Date Published: September 12, 2011
Publisher: SAGE-Hindawi Access to Research
Author(s): Orhan Aylan, Aly Fahmy Mohamed El-Sayed, Firouzeh Farahtaj, Ali R. Janani, Olga Lugach, Olgha Tarkhan-Mouravi, Gaye Usluer, Rodovan Vodopija, Nenad Vranjes, Noël Tordo, Betty Dodet.
Rabies is a threat in all parts of the world where animal reservoirs persists, including Eastern Europe and the Middle East. Rabies experts from seven Middle East and Eastern European countries (Croatia, Egypt, Georgia, Iran, Serbia, Turkey, and Ukraine) met for two days in Istanbul, Turkey (June 8-9, 2010), to exchange information on the epidemiological situation concerning human and animal rabies in their respective countries and to discuss strategies for rabies elimination and control. They decided to establish a regional network, the Middle East and Eastern Europe Rabies Expert Bureau (MEEREB), a regional network of experts, to increase collaboration in rabies prevention and control at the local, regional, and global levels.
Rabies is a major public health problem causing approximately 55,000 human deaths every year, mainly in Asia and Africa . It is also a threat in other parts of the world where animal reservoirs persist, as is the case in Middle East countries. Rabies continues to be a significant but underestimated public health concern in the region and the situation in some countries has worsened, given the deteriorating environment [2, 3]. While rabies rarely occurs in humans in most of Eastern Europe, thanks to post-exposure prophylaxis (PEP), it remains present in animal reservoirs, particularly in countries situated at the crossroad of Asia, Africa, and Western Europe [4, 5].
The rabies situation presented during the meeting is summarized in Table 1. All countries represented at MEEREB reported animal rabies, and in some countries where canine rabies is prevalent, the disease still occurs in humans. Cats also play a role as a vector especially in Ukraine, where, according to the data presented, 12 out of 29 (41.4%) human rabies cases in the last 10 years were transmitted by cats, and in Turkey where the recent reappearance of the disease in this species is a concern.
According to WHO, immediate post-exposure vaccination is recommended for category II exposure (nibbling of uncovered skin, minor scratches, or abrasions without bleeding;) and immediate vaccination and administration of rabies immunoglobulin are recommended for category III (single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks, licks on broken skin, exposures to bats). For categories II and III, thorough washing and flushing (for 15-minutes, if possible) with soap or detergent and copious amounts of water of all bite wounds and scratches should be done immediately, or as early as possible following the bite . Intramuscular vaccination consists of either a 5-dose (1 dose on each of days 0, 3, 7, 14, and 28) or a 4-dose schedule (2 doses on day 0—1 in each of the 2 deltoid or thigh sites—followed by 1 dose on each of days 7 and 21). An intradermal regimen (injection of 0.1 ml at 2 sites—deltoid and thigh—on days 0, 3, 7, and 28) may be used for people with category II and III exposures in countries where the intradermal route has been endorsed by national health authorities .
This meeting was a first step in establishing a rabies network in the Middle East and Eastern Europe. During this initial meeting, participants noted the common issues and differences in their respective rabies situation and discussed how they could benefit from sharing their experiences to establish a regular, supranational collaboration to fight rabies.