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[1] Date: Fri 14 Mar 2008 Source: Eurosurveillance edition 2008; 13(11) [edited] http://www.eurosurveillance.org/edition/v13n11/080313_1.asp

Identification of a rabid dog in France illegally introduced from Morocco

Introduction

On 26 Feb 2008, the National Reference Centre for Rabies at the Institut Pasteur in Paris, France, confirmed the diagnosis of rabies in a domestic dog living in Grandpuits, Seine-et-Marne district, a suburb of Paris. The dog was a 9 month old mixed-breed female, named Cracotte (pictures available at http://www.invs.sante.fr/display/?doc=surveillance/rage/actu.htm.)

It developed its 1st symptoms on 15 Feb 2008, had bitten its owner and one neighbour and was euthanized on 19 Feb 2008. The viral strain was identified by the National Reference Centre for Rabies as a strain belonging to Lyssavirus genotype 1, Africa 1 lineage, originating from Morocco. According to its owner, Cracotte had never been outside France. France has been declared officially rabies-free since 2001 [see comment]. An investigation was undertaken to identify the source of infection and modes of transmission for Cracotte in order to identify potentially exposed individuals and animals and to carry out an assessment of the risk of rabies virus transmission in France.

Investigation

Origin of infection and chain of transmission

The owners of Cracotte had a 2nd dog, a female black mixed-breed Labrador named Youpee. Youpee was euthanized on 5 Jan 2008 after a brief illness. In retrospective, its symptoms were compatible with rabies. Youpee had been in contact with a dog named Gamin during a stay in the Gers district of southern France in November 2007. Gamin was euthanized on 12 Nov 2007 because of an illness that, retrospectively, would be compatible with rabies. Both Youpee and Gamin had been incinerated and had not been tested for rabies. Gamin had been illegally introduced into France from Morocco, and is the likely index dog that infected Youpee, that subsequently infected Cracotte.

Areas and periods at risk

The probable index case Gamin and its 2 owners left Morocco by ferry on 20 Oct 2007 and reached France by car via Portugal and Spain. The owners reported having spent 3 days in Portugal on a beach (precise location unknown), then drove through Spain without stopping. They arrived in the Hautes-Pyrenees district on 28 Oct 2007 and stayed there until 1 Nov 2007 with a friend in an industrial area that had no other inhabitants. According to the owners and their host, Gamin was kept inside the car and had no contact with persons except for their host, and no contact with other animals, during these 3 days. The owners then drove to the Gers district, where they stayed and where Gamin was euthanized on 12 Nov 2007. Gamin and Youpee stayed together in the Gers district, where Youpee was probably contaminated by Gamin. Youpee and its owner left the Gers district for Seine-et-Marne by train on 29 Nov 2007. It stayed in Seine et Marne until it was euthanized on 5 Jan 2008. Youpee and its owner traveled by train outside the district for 3 days (15-17 Dec 2007) to Lisieux (Calvados district, Normandy).

The at-risk period for transmission of rabies to humans or animals is considered to begin from the 1st day of estimated viral excretion of the dogs and to be ongoing (due to possible secondary animal cases). We assumed that viral excretion started 15 days before the onset of symptoms of illness. As of 13 March 2008, the geographical areas and periods at risk are as follows: - Montestruc-sur-Gers (Gers district) and surroundings, from 1 Nov 2007; - Grandpuits (Seine-et-Marne district) and surroundings, from 15 Dec 2007; - Lisieux (Calvados district) and surroundings, from 15 Dec 2007.

Control measures

An active tracing of people and animals in contact with the 3 dogs has been carried out by health and veterinary authorities in the 3 districts. To date, 177 people with close contacts with one of the 3 dogs have been identified and referred to the rabies vaccination centres; 152 of them have been vaccinated and several also received immunoglobulins. A national rabies hotline has been implemented for the public at the Ministry of Health (00.33/800.13.00.00). Local and national press releases have been issued to relay the message that any individual who could have had a potentially contaminating contact with one of the 3 dogs or with any other dog in the at-risk area during the at-risk period should contact the hotline. Pictures of the dog have been shown on television, in newspapers, and on the Internet. Owners of dogs that might have been exposed to the infected dogs have been advised to contact their district veterinary services. As of 10 Mar 2008, no additional exposed individuals have been identified among the 1071 people who have called the hotline. No human or animal contact with the rabid dog Youpee has yet been identified among the passengers during the trip by train of its owner (between Paris and Lisieux cities on 15 and 17 Dec 2007).

Dogs and cats having been in contact with one of the 3 dogs have been euthanized or placed under observation. To date, 7 dogs and a cat were euthanized and all tested negative for rabies. Owners of dogs and cats in the 3 districts have been recommended to keep their cats indoors, put their dogs on leashes, and have their pets legally identified. The veterinary services are maintaining a high level of vigilance.

The French hospital emergency medical services and general practitioners were informed, via email, of the event and of the need for anti-rabies prophylaxis for patients with any potentially contaminating contact with one of the 3 dogs or any other unknown dog or cat, especially in the 3 districts involved. All rabies clinics were informed by the National Reference Centre for Rabies. Moreover, pediatricians, intensive care physicians, neurologists, and infectious disease experts have all been informed by email in order to strengthen awareness and increase the likelihood of early diagnosis in the event of a human case. To date, no suspect human cases have been reported.

The last case of indigenous human rabies transmitted by a carnivore in France occurred in 1924. Human cases of imported rabies are rare, with only 20 cases identified in France between 1970 and 2008 (90 per cent of them from Africa). Since 2000, 9 imported cases have been reported in Western Europe [1]. Two of them contracted their infection in Morocco [2,3]. In France, rabies was endemic in foxes, especially along the German border in eastern France, until the 1990s [4]. In 2001, after 30 years of extensive control measures, including oral vaccination of foxes, and in the absence of cases of rabies identified in terrestrial carnivores the World Organisation for Animal Health [OIE] declared France free of rabies in terrestrial animals [see comment]. Surveillance of rabies in carnivores has been maintained in order to detect any re-introduction of the virus.

This event is not the 1st illegal introduction of a carnivore from a rabies-endemic country into France [5,6]. In 2004, 3 cases of canine rabies were diagnosed. All 3 dogs were illegally imported from Morocco and reached France after having been transported through Spain by car. No secondary transmission to humans or carnivores occurred during those events. The sanitary regulations regarding rabies vaccination status of all carnivores entering the European Union are essential for rabies control, and must be strictly applied in European areas that have been declared rabies-free. This applies to France in particular, as the illegal pet importation route from Morocco through Spain to France has previously been reported.

For further information, please contact Alexandra Mailles at the Institut de Veille Sanitaire a.mailles@invs.sante.fr or the National Reference Centre for rabies at the Institut Pasteur cnrrage@pasteur.fr.

References

1. Bourhy H, Dacheux L, Strady C, Mailles A. Rabies in Europe in 2005. Euro Surveill 2005; 10(11): 213-6. Available from http://www.eurosurveillance.org/em/v10n11/1011-222.asp
2. Krause R, Bago Z, Revilla-Fernandez S, Loitsch A, Allerberger F, Kaufmann P, et al. Travel-associated rabies in Austrian man. Emerg Infect Dis 200511: 719-721. Available from http://www.cdc.gov/Ncidod/eid/vol11no05/04-1289.htm

3. ProMED-mail. Rabies -- Germany (Hamburg) ex Morocco. ProMED-mail 2007; 19 April: 20070419.1287. Available from http://www.promedmail.org/pls/otn/f?p=2400:1202:978361037408857::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,37114

4. Toma B: Fox rabies in France. Euro Surveill 2005; 10(11): 220-2. Available from http://www.eurosurveillance.org/em/v10n11/1011-224.asp

5. World Health Organization Communicable Disease Surveillance & Response: Rabies in France. Disease Outbreak News. 1 Sep 2004. Available from http://www.who.int/csr/don/2004_09_01a/en
6. 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): 222-5. Available from http://www.eurosurveillance.org/em/v10n11/1011-225.asp

[byline: multidisciplinary investigation team, France (full list, see source URL)]

-- communicated by: ProMED-mail promed@promedmail.org

[2] Date: Fri 14 Mar 2008 Source: Eurosurveillance edition 2008; 13(11) [edited] http://www.eurosurveillance.org/edition/v13n11/080313_2.asp

Identification of a rabid dog in France illegally introduced from Morocco:

comment

As highlighted in the article above by a multidisciplinary investigation team from France, there have been previous reports of dogs being illegally introduced to France and subsequently identified with rabies infection. No human cases related to these events have been identified to date. Although exposure to rabies from animals in the European Union (EU) remains a rare event, in the absence of post exposure prophylaxis before symptoms rabies is invariably a deadly infection in humans. The French authorities have implemented extensive measures, including the tracing of humans and animals possibly in contact with the suspected rabid dogs, and awareness of the event has been relayed to the general public through the media in order to assist in identifying other possible human or animal contacts.

The index dog was reported to have been in Portugal for a few days while travelling to France. Thus, information to the public has also been published by the Portuguese health authorities on the website of the Ministry of Health (http://www.dgs.pt). It cannot be excluded that other EU citizens who have visited those particular geographical areas in France or Portugal during these periods may have been bitten or scratched by the index dog. The European Centre for Disease Prevention and Control (ECDC) thus published a threat assessment of this event on its website http://www.ecdc.europa.eu/pdf/threat%20assessment%20080311_.pdf to raise awareness among clinicians for returning travellers from the at-risk areas during the at-risk periods who may have been in contact with these dogs.

This event in animals also emphasises the importance of good communication between animal and human health authorities, in each country and at the EU level, in identifying and responding to any subsequent threat to human health from animal health events.

[byline: L Payne on behalf of the Preparedness and Response Unit threat event team (D Coulombier, C Varela, M Ciotti, H Needham, B Ciancio), European Centre for Disease Prevention and Control, Stockholm, Sweden]

-- communicated by: ProMED-mail promed@promedmail.org

[The intensive, thorough epidemiological investigation described in Eurosurveillance is being posted by ProMED-mail to keep subscribers informed about the course of the 3-stage event and on the discovered exposures since end October 2007. This may be helpful in allowing the tracing of additional, potentially missed contacts, within Portugal, Spain, and France, and among individuals from other countries who may have shared a part of the 3 dogs' routes.

Youpee and Cracotte, the 2 locally infected dogs, were most likely unvaccinated -- vulnerable to infection, similarly to the entire canine and feline population of France and other EU countries, where compulsory vaccination was discontinued since the eradication of rabies. According to a previous ProMED-mail posting (20080307.0938), Gamin was a mixed breed collie and Youpee a black cross Labrador; the age(s) of both have not been disclosed and, if available, will be interesting to note. The report does not say whether they were seen by a veterinary practitioner prior to their euthanasia. In a rabies-free country, practitioners -- and in particular those who have never experienced clinical rabies, may miss a case, particularly an atypical one. In view of the severity of this disease, authorities may consider the dissemination of a reminder on the clinical signs in pets and in domestic livestock and on the prescribed mode of handling suspected cases, to practitioners and to others involved in the (small and large) animals industry.

The statement "the World Organisation for Animal Health [Office International des Epizooties; OIE] declared France free of rabies in terrestrial animals," deserves a correction. Rabies is not included in the list of 4 diseases (FMD [foot and mouth disease,] rinderpest, CBPP [contagious bovine pleuropneumonia], and BSE [bovine spongiform encephalopathy]) allowing an official OIE declaration of freedom. The declaration of France as rabies-free in 1998 was a "self-declaration", not an official OIE declaration. - Mod.AS]