The importance of the UK’s quarantine requirements for imported animals, and of vaccination requirements for at‑risk occupational groups, was demonstrated by two recent cases of rabies being brought into European countries by imported animals.
First, the Ministry of Agriculture in France confirmed in April that the country has lost its rabies-free status following transmission of the disease from an illegally imported dog to two indigenous dogs, one in the Paris area. French officials have confirmed that there is a low but increased risk of rabies in three areas of France (Gers, Grandpuits and Calvados).
In contrast, in an incident in the UK the spread of infection from a rabid puppy imported from Sri Lanka was successfully contained. An urgent investigation took place into the circumstances leading up to the animal’s death on 25 April. It was one of five stray dogs picked up from the streets in Sri Lanka a week earlier by an animal charity and flown to Heathrow airport. The 10-week-old animal died in a quarantine centre in Chingford, north-east London having spent a night at the airport’s Animal Reception Centre.
The rabies immunisation status of 42 people who had some degree of contact with the animal was reviewed. Twelve had direct physical contact with the animal or its body fluids: a vet in Sri Lanka, four members of the animal charity, one baggage handler at the airport and six members of staff at the quarantine kennels. Four workers in the quarantine kennels had high-risk contact, three having been bitten. Only three of the 11 at-risk individuals in the UK had had complete vaccination (ie including adequate boosters) and three had had no vaccination. All 11 were given rabies post-exposure prophylaxis. The Health Protection Agency subsequently issued a reminder on vaccination requirements for those working with imported animals.”1
Those exposed at Heathrow airport were fortunate that pre‑emptive post-exposure prophylaxis (PEP) is extremely effective because once clinical symptoms appear the human disease is almost always fatal. In the developing world, however, lack of basic medical services and sanitation, combined with the prohibitive cost of PEP, mean that more than 55,000 people die every year following exposure to the infection.
Writing in the latest issue of the Health Protection Agency’s magazine Health Protection Matters, two rabies scientists from the UK Veterinary Laboratories Agency (VLA) explain how a World Health Organisation (WHO) strategy involving centres in Asia aims to reduce the human disease burden and mortality in rabies‑endemic areas through mass canine vaccination2. Virtually all human rabies is caused by dog bites and vaccination of canine populations has proved extremely successful in reducing its incidence in humans, the VLA scientists note. In Mexico, for example, a 92% reduction in the prevalence of canine rabies due to vaccination was accompanied by an 82% reduction in the number of reported human deaths from rabies.
1Reminder on vaccination requirements for those working with imported animals, 7 May 2008, Health Protection Agency (rabies incidents webpage).
2 “Rabies – a ‘one health approach'”, Fooks T and Harkess G, Health Protection Matters, Spring 2008 (number 10), published by the Health Protection Agency