Rabies is an important health issue worldwide due to its high mortality and its possibly insidious outline determined by the relatively long incubation period, of three to eight weeks1 and sometimes longer than one year.2 One fatal case of human rabies in Australia presented an incubation of 27 months after a fruit bat bite3 and a number of other cases in endemic areas reported longer, less plausible incubation periods,2 up to 20 years.4,5
The high number of human cases reported by Najar et al.6 in this issue of GERMS brings into the spotlight a quite stringent problem, that of endemic rabies. According to the European Center for Disease Prevention and Control (ECDC) reports, since 2005, all cases of rabies in the European Union have been imported from countries such as India, the Philippines, Morocco, French Guyana or Kenya, except for the Romanian cases.7
There is obvious need for the eradication of animal rabies, which can be accomplished, at least in part, through the program for oral vaccination of foxes, as described by Muller et al.8 Meanwhile, measures should be taken to limit the transmission of rabies to humans and to domestic animals such as cats and dogs in rural areas or in the vicinity of forests, through informing the population in rural areas on the need to seek medical advice after animal bites and through offering easier access to healthcare (shorter distances to hospitals or clinics, transportation systems, etc).
Another interesting aspect of the epidemiology of human rabies in Romania, as pointed out by Najar et al.,6 is that one third of the cases were associated with rabid cat bites. This should raise an alarm signal, particularly since the general view on rabies is that the highest risks are associated with wild animals or stray dog bites. Therefore, people should be educated to seek medical advice for cat bites as well.
References
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