Rabies in Poland in2011 - Epidemiological Review

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.H\ZRUGV rabies, epidemiology, Poland, 2011

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MATERIALS AND METHODS

The analysis of the epidemiological situation of UDELHVLQ3RODQGLQZDVEDVHGRQLQIRUPDWLRQ

from the questionnaires sent to the Department of Epi-GHPLRORJ\1,3+1,+E\WKH6DQLWDU\(SLGHPLRORJLFDO 6WDWLRQV LQFOXGLQJ   UHSRUWV RI SHRSOH YDFFL-QDWHGDJDLQVWUDELHVDIWHUH[SRVXUHLQ3RODQGDQG TXHVWLRQQDLUHVSHRSOHYDFFLQDWHGDJDLQVWUDELHVDIWHU H[SRVXUHLQRWKHUFRXQWULHVGDWDIURPDQQXDOEXOOHWLQ ³,QIHFWLRXVGLVHDVHVDQGSRLVRQLQJVLQ3RODQGLQ´ (Czarkowski MP et al., Warsaw, NIPH-NIH and GIS) DQGHSL]RRWLFGDWDSURYLGHGE\WKH*HQHUDO5(68/76

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0DáJRU]DWD6DGNRZVND7RG\V%RĪHQD.XFKDUF]\N  No 3 ANIMAL RABIES ,QWKHUHZHUHUHJLVWHUHGFDVHVRIDQLPDOV ZLWKUDELHV)URPWRWKHUHZDVDVWHDG\GH-FOLQHLQWKHQXPEHURIUDELHV<HDULVWKHVHFRQG \HDULQZKLFKWKHUHZDVDQLQFUHDVHLQWKHQXPEHURI FDVHVRIDQLPDOUDELHV7KRVHFDVHVRFFXUUHGSULPDULO\ in the province of Malopolskie and Podkarpackie, 60 and 63 respectively. In the province of Malopolskie QXPEHURIUHSRUWHGFDVHVZDVDERXWKDOIRIWKHQXPEHU RIFDVHVUHSRUWHGLQWRFDVHV+RZHYHU LQWKH3RGNDUSDFNLHUHJLRQQXPEHURIFDVHVKDVPDUN-HGO\LQFUHDVHG,QLWZDVRQO\2QHFDVHRIIR[ UDELHVZDVDOVRUHFRUGHGLQ6LOHVLDZKHUHUDELHVKDV QRWRFFXUUHGIRUPDQ\\HDUV,QFDVHVRIUDELHVLQ terrestrial animals were registered in six provinces. Ra-ELHVZDVIRXQGERWKLQZLOGDQGGRPHVWLFRQHV5DELHV prevailed in foxes - 103 cases (over 64%), including in 3RGNDUSDFNLHLQWKH0DORSROVNLHLQ/XEHOVNLH LQWKH:DUPLQVNR0D]XUVNLHLQ3RGODVNLH and in Slaskie – 1. As in the previous years, there were DOVRUHFRUGHGFDVHVRIEDWUDELHV$WRWDORIIRXUUDELG EDWVZHUHQRWLILHGLQWKH:DUPLQVNR0D]XUVNLHDQG in Mazowieckie and Pomorskie one in each.

7KH QXPEHU RI VLFN DQLPDOV DQG WKH QXPEHU RI SHRSOHYDFFLQDWHGDJDLQVWUDELHVEHFDXVHRIFRQWDFWZLWK DQLPDOVFDWHJRU\$%UDELGDQLPDOUDELHVODERUDWRU\ FRQILUPHGRUFOLQLFDOO\GLDJQRVHG&UDELHVLQDQLPDOV is excluded) and D (pet healthy at the time of exposure) DUHJLYHQLQ7DEOHV,DQG,, 7DEOH,, 1XPEHURISHUVRQVYDFFLQDWHGDJDLQVWUDELHVLQ 3RODQGLQH[SRVHGWRUDELG$%RUUDELHV suspected (CD) animals Province No of people

vacci-QDWHGDJDLQVWUDELHV Total Registry Mz-56 AB C D 'ROQRĞOąVNLH _  10   Kujawsko-Pomorskie _     /XEHOVNLH _  36   /XEXVNLH _ 109 4 113 111 àyG]NLH _ 641 45   0DáRSROVNLH 113     Mazowieckie 1 903   996 Opolskie _ 105 3  114 Podkarpackie 143  69   Podlaskie 30 193    Pomorskie _ 509 33  560 ĝOąVNLH _    635 ĝZLĊWRNU]\VNLH _  10  199 :DUPLĔVNR0D]XUVNLH 13 439 150  591 Wielkopolskie _ 445 61 506  Zachodnio-Pomorskie _ 310 31 341 343 Polska 300 6591    'DWDVRXUFHV4XHVWLRQQDLUHV3HUVRQYDFFLQDWHGDJDLQVWUDELHV Infectious diseases and poisonings in Poland. NIZP-PZH, MZiOS *,6:DUVDZ

REGISTRATION OF PERSONS EXPOSED TO RABIES

,QDQDO\VLVZDVGRQHRQUHSRUWLQJIRUPV which represent 96% of the official reports. Detailed LQIRUPDWLRQRQWKHYDFFLQDWLRQRISHRSOHDJDLQVWUDELHV LQGLIIHUHQWUHJLRQVDUHVKRZQLQ7DEOH,, ,QRXWEUHDNVRIDQLPDOUDELHVSHRSOHZHUH YDFFLQDWHG,QFRPSDULVRQZLWKWKH\HDUWKLVILJ-XUHZDVFRPSDUDEOHEXWVLJQLILFDQWO\KLJKHUWKDQLQWKH SUHYLRXV\HDUVLQZDVLQSHRSOHLQ DQG+RZHYHULWZDVPXFKVPDOOHU WKDQLQZKHQDPRXQWHGWRSHRSOH 0RVWSHRSOHDUHYDFFLQDWHGEHFDXVHRIH[SRVXUH WRWKHDQLPDOVLQZKLFKUDELHVFDQQRWEHH[FOXGHG,Q WKHILJXUHZDVRYHUDQGZDVFORVHWRYDOXHV REWDLQHGLQWKHODVWIRXU\HDUV7DEOH,,

,Q 3RODQG LQ  PHQ ZHUH VOLJKWO\ PRUH IUH-quently vaccinated than women while in the age group DERYHPRUHYDFFLQDWLRQVRFFXUUHGLQZRPHQ7DEOH ,,,$VLQWKHSUHYLRXV\HDUVPD[LPXPQXPEHURIYDF-cinations fell on the second and third quarters of the

7DEOH, 1XPEHU RI UDELG DQLPDOV $% DQG QXPEHU RI YDFFLQDWHGSHUVRQVH[SRVHGE\UDELG$%RUUDELHV VXVSHFWHG&'DQLPDOVLQ3RODQGLQ Animal No of UDELG animals % No of people vaccinated DJDLQVWUDELHV Total AB C D dog 9 6 63 4614 531  cat 10  51  119 1430 livestock 15 10   1 96 fox 103  63  _  EDGJHU 4 3 4 1 _ 5 raccoon dog  1 11 3 _ 14 marten 9 6 33  _  polecat _ _ _ 6 _ 6 weasel _ _ _ 5 _ 5 EDW 4 3 11  _ 113 rat _ _ _ 199 _ 199 mouse _ _ _ 46 _ 46 squirrel _ _ _  _  wild hamster _ _ _ 1 _ 1 wild ruminant 3  5  _ 31 hedgehog _ _ _ 19 _ 19 mole _ _ _ 16 _ 16 hare 1 _ 1 3 _ 4 ZLOGERDU _ _  _ other _ _ _ 41 1  QRWLGHQWL¿HG _ _ _  _  Total 160 100 300 6591   'DWDVRXUFHV0RQWKO\5HSRUWVRQ$QLPDO5DELHVLQ3RODQG (General Veterinary Inspectorate), Questionnaires - Person vac-FLQDWHGDJDLQVWUDELHV

Rabies in Poland in 2011  No 3

\HDU7DEOH,91XPEHURISHRSOHYDFFLQDWHGLQUXUDO areas was more than 1.5 times higher than in the cit-ies. Both in the countryside or in the city, vaccinations were most often done due to exposure to the animals LQZKLFKUDELHVLVQRWH[FOXGHG&DWHJRU\&7DEOH9 Veterinary Inspectorate.

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Gender Age 0-6  ! Total

Men     Women     Total     7DEOH,96HDVRQDOGLVWULEXWLRQRIKXPDQDQWLUDELHVYDFFLQD-WLRQLQ3RODQGLQE\TXDUWHU Quarter 1RRISHRSOHYDFFLQDWHGDJDLQVWUDELHV AB C D Total I 93  114 1495 II 45    III     IV     Total 300 6591   7DEOH9 +XPDQDQWLUDELHVYDFFLQDWLRQLQ3RODQGLQ DFFRUGLQJWRXUEDQUXUDOGLVWULEXWLRQRIFDVHV 1RRISHRSOHYDFFLQDWHGDJDLQVWUDELHV AB C D total Town  4163   Countryside     Total 300 6591  

SOURCES OF HUMAN EXPOSURE TO RABIES

'DWDRQWKHVRXUFHRIKXPDQH[SRVXUHWRUDELHV YLUXVDUHJLYHQLQ7DEOHV,9,DQG9,,,QWKHRXWEUHDNV RIDQLPDOUDELHVLQ3RODQGLQWRRQHVLFNDQLPDO LW ZDV H[SRVHG E\ DYHUDJH PRUH WKDQ IRXU SHUVRQV $OWRJHWKHUDIWHUH[SRVXUHWRUDELGDQLPDOVSHRSOH were vaccinated. Vaccinations were performed after FRQWDFWVZLWKDQLPDOVLQFOXGLQJIR[HVFDWV GRJVDQGWZREDWV7DEOH9,+RZHYHUDVLQSUHYLRXV years, the most common cause of people vaccination were contacts with domestic animals such as cats and GRJVVXVSHFWHGRIEHLQJLQIHFWHG7DEOHWDE9,,

,Q3RODQGLQSHRSOHZHUHYDFFLQDWHGGXH to the exposure which occurred outside the country: in other European countries (such as Ukraine and Rus-sia) or in non-European countries such as Thailand, Indonesia and Vietnam. Exposure was caused mainly E\GRJVDQGFDWVLQSDWLHQWV0RVWSHRSOH KDYHEHHQH[SRVHGGXULQJWKHKROLGD\VHDVRQLHLQWKH third quarter of the year- more than 43%.

EFFICACY AND SAFETY OF HUMAN RABIES VACCINATION

Vaccine effectiveness depends on many factors in-cluding, in addition to the use of highly immunogenic vaccines or serum, the severity of the injuries inflicted E\LQIHFWHGDQLPDOVWLPLQJRIDGPLQLVWUDWLRQRIWKH vaccine after exposure and compliance with vaccina-WLRQVFKHPHUHFRPPHQGHGE\WKHPDQXIDFWXUHU,QWKH RXWEUHDNVZHUHYDFFLQDWHGSHRSOHLQFOXGLQJZLWK GDPDJHGVNLQELWWHQRUVFUDWFKDQGLQFRQWDFWZLWK VDOLYD7DEOH9,DQG7DEOH9,,, 7DEOH9,+XPDQH[SRVXUHLQDQLPDOUDELHVIRFXVHV$% LQ3RODQGLQ1XPEHURIUDELGGRPHVWLFDQG wild animals (AB)

Province No of UDELHV animal out-EUHDNV 1RRIUDELG animal No of people vaccinated DJDLQVWUDELHV wild do-mestic with skin injures witout skin injures Total 0DáRSROVNLH   14 9 104 113 Mazowieckie 1 1 0 1 0 1 Podkarpackie 31   5  143 Podlaskie 5 0 5 3  30 :DUPLĔVNR Mazurskie  1 1 0 13 13 Polska 65     300 7DEOH9,,+XPDQDQWLUDELHVYDFFLQDWLRQFDXVHGE\UDELHV suspected animals (C) No of people vaccinated against UDELHV  1RRISHRSOHYDFFLQDWHGDJDLQVWUDELHV domestic anumals wild animals animal escaped animal: dead not tested test re-sults not taken into account ** no infor-mation DERXW animal    313 10 0 LQFDHVWKHDQLPDOZDVQRWLGHQWL¿HG LQFDVHVUDELHVRIDQLPDOZDVH[FOXGHGDQGYDFFLQDWLRQ was stopped ,QLWZDVIRXQGWKHIROORZLQJFDVHVRIPLVFRQ-GXFWLQYDFFLQDWLRQ7DEOH,;VHUXPZDVJLYHQRQO\ to seven people who have had contact with the animal ZLWKUDELHVDQGLQZKRPWKHVNLQKDVEHHQGDPDJHG,W was not given to and any person who was soiled with VDOLYD,QDGGLWLRQVHUDZHUHJLYHQRQO\WRSHRSOH DWULVNIURPWKHDQLPDOVVXVSHFWHGRIEHLQJLQIHFWHG 9DFFLQDWLRQDWGD\VRUODWHUVLQFHWKHWLPHRIH[SRVXUH was started in 1303 people. The main departure from WKHSULQFLSOHVRIYDFFLQDWLRQZDVWKHODFNERRVWHUGRVH or continuation of vaccination despite the exclusion of UDELHVLQDQDQLPDORIFRQWDFW

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7DEOH9,,,+XPDQH[SRVXUHWRUDELHVLQIHFWLRQLQ3RODQGLQE\UDELG$%DQGUDELHVVXVSHFWHG&'GRPHVWLFDQG wild animals. Kind of injures.

Kind of exposure

1RRISHRSOHH[SRVHGE\

dogs and cats livestocks wild animals QRWLGHQWL¿HG animals

A C D A C D AB C D C

no contact, undirect contact, touching     3 _ 109  _ _

licks 10 55  30 _ _ 16 13 _  scraches 5 169 16 _ _ _ _  _ _ ELWHZRXQGRISDOPVDQGKHDGQRWEUHDNVWKHVNLQ 6   _  1 3 454 _  ELWHZRXQGRISDOPVDQGKHDGEUHDNVWKHVNLQ _  99 _ 5 _ _  _ _ ELWHZRXQGRIWRUVROLPEVDQGDUPVQRWEUHDNVWKHVNLQ 4   _ 5 _ _  _ 10 ELWHZRXQGRIWRUVROLPEVDQGDUPVEUHDNVWKHVNLQ _   _ _ _ _ 11 _ _ Total 114     1  656 0  7DEOH,;3URSK\ODFWLFSURFHGXUHVLQSHUVRQH[SRVHGWRUDELHV LQIHFWLRQLQ3RODQGLQ

Information on prophylactic procedure

No of people vacci-QDWHGDJDLQVWUDELHV AB C D 7RWDOQXPEHU of vaccinated people 300 6591  sera was given XSWRKDIWHUH[SRVXUH 4 69 1 !KDIWHUH[SRVXUH 5 15 0 vaccinated XSWRKDIWHUH[SRVXUH   541 4-6 days after exposure   64 GD\VDIWHUH[SRVXUH 91  39 > 14 days after exposure 33   vaccine administered according to

instruction  6061 605

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SUMMARY AND CONCLUSIONS

 $OWKRXJKWKH\HDULVWKHVHFRQG\HDULQZKLFK REVHUYHGDVOLJKWLQFUHDVHLQWKHUHFRUGHGQXPEHU RIDQLPDOUDELHVFDVHVLWFDQEHFRQFOXGHGWKDWWKH epizootic situation in Poland of this disease is good and not deteriorated.

 6WDEOHHSL]RRWLFVLWXDWLRQRIUDELHVLQWKHFRXQWU\LV a result of the program for oral vaccination of wild animals, which was introduced in the country in 1993  $VPDOOQXPEHURIUDELGDQLPDOVUHJLVWHUHGLQWKH

country in recent years, does not significantly affect WKHQXPEHURIYDFFLQDWLRQDJDLQVWUDELHVLQKXPDQV who come into contact with animals which poten-WLDOO\FRXOGEHWKHVRXUFHRIUDELHV)RUPDQ\\HDUV DWRWDOQXPEHURIYDFFLQDWHGSHRSOHUHPDLQVDWWKH OHYHORIWKRXVDQG

 6SHFLDODWWHQWLRQVKRXOGEHSDLGWRWKHDGPLQLVWUD-tion of serum to people exposed or deeply wounded E\UDELGDQLPDOVRUWKRVHLQZKLFKUDELHVFDQQRWEH excluded. 5HFHLYHG $FFHSWHGIRUSXEOLFDWLRQ $GGUHVVIRUFRUUHVSRQGHQFH 'U0DáJRU]DWD6DGNRZVND7RG\V Department of Epidemiology 1DWLRQDO,QVWLWXWHRI3XEOLF+HDOWK1DWLRQDO,QVWLWXWHRI Hygiene XO&KRFLPVND:DUV]DZD email: mtodys@pzh.gov.pl