Eurosurveillance - Current Issue -Volume 25, Issue 38, 24/Sep/2020

Mitigation of the coronavirus disease (COVID-19) pandemic in Germany included school closures in early March 2020. After reopening in April, preventive measures were taken in schools. We analysed national surveillance system data on COVID-19 school outbreaks during different time periods. After reopening, smaller outbreaks (average: 2.2/week) occurred despite low incidence in the general population. School closures might have a detrimental effect on children and should be applied only cautiously and in combination with other measures.

Rabies is enzootic in over one hundred countries worldwide. In the European Union/European Economic Area (EU/EEA), the vast majority of human rabies cases are travellers bitten by dogs in rabies-enzootic countries, mostly in Asia and Africa. Thus, EU/EEA travellers visiting rabies enzootic countries should be aware of the risk of being infected with the rabies virus when having physical contact with mammals. They should consider pre-exposure vaccination following criteria recommended by the World Health Organization and if unvaccinated, immediately seek medical attention in case of bites or scratches from mammals. As the majority of the EU/EEA countries are free from rabies in mammals, elimination of the disease (no enzootic circulation of the virus and low number of imported cases) has been achieved by 2020. However, illegal import of potentially infected animals, mainly dogs, poses a risk to public health and might threaten the elimination goal. Additionally, newly recognised bat lyssaviruses represent a potential emerging threat as the rabies vaccine may not confer protective immunity. To support preparedness activities in EU/EEA countries, guidance for the assessment and the management of the public health risk related to rabies but also other lyssaviruses, should be developed.

The World Health Organization (WHO) issued an updated position paper on rabies in 2018, mainly focusing on simplification of vaccination schedules and use of rabies immunoglobulin (RIG). The maximum amount of RIG anatomically feasible should be infiltrated exclusively in and around the wound and will no longer be calculated solely based on body weight. We describe the practical guideline implementing the revised RIG policy in the Netherlands on how to determine the amount of RIG for local administration. We calculated savings achieved through the revised WHO policy. We used information from a national database including rabies consultations in the Netherlands and clinical information from a public health service, clinical practitioners and national data on the amount of distributed RIG. Between 2008 and 2019, 5,164 consultations were registered. The most frequently affected anatomical location was hand or leg (43%). Around 80% concerned minor injuries (< 2 cm). From January 2016 to end December 2019, 7,361 mL RIG were distributed for 1,042 possible rabies exposures (EUR 1.4 million). Since implementing the revised policy, the amount of RIG distributed per order has sharply decreased (59%). Infiltrating RIG only locally saved large quantities of human RIG (EUR 1.1 million during 4 years) in the Netherlands.