human rabies is almost always fatal if prophylactic measures are not initiated, it is essential to increase awareness of who should receive PEP and when it should be administered.
Pre-exposure prophylaxis entails the administration of the rabies vaccine to individuals at high risk for exposure to rabies viruses, e.g., laboratory workers who handle infected specimens, diagnosticians, veterinarians, animal-control workers, rabies researchers, cave explorers… 
PEP consists of a multimodal approach to decrease an individual's likelihood of developing clinical rabies after suspected exposure to the virus. Regimens depend on the victim's vaccination status and involve a combination of wound cleansing, rabies-vaccine inoculation, and administration of human rabies immunoglobulins 
. When used in a timely and accurate fashion, PEP is nearly 100% effective. However, once clinical rabies manifestations have developed, rabies PEP remains supportive. To date, only 5 well-documented cases of prolonged survival or recovery from rabies have been described and were specifically associated with PEP administration before the onset of symptoms 
. The recently developed Milwaukee protocol added induction of therapeutic coma to supportive care measures and antivirals, claiming it ensured the recovery of an unvaccinated patient. However, its use has yielded inconsistent outcomes 
The impact of this rabies-virus emergence in French Guiana was dramatic, especially in the context of a Department far from continental France. Despite the enormous pressure placed on the crisis-managing team by the local population, healthcare workers and politicians, the number of PEP remained relatively limited compared with previous cases in continental France 
and other countries 
. Notably, no subsequent case developed.
This case illustrates the need for further preparedness of public health infrastructures in rabies-enzootic areas that have not yet recorded human rabies cases. Pertinently, lessons learned from other countries, informing public health professionals and a multidisciplinary approach were essential to crisis management of our case 
. His case history enhanced the perception of the risk and, consequently, a vast campaign to educate and inform the general population about zoonotic diseases acquired from domestic, as well as wild animals, like bats, was undertaken in French Guiana as had been done in neighboring countries 
. In addition to these measures, rabies is now more systematically included in the differential diagnosis of human encephalitis cases consulting at French Guiana hospitals. Indeed, 2 suspected human cases, subsequently found negative, were subjected to rabies testing during 2008–2010 period. In parallel, active surveillance of bat rabies has been established to learn more about rabies-virus circulation in the local bat populations.