Surveillance and outbreak report Open Access
Like 0


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.


Article metrics loading...

Loading full text...

Full text loading...



  1. Fooks AR, Banyard AC, Horton DL, Johnson N, McElhinney LM, Jackson AC. Current status of rabies and prospects for elimination. Lancet. 2014;384(9951):1389-99.  https://doi.org/10.1016/S0140-6736(13)62707-5  PMID: 24828901 
  2. Troupin C, Dacheux L, Tanguy M, Sabeta C, Blanc H, Bouchier C, et al. Large-Scale Phylogenomic Analysis Reveals the Complex Evolutionary History of Rabies Virus in Multiple Carnivore Hosts. PLoS Pathog. 2016;12(12):e1006041.  https://doi.org/10.1371/journal.ppat.1006041  PMID: 27977811 
  3. Srinivasan A, Burton EC, Kuehnert MJ, Rupprecht C, Sutker WL, Ksiazek TG, et al. Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med. 2005;352(11):1103-11.  https://doi.org/10.1056/NEJMoa043018  PMID: 15784663 
  4. Maier T, Schwarting A, Mauer D, Ross RS, Martens A, Kliem V, et al. Management and outcomes after multiple corneal and solid organ transplantations from a donor infected with rabies virus. Clin Infect Dis. 2010;50(8):1112-9.  https://doi.org/10.1086/651267  PMID: 20205588 
  5. Vora NM, Basavaraju SV, Feldman KA, Paddock CD, Orciari L, Gitterman S, et al. Raccoon rabies virus variant transmission through solid organ transplantation. JAMA. 2013;310(4):398-407.  https://doi.org/10.1001/jama.2013.7986  PMID: 23917290 
  6. Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, Shuangshoti S, Laothamatas J. Human rabies: neuropathogenesis, diagnosis, and management. Lancet Neurol. 2013;12(5):498-513.  https://doi.org/10.1016/S1474-4422(13)70038-3  PMID: 23602163 
  7. World Health Organization (WHO). Rabies vaccines: WHO position paper. Wkly Epidemiol Rec. 2010;32(85):309-20.
  8. World Health Organization (WHO). WHO expert Consultation on Rabies. Second report. Geneva: WHO; 2013. Available from: http://apps.who.int/iris/bitstream/handle/10665/85346/9789240690943_eng.pdf;jsessionid=F4F331EB12424110FFF3E456AC1BCD57?sequence=1
  9. Suraweera W, Morris SK, Kumar R, Warrell DA, Warrell MJ, Jha PMillion Death Study Collaborators. Deaths from symptomatically identifiable furious rabies in India: a nationally representative mortality survey. PLoS Negl Trop Dis. 2012;6(10):e1847.  https://doi.org/10.1371/journal.pntd.0001847  PMID: 23056661 
  10. Dodet B, Korejwo J, Briggs DJ. Eliminating the scourge of dog-transmitted rabies. Vaccine. 2013;31(10):1359.  https://doi.org/10.1016/j.vaccine.2012.11.018  PMID: 23280358 
  11. Dodet B, Durrheim DN, Rees H. Rabies: underused vaccines, unnecessary deaths. Vaccine. 2014;32(18):2017-9.  https://doi.org/10.1016/j.vaccine.2013.12.031  PMID: 24434045 
  12. Knobel DL, Cleaveland S, Coleman PG, Fèvre EM, Meltzer MI, Miranda ME, et al. Re-evaluating the burden of rabies in Africa and Asia. Bull World Health Organ. 2005;83(5):360-8. PMID: 15976877 
  13. Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 2015;9(4):e0003709.  https://doi.org/10.1371/journal.pntd.0003709  PMID: 25881058 
  14. Nel LH. Factors Impacting the Control of Rabies. Microbiol Spectr. 2013;1(2). PMID: 26184959 
  15. Müller T, Freuling CM, Wysocki P, Roumiantzeff M, Freney J, Mettenleiter TC, et al. Terrestrial rabies control in the European Union: historical achievements and challenges ahead. Vet J. 2015;203(1):10-7.  https://doi.org/10.1016/j.tvjl.2014.10.026  PMID: 25466578 
  16. Stahl JP, Gautret P, Ribadeau-Dumas F, Strady C, Le Moal G, Souala F, et al. Update on human rabies in a dog- and fox-rabies-free country. Med Mal Infect. 2014;44(7):292-301.  https://doi.org/10.1016/j.medmal.2014.05.002  PMID: 25011930 
  17. Gautret P, Ribadeau-Dumas F, Parola P, Brouqui P, Bourhy H. Risk for rabies importation from North Africa. Emerg Infect Dis. 2011;17(12):2187-93.  https://doi.org/10.3201/eid1712.110300  PMID: 22185767 
  18. Cliquet F, Picard-Meyer E, Robardet E. Rabies in Europe: what are the risks? Expert Rev Anti Infect Ther. 2014;12(8):905-8.  https://doi.org/10.1586/14787210.2014.921570  PMID: 24847903 
  19. Klevar S, Høgåsen HR, Davidson RK, Hamnes IS, Treiberg Berndtsson L, Lund A. Cross-border transport of rescue dogs may spread rabies in Europe. Vet Rec. 2015;176(26):672. PMID: 26113337 
  20. Perez de Diego AC, Vigo M, Monsalve J, Escudero A. The One Health approach for the management of an imported case of rabies in mainland Spain in 2013. Euro Surveill. 2015;20(6):21033.  https://doi.org/10.2807/1560-7917.ES2015.20.6.21033  PMID: 25695478 
  21. Ribadeau-Dumas F, Cliquet F, Gautret P, Robardet E, Le Pen C, Bourhy H. Travel-Associated Rabies in Pets and Residual Rabies Risk, Western Europe. Emerg Infect Dis. 2016;22(7):1268-71.  https://doi.org/10.3201/eid2207.151733  PMID: 27314463 
  22. Gautret P, Harvey K, Pandey P, Lim PL, Leder K, Piyaphanee W, et al. Animal-associated exposure to rabies virus among travelers, 1997-2012. Emerg Infect Dis. 2015;21(4):569-77.  https://doi.org/10.3201/eid2104.141479  PMID: 25811076 
  23. Lardon Z, Watier L, Brunet A, Bernède C, Goudal M, Dacheux L, et al. Imported episodic rabies increases patient demand for and physician delivery of antirabies prophylaxis. PLoS Negl Trop Dis. 2010;4(6):e723.  https://doi.org/10.1371/journal.pntd.0000723  PMID: 20582307 
  24. Public Health England (PHE). Guidelines on managing rabies post-exposure (June 2018). [Accessed: 5 Sep 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/720075/PHE_guidelines_on_rabies_post-exposure_treatment.pdf
  25. Feyssaguet M, Dacheux L, Audry L, Compoint A, Morize JL, Blanchard I, et al. Multicenter comparative study of a new ELISA, PLATELIA RABIES II, for the detection and titration of anti-rabies glycoprotein antibodies and comparison with the rapid fluorescent focus inhibition test (RFFIT) on human samples from vaccinated and non-vaccinated people. Vaccine. 2007;25(12):2244-51.  https://doi.org/10.1016/j.vaccine.2006.12.012  PMID: 17224214 
  26. Crepin P, Audry L, Rotivel Y, Gacoin A, Caroff C, Bourhy H. Intravitam diagnosis of human rabies by PCR using saliva and cerebrospinal fluid. J Clin Microbiol. 1998;36(4):1117-21. PMID: 9542950 
  27. Dacheux L, Reynes JM, Buchy P, Sivuth O, Diop BM, Rousset D, et al. A reliable diagnosis of human rabies based on analysis of skin biopsy specimens. Clin Infect Dis. 2008;47(11):1410-7.  https://doi.org/10.1086/592969  PMID: 18937576 
  28. Dacheux L, Larrous F, Lavenir R, Lepelletier A, Faouzi A, Troupin C, et al. Dual Combined Real-Time Reverse Transcription Polymerase Chain Reaction Assay for the Diagnosis of Lyssavirus Infection. PLoS Negl Trop Dis. 2016;10(7):e0004812.  https://doi.org/10.1371/journal.pntd.0004812  PMID: 27380028 
  29. Bourhy H, Rollin PE, Vincent J, Sureau P. Comparative field evaluation of the fluorescent-antibody test, virus isolation from tissue culture, and enzyme immunodiagnosis for rapid laboratory diagnosis of rabies. J Clin Microbiol. 1989;27(3):519-23. PMID: 2654181 
  30. Institut Pasteur. Centre national de référence de la Rage. Bulletins sur l’épidémiologie et la prophylaxie de la rage humaine en France. [Bulletins on the epidemiology and prophylaxis of human rabies in France]. Paris: Institut Pasteur. [Accessed: 26 Aug 2016]. French. Available from: https://www.pasteur.fr/fr/sante-publique/cnr/les-cnr/rage/rapports-d-activite
  31. Institut national de la statistique et des études économiques (Insee). Les résultats des recensements de la population. [Population census results]. Paris: Insee; 27 Dec 2017. French. Available from: http://www.insee.fr/fr/bases-de-donnees/default.asp?page=recensements.htm
  32. Direction Générale des Entreprises. Memento du Tourisme. [Tourism Handbook] Edition 2016[TS1] [MOU2] [Accessed: 5 Sep 2018]. French. Available from: https://www.entreprises.gouv.fr/etudes-et-statistiques/memento-du-tourisme-edition-2016
  33. Servas V, Mailles A, Neau D, Castor C, Manetti A, Fouquet E, et al. An imported case of canine rabies in Aquitaine: Investigation and management of the contacts at risk, August 2004-March 2005. Euro Surveill. 2005;10(11):9-10.  https://doi.org/10.2807/esm.10.11.00578-en  PMID: 29208098 
  34. French multidisciplinary investigation team. Identification of a rabid dog in France illegally introduced from Morocco. Euro Surveill. 2008;13(11).
  35. French and Belgian multidisciplinary investigation teams. Identification of a rabid dog illegally introduced from the Republic of the Gambia to Belgium and France. Euro Surveill. 2008;13(18).
  36. Mailles A, Boisseleau D, Dacheux L, Michalewiscz C, Gloaguen C, Ponçon N, et al. Rabid dog illegally imported to France from Morocco, August 2011. Euro Surveill. 2011;16(33):19946. PMID: 21871230 
  37. Gautret P, Labreuil C, Seyni M, Delmont J, Parola P, Brouqui P. Effect of media warnings on rabies postexposure prophylaxis, France. Emerg Infect Dis. 2011;17(6):1131-2.  https://doi.org/10.3201/eid1706.101962  PMID: 21749791 
  38. Sadkowska-Todys M, Kucharczyk B. Rabies in Poland in 2012. Przegl Epidemiol. 2014;68(3):465-8, 567-9. PMID: 25391011 
  39. Peigue-Lafeuille H, Bourhy H, Abiteboul D, Astoul J, Cliquet F, Goudal M, et al. [Human rabies in France in 2004: update and management]. Med Mal Infect. 2004;34(12):551-60.  https://doi.org/10.1016/j.medmal.2004.07.031  PMID: 15603930 
  40. Contou D, Dacheux L, Bendib I, Jolivet S, Rodriguez C, Tomberli F, et al. Severe ketoalkalosis as initial presentation of imported human rabies in France. J Clin Microbiol. 2015;53(6):1979-82.  https://doi.org/10.1128/JCM.00219-15  PMID: 25854482 
  41. Carrara P, Parola P, Brouqui P, Gautret P. Imported human rabies cases worldwide, 1990-2012. PLoS Negl Trop Dis. 2013;7(5):e2209.  https://doi.org/10.1371/journal.pntd.0002209  PMID: 23658853 
  42. de Thoisy B, Bourhy H, Delaval M, Pontier D, Dacheux L, Darcissac E, et al. Bioecological Drivers of Rabies Virus Circulation in a Neotropical Bat Community. PLoS Negl Trop Dis. 2016;10(1):e0004378.  https://doi.org/10.1371/journal.pntd.0004378  PMID: 26808820 
  43. Meynard JB, Flamand C, Dupuy C, Mahamat A, Eltges F, Queuche F, et al. First human rabies case in French Guiana, 2008: epidemiological investigation and control. PLoS Negl Trop Dis. 2012;6(2):e1537.  https://doi.org/10.1371/journal.pntd.0001537  PMID: 22363830 
  44. Ribadeau Dumas F, N’Diaye DS, Paireau J, Gautret P, Bourhy H, Le Pen C, et al. Cost-effectiveness of rabies post-exposure prophylaxis in the context of very low rabies risk: A decision-tree model based on the experience of France. Vaccine. 2015;33(20):2367-78.  https://doi.org/10.1016/j.vaccine.2015.02.075  PMID: 25797366 
  45. Eidson M, Bingman AK. Terrestrial rabies and human postexposure prophylaxis, New York, USA. Emerg Infect Dis. 2010;16(3):527-9.  https://doi.org/10.3201/eid1603.090298  PMID: 20202438 
  46. Middleton D, Johnson KO, Rosatte RC, Hobbs JL, Moore SR, Rosella L, et al. Human Rabies Post-Exposure Prophylaxis and Animal Rabies in Ontario, Canada, 2001-2012. Zoonoses Public Health. 2015;62(5):356-64.  https://doi.org/10.1111/zph.12155  PMID: 25244148 
  47. Bourhy H, Goudal M, Mailles A, Sadkowska-Todys M, Dacheux L, Zeller H. Is there a need for anti-rabies vaccine and immunoglobulins rationing in Europe? Euro Surveill. 2009;14(13):19166. PMID: 19341608 
  48. Blaise A, Parola P, Brouqui P, Gautret P. Rabies Postexposure Prophylaxis for Travelers Injured by Nonhuman Primates, Marseille, France, 2001-2014. Emerg Infect Dis. 2015;21(8):1473-6.  https://doi.org/10.3201/eid2108.150346  PMID: 26196180 
  49. Gautret P, Adehossi E, Soula G, Soavi MJ, Delmont J, Rotivel Y, et al. Rabies exposure in international travelers: do we miss the target? Int J Infect Dis. 2010;14(3):e243-6.  https://doi.org/10.1016/j.ijid.2009.05.009  PMID: 19674923 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error