1. OIE/OMS, Paris, 2007 EPIDEMIOLOGY AND PROPHYLAXIS OF RABIES IN HUMANS IN FRANCE. EVALUATION AND PERSPECTIVES OF A TWENTY FIVE YEAR SURVEILLANCE PROGRAM. Y. ROTIVEL, M. GOUDAL A. SIMONS DE FANTI D. VAN DER VLIET AND FRENCH RABIES TREATMENT CENTRES. Centre National de R é f é rence pour la Rage Institut Pasteur Centres de Traitement Antirabique

2. OIE/OMS, Paris, 2007 …towards the elimination of rabies in Eurasia! Thanks to the many experts and reference books, we all know now that rabies has been a known disease for more than 40 centuries. Moreover, rabies has been and is still the usual companion of our pets, especially dogs, in many parts of the world Elimination of rabies in pets, primarily dogs, and even in terrestrial wild fauna has proven to be possible, but difficult and costly. But, bats, seem to be currently an inexhaustible reservoir. This is why our primary goal should be the elimination of rabies in humans. And this can only be done globally.

3. OIE/OMS, Paris, 2007 21 antennes 66 centres Rabies treatment centers and antennas in France

4. OIE/OMS, Paris, 2007 « Bulletin about epidemiology and prophylaxis of rabies in humans » Demand from the Health Authorities Sent to Health Authorities, RTC, Veterinary Authorities, local veterinary laboratories, vet schools… Data from the RTC Collected and analyzed by the NRC for Rabies Direct entry of the data on the Internet Direct access to the data to authorized persons thanks to Voozanoo®

5. OIE/OMS, Paris, 2007 Rabies in humans in France No autochtonous cases Exposures during long stays in rabies enzootic countries (mostly northern and sub saharian african countries) 18/20 cases from Africa 2 tourists (Mexico and India) Dogs (17), Cat (1), ? (1) 10 children (<10 years old) 18 males, 2 females

6. OIE/OMS, Paris, 2007 A few data from the RTC and the NRC for Rabies… Domestic animals(90%) Dogs: 65%! Sex ratio (M/F): 0.54 Age : 30% 60 Category III exposure : 70% Stability of the caracteristics of the population who receives PET along the years

7. OIE/OMS, Paris, 2007 Data about PET Vaccine : –1982 -1989 : mostly HDCV + FBKV –1990-2003 : PVRV –2004 : mostly PVRV+ PCECV Regimens –Essen (5 doses) –Mostly Zagreb (2-1-1, 4 doses) RIG : HRIG

8. OIE/OMS, Paris, 2007 Rabies in France 1982-2004 Cases in animals and PET Bats Imported pets Last autochtonous terrestrial cases

9. OIE/OMS, Paris, 2007 PET after rabies cases in humans France 1991-2003 Mexico-Nice, 1991 : 44 Mali, 1994 :36 Madagascar-La Réunion, 1996 : 290 Algeria-Nice, 1996 : 45 Algeria-Marseille, 1996 : 35 India-Bretagne, 1997 : 50 Gabon-Lyon, 2003 : 142 Mean PET: 92 Without the 2 rabies cases in children (Lyon and La Réunion): 42

10. OIE/OMS, Paris, 2007 PET after exposures to bats or monkeys

11. OIE/OMS, Paris, 2007 Number of PET according to the status of the animal towards rabies

12. OIE/OMS, Paris, 2007 Percentage of PET after exposure during travel France Pasteur Institute : 40% in 2006

13. OIE/OMS, Paris, 2007 Conclusions No autochtonous case in humans Education of the public –Risk from imported animals –Rabies exposure while traveling –Diversity of animal species : bats! Training –RTC –Travel clinics –Occupational medicine

14. OIE/OMS, Paris, 2007 Thank you for your attention! Medical team of the NRC for Rabies, M. Goudal, A. Simons de Fanti, D. Van der Vliet Rabies Treatment Centers