The Middle East and Eastern Europe rabies Expert Bureau (MEEREB) third meeting: Lyon-France (7-8 April, 2015).

MEEREB is an inter-regional network of countries from North Africa, Europe, the Middle East and Central Asia that work together with the aim of improving rabies control and prevention at local, regional and global level. MEEREB members met for the third time in 2015 in France (Lyon) to review the current rabies situation within the network and to discuss the way forward the prospect of a One Health approach against rabies. Dogs were the main vector of transmission in all MEEREB countries except for Croatia and Serbia where foxes represented the primary source. The number of rabies animal cases reported in 2014 varied substantially between countries with Ukraine reporting the highest number of animal cases. Human cases still occur in North Africa and all Middle East and Eurasian countries while no cases of human rabies were reported in Croatia, Serbia and Romania, although cases of rabies were identified in both dogs and foxes in 2014. Participants concluded that MEEREB can act as a think-tank where countries can share data, information, experiences and best practices to jointly address challenges in rabies control and prevention. They called for elimination of dog-transmitted rabies through vaccine and rabies immunoglobulin stockpiles and implementation of a One Health approach to achieve rabies's eradication.

Fighting rabies in Eastern Europe, the Middle East and Central Asia--experts call for a regional initiative for rabies elimination.

MEEREB is an informal network of rabies experts from the Middle East, Eastern Europe and Central Asia, seeking to eliminate rabies from the region. They met for the second time to review the current rabies situation, both globally and in their respective countries, highlighting current rabies control problems and potential solutions. Success stories in Latin America, in Western Europe, in some Asian countries, as well as in Croatia and Serbia prove that elimination of human rabies is achievable in the MEEREB region. It requires political willingness and cooperation of all stakeholders, including Ministries of Health and of Agriculture; adequate management of animal bites through post-exposure prophylaxis; pre-exposure prophylaxis for populations at high risk of rabies exposure, animal vaccination and humane control of stray dog populations. MEEREB members called for a regional initiative for rabies elimination in Eastern Europe and the Middle East. They are confident that the elimination of human rabies of canine origin can be achieved in the region through adopting a One Health approach, and that campaigns for rabies elimination will have significant benefit for public health, including strengthening the structure for control of other zoonoses.

Rabipur: a reliable vaccine for rabies protection.

Rabipur, a vaccine propagated on chick embryo fibroblasts, is one of the 'second generation' rabies vaccines produced by cell culture techniques. It compares in tolerance, immunogenicity and efficacy with the human diploid cell culture vaccines and is significantly more economical to be produced. It has proven to be an excellent vaccine, particularly when employed by the 2-1-1 schedule vaccination. This approach combines economy of vaccine with increased safety of treatment. Rabipur was investigated in all immunological parameters and can be recommended as a vaccine of choice for postexposure rabies treatment.

Type, severity, location, and timing of battle casualties in a Croatian Army brigade during an offensive action in 1992.

AIM: To analyze the type, severity, location, and timing of casualties in a Croatian Army brigade during an offensive action against enemy forces of about two infantry battalions timely prepared for defense. METHODS: Casualties were analyzed according to bilateral manpower and equipment conditions, morale, time of the day, weather conditions, type of ground where the action took place, quality of planning and steering the course of the action, and especially the medical help. The action was carried out along one main and two auxiliary directions, including river crossing. The action involved about 1,000 soldiers and took 7 hours. It was divided into three phases: approaching the enemy, direct contact, and self-imposed retreat and evacuation. Medical care for the injured soldiers was organized in echelons, relying on civilian health care institutions. RESULTS: During the action, 92 casualties were recorded. The mean injury severity according to the Abbreviated Injury Scale (AIS) was 2.9+/-1.4. The highest proportion of casualties occurred on the main direction (48 or 52.2%) but the most severe injuries were inflicted on the second auxiliary direction (mean AIS, 2.6+/-1.4). Extremely severe injuries (mean AIS, 2.0+/-1. 4) were recorded on the second auxiliary direction during the phase of retreat after a successfully performed action. However, regarding the whole action, the observed differences did not prove to be statistically significant. CONCLUSIONS: Offensive action was properly planned and successfully led during the first two phases. Evacuation and retreat of the brigade were in part poorly organized. Health care for the soldiers functioned well throughout the action.

Persistence of humoral immunity to rabies 1100 days after immunization and effect of a single booster dose of rabies vaccine.

Forty-four vaccinees immunized with rabies vaccine and human rabies immunoglobulin according to the abbreviated intramuscular regimen (the 2-1-1 schedule) were followed-up after 1100 days and had their blood samples taken. The persistence of rabies neutralizing antibody was proven in the sera of all vaccinees. 56% of whom demonstrated titres > or = 0.5 IU ml-1. At the same day the vaccinees were given a single booster dose of vaccine whose effect was measured 2 weeks later. With the RFFI test on day 1114, sera revealed an extraordinarily high booster response in all 44 vaccinees. The study proved the anamnestic response after a full course of rabies vaccination to be a very stable one, and the capability of a single booster dose of vaccine to evoke high-titred rabies antibody response. Of the four vaccines used in the study, under comparable conditions HDCV proved superior to PCECV PDEV and PVRV on all 3 days of serology-35, 1100 and 1114, though this difference was statistically attested only on days 35 and 1114.

Immune Response to Hepatitis A Vaccine Combined or Given Simultaneously with Typhoid Fever Vaccine.

Background: Because both hepatitis A and typhoid vaccination are frequently indicated in the same traveler, a prospective, randomized controlled study was performed to evaluate the feasibility of simultaneous administration of hepatitis A and typhoid fever vaccines in adult volunteers. Methods: Two groups of 25 subjects received either separate injections of hepatitis A (Havrixtrade mark, SmithKline Beecham Biologicals) and typhoid fever (Typhim Vitrade mark, Pasteur-Mérieux) vaccines in opposite arms, or a syringe-mixed combination of both vaccines as a single injection. A booster dose of Havrix was given at 6 months. Results: The immune response to hepatitis A tended to be higher in the mixed-injection group, but this difference was significant (p=.048) only following the booster dose. Adverse reactions were generally mild with no differences between the two groups. Conclusion: A combined formulated vaccine against both typhoid fever and hepatitis A is feasible and offers more convenience without added adverse reactions to travelers who have appropriate indications for both vaccines.