Rabies in the Middle East, Eastern Europe, Central Asia and North Africa: Building evidence and delivering a regional approach to rabies elimination.

The Middle East, Eastern Europe, Central Asia and North Africa Rabies Control Network (MERACON), is built upon the achievements of the Middle East and Eastern Europe Rabies Expert Bureau (MEEREB). MERACON aims to foster collaboration among Member States (MS) and develop shared regional objectives, building momentum towards dog-mediated rabies control and elimination. Here we assess the epidemiology of rabies and preparedness in twelve participating MS, using case and rabies capacity data for 2017, and compare our findings with previous published reports and a predictive burden model. Across MS, the number of reported cases of dog rabies per 100,000 dog population and the number of reported human deaths per 100,000 population as a result of dog-mediated rabies appeared weakly associated. Compared to 2014 there has been a decrease in the number of reported human cases in five of the twelve MS, three MS reported an increase, two MS continued to report zero cases, and the remaining two MS were not listed in the 2014 study and therefore no comparison could be drawn. Vaccination coverage in dogs has increased since 2014 in half (4/8) of the MS where data are available. Most importantly, it is evident that there is a need for improved data collection, sharing and reporting at both the national and international levels. With the formation of the MERACON network, MS will be able to align with international best practices, while also fostering international support with other MS and international organisations.

MONKEY BITES AND INJURIES IN THE ZAGREB ANTIRABIES CLINIC IN 2014.

- Travelling around the world and visiting distant places and countries (especially national parks, parks of nature, natural resorts, etc.) sometimes may result in animal bites and injuries from the species which are not usually represented as the source of human rabies cases, such as monkeys. In the last ten to fifteen years, monkey bites and injuries present an unpleasant experience and cause a lot of problems for travelers and tourists when travelling to India, Thailand, Indonesia or Bali because they have to seek a medical facility for wound treatment, tetanus prophylaxis, antimicrobial therapy and rabies postexposure prophylaxis (PEP). In 2014, 706 persons were registered at the Zagreb Antirabies Clinic as having sustained bites by various animals, ten of them reported to have been bitten or injured by monkeys. Nine of them sustained injuries during their travel to India, Thailand, Indonesia and Bali. All injuries occurred when they wanted to pet or tried to feed monkeys, or refused to give them food. Most of the monkeys were macaques, capuchins, or of unknown type. Only one monkey bite recorded in the city of Zagreb occurred in the Zagreb ZOO while a professional animal handler was feeding a capuchin monkey in the cage. He did not receive rabies PEP, but instead, the capuchin monkey was put under veterinary supervision. All other patients started with PEP in the countries where the injuries occurred and continued/completed it at the Zagreb Antirabies Clinic. They received antirabies vaccine only (PVRV, RABIPUR) upon 5-dose regimen (Essen scheme) and 2-1-1 (Zagreb scheme) regimen. None of them contracted rabies. After many years, monkeys were the animal species immediately following dogs and cats in the official report of the Zagreb Antirabies Clinic, which was quite surprising. Usually, monkey bites and injuries do not present a serious problem in daily routine because they occur sporadically.

THE INCIDENCE OF JACKAL BITES AND INJURIES IN THE ZAGREB ANTI RABIES CLINIC DURING THE 1995-2014 PERIOD.

Rabies is a zoonotic disease (a disease transmitted to humans from animals) that is caused by a virus. The disease affects domestic and wild animals, and is spread to people through close contact with infectious material, usually saliva, via bites or scratches. Rabies is present on all continents with the exception of Antarctica, but more than 95% of human deaths occur in Asia and Africa. Once the symptoms of the disease have developed, rabies is nearly always fatal. People are usually infected following deep bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies. They are the source of infection in all of the estimated 55 000 human rabies deaths annually in Asia and Africa. Bats are the source of most human rabies deaths in the Americas. Bat rabies has also recently emerged as a public health threat in Australia and Western Europe. Human deaths following exposure to foxes, raccoons, skunks, jackals, mongooses and other wild carnivore host species are very rare. In the Zagreb Anti Rabies Clinic, from 1995 to 2014, there were 18,094 patients bitten by various animals, but only 2 cases were caused by jackals. One was imported (from France), and the other was from Croatia. The incidence of jackal injuries during the observed period was extremely low, accounting for 0.011% of all animals. When the imported case is excluded, the incidence was 0.0055%. Accordingly, it is concluded that jackal bites and injuries are exceptionally low and that they pose no risk for patients who present routinely to the Zagreb Anti Rabies Clinic. Therefore, it is justified that jackal as an animal species be classified in the group of 'other animals', when officially reported.

[Epidemiological characteristics of salmonellosis in New Zagreb during the 1990-2009 period]. / Epidemioloske karakteristike salmoneloza u novom Zagrebu od 1990. do 2009. Godine.

In Croatia, salmonellosis is the leading cause of bacterial foodborne diseases. The aim of the study was to determine the incidence of the disease, patient breakdown by age and sex, the most frequently isolated Salmonella serotypes, the length of carriership, and the most frequent source of infection. It was a retrospective analysis, and the sources of data were reports and epidemiological questionnaires administered to those affected with the disease. During the 1990-2009 period, 4492 cases of salmonellosis were reported in the New Zagreb area. The average incidence was 179/100,000. From 2004 onwards, salmonellosis has been on a decrease in Western Europe countries and the USA, whereas in Croatia it is still the leading cause of bacterial food poisoning. The highest incidence is recorded in children up to the age of 1 year (880/100,000), due to low immunity and a lower infective dose. In the observed period (1990-2009), the most frequently isolated serotype was Salmonella enteritidis (84%), followed by Salmonella typhimurium (7%), Salmonella virchow (3%) and Salmonella hadar (2%). There was a slight female predominance (F:M ratio 1.2:1) in salmonellosis cases. All persons affected with the disease are placed under sanitary surveillance including bacteriological control of the stool. Acute carriership was recorded in 2557 (57%) subjects, whereas stool excretion of Salmonella for more than 90 days (chronic carriership) was present in 139 subjects. In nine (0.2%) subjects, chronic carriership was observed for more than a year. During carriership, 22,460 stool samples were examined, i.e. 5 samples per patient on an average. A total of 1033 (23%) subjects were hospitalized for 7 days on an average, whereas 359 persons stayed in day hospital (1-2 days). Out of 3592 (88.4%) subjects with symptoms of the disease reported on their own, Salmonella was detected by the examination of contacts in 413 (9.3%) and carriership proven in 127 (2.3%) subjects examined for sanitary certificate (persons under sanitary surveillance due to the work with food). There were 90% of sporadic cases and 10% of small outbreaks. The most common source of infection were eggs (32%), poultry (10%) and pastry (10%). The outbreaks were mostly confined to the families. Salmonellosis is a major public health and economic problem, as well as an issue pertaining to veterinary and human medicine. The best and most efficient way to prevent the spread of infection by food is reduction of salmonellosis in animal population.