Notifications of suspected rabies exposure increased in Finland: 26 years of one health surveillance, 1995-2020.

ABSTRACT

BACKGROUND: Finland is a rabies virus-free country since 1991. Notification of suspected cases of rabies exposures, leading to post-exposure prophylaxis, is mandatory. We characterised suspected cases of rabies exposure, analysed animal surveillance data and calculated costs for vaccine and immunoglobulin and treatment to estimate the financial burden of rabies control in Finland. METHODS: The incidence rate ratios of suspected cases of rabies exposure were calculated from Finnish Infectious Disease Registry and Statistics Finland data. Animal surveillance data were obtained from the Finnish Food Authority's registries. Calculation of costs were based on the medical and treatment costs of rabies control. RESULTS: In 2007, one human rabies infection linked to a dog bite in the Philippines and rabies infection in a dog imported from India were diagnosed in Finland. In 2009, 2016 and 2017, lyssaviruses were found in bats. Notifications of suspected rabies exposures increased during 2007-2019. Two-thirds of the exposures occurred abroad, mainly in Asian and African countries. Bats were the most frequent domestic exposing animal. The import of vaccine and immunoglobulin doses increased. The annual cost of Finnish rabies control is estimated to be over €1.65 million. CONCLUSIONS: Increased awareness of rabies and bat lyssavirus infections probably increased post-exposure prophylaxis and reporting. Travellers need country-specific guidance on how to prevent exposures, and citizens need instructions on animal imports and how to handle bats.