Rabies is incurable, but preventable. Regular vaccination of dogs and oral vaccination of reservoir animals can largely prevent human infections. Prophylactic vaccination (pre-exposure prophylaxis) is recommended for travellers to countries with a high rabies risk. In the event of a bite by a suspect animal, postexpositive prophylaxis (PEP) with administration of immunoglobulins and active immunisation are carried out.
The last human death due to wildlife-transmitted silvatic rabies was recorded in Carinthia in 1979 following a fox bite. An imported rabies death in Austria was last documented in 2004: a man died after being bitten by a rabid dog in Morocco.
Austria was declared free of terrestrial rabies in 2008. The last time a fox was diagnosed with rabies was in 2004 and 2006. However, further investigations revealed that it was a vaccine virus picked up from young animals. Prior to this, an animal rabies outbreak occurred in Carinthia in 2002 due to an immigration of foxes from Slovenia. The circulation of the rabies virus in the Austrian dog population has been extinct since 1950.
Bat rabies is an independent infectious disease and is not related to silvatic rabies. So far, it has not been observed in Austria, neither in bats nor in other animals as well as in humans.
Rabies surveillance in Austria
The current Austrian surveillance programme is based on a study by EFSA, which recommends passive surveillance for rabies - especially in rabies-free countries. Since 2013, only so-called "indicator animals" - i.e. foxes, badgers, raccoon dogs and raccoons found dead or killed in road traffic, as well as all wild animals suspected of being rabid (confirmation by the official veterinarian required) - have been tested for rabies. In Austria, oral vaccination of the fox population - which, in contrast to the active vaccine used in human medicine, uses live vaccine rather than inactivated vaccine - was discontinued as early as 2012. In 2020, there were no animals infected with rabies virus in Austria. A total of 392 animals were tested for rabies. Foxes were most frequently represented with 126 and bats with 192 submissions. In 2020, 41 animals that had bitten a human were tested: all results were negative. Most of these were dogs and cats (17 dogs, 16 cats, 4 bats, 3 martens, 1 fox).
Terrestrial rabies was also not detected in Austria's neighbouring countries in 2020. As an absolute rarity, an infection with the West Caucasian bat rabies virus (WCBV) was detected in a cat in Italy.
The rabies viruses belong to the family Rhabdoviridae, genus Lyssavirus. A total of 11 different rabies virus strains (genotypes) are currently distinguished. 4 further isolates are at the stage of verification whether they are genotypes.
According to the World Health Organization (WHO), approximately 55,000 - 60,000 people are infected with the rabies virus every year, with dogs acting as carriers in most cases. Nearly half of the people bitten by dogs suspected of being infected with rabies are children under the age of 15. In Austria, the last human death due to wildlife-transmitted silvatic rabies was recorded in 1979 in Carinthia following a fox bite. An imported rabies death in Austria was last documented in 2004: a man died after being bitten by a rabid dog in Morocco.
Rabies can occur in three different forms, depending on the host animal:
Urban rabies: Dogs are the main reservoir and transmit the rabies virus to other animals and humans. The circulation of the rabies virus in the Austrian dog population has been extinct since 1950.
Silvatic rabies: This is a rabies transmitted by wild carnivores. The main reservoir in Europe is the red fox, in Eastern Europe additionally the raccoon dog. Since 2007, no rabies virus has been detected in wild animals in Austria.
Bat rabies: Bat rabies is an independent infection and is not related to silvatic rabies. It has not yet been observed in Austria, neither in bats nor in other animals or humans.
The pathogen is transmitted through the saliva of infected animals, in most cases through a bite. However, in rare cases, the virus can also use uninjured mucous membranes and abrasions as a portal of entry if there is direct contact with saliva. Contact with blood, urine or faeces of an infected animal or simply touching or stroking diseased animals does not pose a risk of infection.
Exposure to bats in their habitats (caves with large bat populations) is controversial as a relevant risk for possible aerogenic transmission. The mere presence of a bat in the same room is not sufficient for transmission of the pathogen. Direct contact with bats, on the other hand, poses a risk of infection.
Some cases of human-to-human transmission have been published. The main cause in this context is transplantation. Individual cases of human-to-human transmission through bites have also been reported. Transmission in the context of caring for patients has not yet been observed.
Course of the disease
Rabies almost always leads to death within 14 days of onset. The time between the bite and the appearance of the first symptoms depends on the bite site. The further away the bite site is from the central nervous system, the longer it takes for the first symptoms to appear. Depending on whether a strong excitation stage or only paralysis symptoms characterise the clinical picture, a distinction is also made between raging and silent rage.
The classical course of the disease comprises three stages:
Stage prodromale (prodromal stage): nonspecific symptoms such as signs of a flu-like infection, pain, itching, or paresthesias (sensations of discomfort) in the area of the bite wound
Stage irritationis (excitation stage): About 80% of patients develop the classic form of rabies ("raging madness"). This is characterised by episodes of confusion, agitation and aggressive behaviour alternating with periods of clear consciousness. Fever, increased salivation, sweating, dilated pupils and goose bumps have also been described. Seizures occur rarely, usually in the advanced course of the disease. The majority of patients develop hydrophobia, characteristic of rabies. Eventually, flaccid paresis, coma, and multiple organ failure occur.
Stage paralyticum (paralysis stage): In the paralytic form of Rabies ("silent rage", approx. 20% of cases), flaccid paralysis develops early on and, as the disease progresses, pain, sensory disturbances and vegetative dysregulation. Hydrophobia is rather atypical in this form of progression, but may occur. Death finally occurs due to paralysis of the respiratory muscles.
Rabies Outreach Clinic
The Rabies Advisory Service at the AGES Institute of Medical Microbiology and Hygiene Vienna offers professional information and advice for doctors and patients on the rabies situation in Austria and abroad, as well as in cases of emergency, including advice on indications for rabies vaccination following a bite wound by an animal suspected of being rabid, and for long-distance travellers on the basis of WHO recommendations. The advisory service is provided 365 days a year by the personal presence of a human physician (Tel: +43 50 555-37111).
Austria was declared free of terrestrial rabies in 2008. The last time a fox was diagnosed with rabies was in 2004 and 2006. However, further investigations revealed that it was a vaccine virus that had been picked up by young animals. Prior to this, an animal rabies outbreak occurred in Carinthia in 2002 due to an immigration of foxes from Slovenia.
The circulation of rabies virus in the Austrian dog population has been extinct since 1950. Since 2007, no rabies virus has been detected in wild animals either. A case of rabies (dog) in the context of an illegal import of domestic animals last occurred in Austria in 1999.
The pathogen is transmitted through the saliva of infected animals, in most cases through a bite. However, in rare cases, the virus can also use uninjured mucous membranes and abrasions as ports of entry when direct contact with saliva occurs. Dogs and cats do not normally shed Rabies virus in saliva until the final stages of the disease. They are extremely unlikely to exhibit normal behavior at this stage. Contact with blood, urine, or feces of an infected animal, or touching or petting diseased animals alone, does not pose a risk of infection.
Controversially, exposure to bats in their habitats (caves with large bat populations) is a relevant risk for possible aerogenic transmission. The mere presence of a bat in the same room is not sufficient for transmission of the pathogen. Direct contact with bats, on the other hand, poses a risk of infection. Rabid bats are often found lying on the ground. They show abnormal behavior patterns, attack nearby objects, have orientation difficulties as well as signs of paralysis. Rabies-infected bats change their habits, become diurnal, and are found in places where they do not normally spend time.
Course of the disease in animals
Stage prodromale (prodromal stage): dejection, fever, nausea, reluctance to eat, vomiting, hydrophobia
stage irritationis (excitation stage): excitement, hyperactivity, aggressiveness, salivation
stage paralyticum (paralysis stage): paralysis, impairment of the sensorium, coma
Rabies vaccination of pets
Since the introduction of the EU pet passport, rabies vaccination has become even more important. The EU pet passport is a uniform animal passport in English and in the respective national language for dogs, cats and ferrets. It replaces all previous border formalities with regard to the EU countries and facilitates travel with animals within the EU.The EU pet passport valid for entry and exit must contain the rabies vaccination and the unique identification of the animal (tattoo or microchip).
A blood test with determination of the rabies titer is required as proof of sufficient rabies vaccination protection. This must be at least 0.5 IU/ml (IU = International Units) and indicates the concentration of antibodies in the blood. The rabies titer determination may only be performed in an EU-approved laboratory. In Austria, this is the AGES Institute for Veterinary Investigations Mödling.
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