rabies

from Wikipedia, the free encyclopedia
Classification according to ICD-10
A82.- Rabies
A82.0 Wildlife Rabies
A82.1 Pet rabies
A82.9 Rabies, unspecified
ICD-10 online (WHO version 2019)

The rabies , and Rabies (from the Latin rabere , be great ',' rage ',' rage '), Lyssa (Greek), rabies or rabies , formerly Hydrophobia , called (see below), is since ancient times known acute infection by the rabies virus , which in warm-blooded animals an almost always fatal encephalitis caused and usually transmitted by animal bite.

Most animals of the same temperature can be infected by the rabies virus; it occurs less frequently among herbivores than among carnivores . Red foxes , dogs , cats , ferrets , badgers , raccoons , skunks and wolves are classic rabies vectors, as are the insectivorous bats . Until the disease was largely eradicated by oral vaccination in the wild animals, the main vector was the red fox, while stray dogs are still a major source of infection in India . The stereotypical image of a rabid animal is the aggressive red fox with foam at the mouth. However, rabies can also show itself in a " paralytic " form, in which the infected animal behaves unnaturally calm and withdrawn.

Squirrels , other rodents and rabbits , on the other hand, are very rarely infected. Birds also rarely get rabies because their body temperature is higher than necessary for the virus to multiply optimally.

According to an estimate by the WHO, 59,000 people die of rabies every year, 60% of them in Asia and 36% in Africa. India is the country with the highest number of rabies-related deaths, it has 35% of all cases worldwide. In Germany, five cases of rabies were registered between 1977 and 2000, three of which originated abroad. There were 281 cases across Europe during this period. More than 15 million people around the world are suspected of being rabies vaccinated each year, preventing around 327,000 rabies-related deaths. Without vaccination or post- exposure prophylaxis (PEP) after infection, the rabies infection is fatal within 15 to 90 days - with very rare exceptions. Post-exposure prophylaxis is only effective within 24 hours of infection, the earlier the better.

Pathogen

Rabies viruses in a cell, EM . The Negri bodies are clearly visible.

Rabies is caused by viruses of the genus Lyssaviruses from the Rhabdoviridae family . These are enveloped viruses of cylindrical shape, the genome of which is present as single-stranded RNA with negative polarity . This is in contrast to other viruses that affect humans, which usually have cubic symmetry. A total of seven genotypes are currently distinguished for all of these pathogens :

With the exception of genotype 2, all of the genotypes listed above have described cases of rabies in humans.

The transcription and replication of the viruses take place in the cytoplasm of the host cell within special "virus factories", the so-called Negri bodies or Negrian inclusion bodies (named after their discoverer, the pathologist Adelchi Negri , who began research into rabies in 1903 and the found bodies named after him in the ganglion cells of the brain). They have a diameter of 2–10  µm and are typical of rabies infection, so that they serve as a pathognomonic feature.

transmission

99% of human cases worldwide are transmitted through the dog. In the USA, on the other hand, most cases in recent years have been caused by bats and these also pose a certain health risk in Australia, Latin America and Western Europe. Other wild, rabies-bearing predators such as fox, raccoon, skunk, jackal or mongoose, are further triggers of a disease.

The virus is present in the saliva of a rabid animal and the route of infection is usually via a bite or scratch wound. Transmission is also possible through direct contact of infected saliva with mucous membranes .

Transmission through mucous membranes has occurred in vitro . Transmission in this form may have occurred in humans whoexplored caves populatedby bats . With the exception of organ transplants (three cases in the USA at the beginning of 2004 and three cases in Germany at the beginning of 2005), human-to-human transmission has not yet been observed.

From the point of entry, the virus quickly migrates along the nerve cells into the central nervous system (CNS). The retrograde axonal transport is the most important step in the natural rabies infection. The exact molecular basis of this transport is not yet clear, but it has been shown that the rabies virus protein P interacts with the protein DYNLL1 (LC8) of the light chain of Dynein . P also acts as an interferon antagonist , thereby reducing the immune response.

The virus also spreads from the CNS to other organs; it occurs in the saliva of infected animals and can thus spread further. Often there is increased aggressiveness with increased biting behavior, which increases the likelihood of spreading the virus further.

Course of the disease and symptoms

Course of disease in humans

After a person has been infected by the bite of an infected animal, the virus remains near the entry point for about three days, is multiplied there and then reaches the spinal cord and finally the brain via the inside of the nerve fibers of the peripheral nerves . From the central nervous system , the virus spreads along peripheral and cranial nerves, including salivary glands and lacrimal glands , and is excreted with their secretions. If, on the other hand, the virus gets directly into the bloodstream through the bite, it reaches the central nervous system much faster. As soon as the virus has reached the central nervous system, vaccination is no longer effective, so post-exposure vaccination is only useful during the more or less long early phase, i.e. within the first few hours.

The incubation period - i.e. the period between the infection and the first cold- like symptoms - is usually between one and three months. However, incubation times of several years have also been described. The longest incubation period described in humans is two years.

Rabies patient

The virus causes inflammation of the brain ( encephalitis ), which is the cause of typical symptoms. It can also affect the spinal cord, which manifests itself in inflammation of the spinal cord ( myelitis ). When transmitted through a bite in the arm or leg, pain is often first expressed in the extremity that has been bitten. Loss of sensitivity corresponding to the skin dermatomes has been observed regularly. Therefore, many, especially atypical disease courses are initially misdiagnosed as Guillain-Barré syndrome . Soon thereafter, the central nervous symptoms such as paralysis , anxiety , confusion , excitement increase, progressing to delirium , abnormal behavior , hallucinations and insomnia . Paralysis of the posterior cranial nerves ( glossopharyngeal nerve , vagus nerve ) leads to pharyngeal paralysis associated with an inability to speak or swallow - this is typical during later stages of the disease. The sight of water can provoke attacks of hydrophobia with spasms of the throat and larynx . The increased salivation ( hypersalivation ) can no longer be swallowed and foams in front of the mouth. The difficulty in swallowing prevents the virus from diluting, which increases its virulence . The slightest environmental stimuli such as an aerophobia- inducing draft, e.g. B. by a fan, or noises and lights lead to tantrums, screaming, hitting and biting, whereby the highly concentrated virus is eventually transmitted.

The disease can also take the "silent" form, in which some of the symptoms mentioned are absent. However, irrespective of the progression, imaging with the magnetic resonance tomograph reveals a lightening in the region of the hippocampus and the caudate nucleus . Death almost always occurs two to ten days after the first symptoms; the few survivors often suffer from severe brain damage.

In 2012, indigenous communities in the two primeval forest villages Truenococha and Santa Marta in the Peruvian Amazon region found evidence of possible rabies resistance in humans.

Course of disease in animals

All mammals and, to a certain extent, birds can contract rabies. The incubation period is usually two to eight weeks. The disease lasts between a day and a week and is practically always fatal. The disease often begins with changes in personality.

Rabid dog with paralysis and salivation

Sick domestic dogs can become particularly aggressive and vicious, are overexcited, show an increased sex drive and bark unmotivated ("mad rage"). Later on, paralysis sets in, which lead to hoarse barking, swallowing disorders (heavy salivation, foam in front of the mouth), the tongue hanging out and paralysis of the hind legs leads to a stuck position. The phase of the “mad rage” can also be absent and the rabies begins with the symptoms of paralysis (“silent rage”). There are also atypical courses that initially resemble gastrointestinal tract inflammation ( gastroenteritis ).

In the domestic cat , the clinical picture is similar to the dog. Often a sick cat withdraws, constantly meows and reacts aggressively to irritation. In the final stage there is paralysis.

In domestic cattle , rabies usually first shows up in digestive disorders, leading to atony and inflation of the rumen and diarrhea . Rabies must always be considered as a possible cause of digestive disorders, especially when grazing. Later, muscle twitching, salivation, constant roaring and paralysis of the hind legs set in. In small ruminants such as sheep and goats , “silent anger” dominates, but restlessness, constant bleating and an increased sexual drive can also occur.

In the case of domestic horses , rabies can appear as “mad rage” with racing against stable walls and colic or as “silent rage” with apathy . The "silent rage" can be confused with Bornash disease .

In domestic pigs , excitement, constant hoarse grunts, forced movements and biting rage dominate.

In birds , the disease is very rare and manifests itself in an anxious beeping, movement disorders and paralysis.

In wild animals, rabies often leads to a loss of fear of humans. However, it should be noted that many urbanized wild animals such as foxes and raccoons no longer have them anyway.

Diagnosis

The diagnosis is made on the basis of clinical symptoms, contact with a source of pathogen (usually an infected animal) and the medical history. Laboratory diagnostics are difficult and not always meaningful, especially in suspected human cases.

Virus diagnostics in animals

In animals that have died or have died, virus detection is carried out by examining fresh brain tissue. The evidence of Negri bodies , i.e. antigens of the rabies virus in inclusion bodies , is considered to be conclusive. These are paraffin sections by a methylene blue-eosin staining for male judges. The detection of the basophilic Negri bodies clearly visible with this staining method has a diagnostic sensitivity of about 75%, i.e. H. in about a quarter of the infected animals the result is false negative. The virus antigens can also be detected using an immunofluorescence test (IFT). In addition, the direct detection of the viral genome in brain samples can also be carried out using PCR ; a negative PCR result from brain tissue rules out a post-mortem rabies infection . Direct virus detection can also take place after the virus has been grown in a cell culture .

A differentiation or differentiation of the various Lyssaviruses is achieved by sequencing genome sections or typing with different type-specific monoclonal antibodies .

Serological examinations, i.e. the detection of antibodies against the rabies virus in the animal's blood, do not play a diagnostic role in the acute suspicion of disease and are scientific questions or the verification of the vaccination success e.g. B. reserved in a circumscribed district according to the interpretation of vaccination baits (see also appendix to §12 Rabies Ordinance ). In most European countries, the direct evidence is carried out by veterinary inspection offices or commissioned, specially accredited laboratories.

Since the test procedures with brain tissue (microscopy, antigen detection, PCR) are the most reliable way to exclude or determine a rabies infection, an official veterinarian order that the suspected animal be killed is possible in many countries. For farm animals and pets, state compensation can be made in accordance with country-specific legislation.

Diagnostics in humans

The suspected diagnosis of a possible rabies infection is based on a careful anamnesis, especially on stays abroad, contact with animals, contact with secretions such as saliva or blood on mucous membranes or open wounds, bite event, behavior and type of animal and any positive virus detection in the animal. A disease is mainly diagnosed clinically based on the typical neurological symptoms. The early infection phase is particularly problematic, when virological test procedures are often still negative and the symptoms are not yet pronounced. Immediately after exposure, no virological examination can prove or rule out the infection, although the decision on immunoprophylaxis must be made within a short time window after exposure.

No virological test method known to date is able to reliably rule out a rabies infection in living people. Only a possibly positive direct pathogen detection or a reliable seroconversion between two serum samples shifted by weeks (if a fresh vaccination is excluded) can prove an infection. However, this evidence is difficult, on the one hand due to the latent spread of the virus in the nervous tissue, so that the virus is no longer present in the test material, on the other hand the virus is quickly inactivated outside the body, which limits test procedures with virus replication. Direct detection methods for rabies viruses are reserved for special laboratories.

Antigen detection by means of immunofluorescence test (IFT), PCR, virus isolation in cell culture (RTCIT) or the mouse inoculation test (MIT) are available as direct detection methods . In the latter case, the sample is injected into the brain of mice and paralysis or death of the mouse is observed for up to two weeks. The material to be examined (depending on the method and the possible stage of infection) includes saliva, corneal swabs or cast-off specimens , as well as skin biopsies (especially neck skin biopsies). All laboratory work and the transport and dispatch of samples for direct pathogen detection must be carried out under special safety measures ( biological protection level L3 ), samples must be kept cool at all times until they are used for testing. Every positive, direct pathogen detection proves a rabies infection, a negative test result cannot rule out the diagnosis. The safe exclusion or the confirmation of the diagnosis is virologically only possible post mortem analogous to the detection in infected animals.

therapy

There is no known cure for rabies. After infection and exceeding the deadline for post-exposure prophylaxis , treatment with antiviral drugs ( virostatics ) and simultaneous sedation to reduce the metabolism have recently been attempted. However, these attempts at therapy have so far not been successful, since only a few patients survived such treatment with severe brain damage. In 2004, Jeanna Giese from the USA, then 15 years old, was the first person to survive such an experimental therapy (known as the Milwaukee Protocol ) after an infection, largely without serious consequential damage . In 2011, an eight-year-old girl survived using the same therapy.

prevention

Joseph Meister was the first person who was successfully vaccinated against rabies.

Louis Pasteur developed the first rabies vaccination with attenuated pathogens in 1885 and saved the life of Joseph Meister , who had been bitten by a rabid dog , with a post-exposure vaccination on July 6, 1885 .

Preventive vaccination

The onset of the disease can be prevented by a preventive (pre-exposure) vaccination.

Today's vaccines can be relatively painless e.g. B. administered as a subcutaneous injection under the upper arm skin. They consist of inactivated viruses, which are grown in cell cultures of human, diploid cell lines or chicken fibroblasts .

The preventive vaccination against rabies is a dead vaccine , which usually consists of inactivated rabies viruses that can no longer cause the disease. This active vaccine is injected into the upper arm in several doses with an interval of a few days to weeks. The exact vaccination schedule depends on the preparation, usually vaccination takes place at 0, 7 and 28 days. The vaccine recipient is after the injection protective antibodies against the virus. Immunocompetent vaccinees have immune protection no later than 35 days after the start of the vaccination schedule. A check of immunity after 1 to 2 years and, if necessary, a booster vaccination is only necessary for risk groups (laboratory staff in contact with rabies viruses, game rangers). In order to determine the vaccination protection, the antibodies are quantified in a test procedure prescribed by the WHO, the Rapid fluorescent focus inhibition test (RFFIT), in which the reduction in virus foci in a cell culture is determined after the test person's serum has been added. Immunity is assumed from an antibody concentration of more than 0.5 IU / ml. Although other ELISA methods can measure antibodies against rabies viruses, they cannot measure the amount of actually protective antibodies and can therefore only be used to a very limited extent for immunity testing.

Post-exposure vaccination

Vaccine administration can also successfully prevent infection immediately after a bite or other exposure. Such post-exposure immune prophylaxis is particularly successful when the wound is relatively far away from the central nervous system and no venous blood vessels have been injured by the bite . Regardless of the elapsed time since exposure, immunoprophylaxis should be used for any reasonable suspicion. The immunoprophylaxis consists of the one-time administration of rabies antibodies in the form of a rabies immunoglobulin preparation (passive immunization, e.g. with the rabies immunoglobulin berirab ) and the simultaneous start of the vaccination scheme for active immunization (administration of dead vaccine, e.g. with the rabies vaccines Rabivac or Rabipur ). The simultaneous administration of passive and active vaccines is called simultaneous vaccination . At least half of the passive vaccine is injected around the previously cleaned and disinfected wound, the rest is given intragluteally . In an intensified vaccination schedule, the inactivated vaccine is usually given at 0, 3, 7, 14, 28 (or 30) days and optionally on the 90th day, whereby the injection site for the active vaccine must be well away from that of the passive one (e.g. the deltoid muscle on the upper arm), otherwise both neutralize each other.

The STIKO gives the following recommendation for post-exposure immunoprophylaxis:

Degree of exposure Type of exposure Immune prophylaxis
by a wild or domestic animal suspected of being rabies or rabid through a rabies vaccine bait
I. Touching / feeding animals, licking intact skin Touching vaccine lures with intact skin no vaccination
II Nibbling on the uncovered skin, superficial, non-bleeding scratches from an animal, licking the non-intact skin Contact with the vaccine from a damaged vaccine bait with non-intact skin vaccination
III Any bite wounds or scratch wounds, contamination of mucous membranes with saliva (e.g. by licking, splashing) Contamination of mucous membranes and fresh skin injuries with the inoculation fluid from a damaged vaccine bait Vaccination and, once, simultaneously with the first vaccination, passive immunization with rabies immunoglobulin (20  IU / kg body weight)

Spread and control

Map of the rabies-free countries (2010): Always been rabies- free Rabies before 1990 eliminates rabies in or after 1990 eliminates rabies-free, year of eradication unknown





Rabies is enzootic in many parts of the world ; only a few countries are rabies-free. With regard to transmission, epidemiology and reservoir hosts , a distinction is made between urban rabies transmitted by domestic animals (mostly dogs ), that transmitted by wild animals ( e.g. foxes , raccoons , porcupines , wolves, depending on the location ), and bat rabies transmitted by bats .

The rabies virus survives in spacious, varied, rural wildlife reservoirs. The compulsory vaccination of animals is less effective in rural areas. Swallow vaccines can be baited out, which has successfully reduced rabies in rural areas of France, Ontario, Texas, Florida and elsewhere. However, vaccination campaigns can be costly and a cost-benefit analysis can lead those responsible to opt for measures aimed at containing the disease rather than eliminating it entirely.

Number of people who died of rabies per 100,000 population every year

In order to combat the spread of the disease, cross-border travel with small pets (dogs, cats, ferrets ) has long been compulsory against rabies. The additional provisions, which differ greatly from country to country, were standardized for the movement of animals within the European Union with the introduction of the EU pet passport from October 4, 2004.

From a global perspective, domestic dogs are the most important source of human rabies infection; They are responsible for 99 percent of deaths. Annually there are around 50,000 registered infections by dogs in humans. Vaccination campaigns and dog population control are the only ways to effectively combat urban rabies.

Germany

Warning of wild rabies in Germany (2005)

According to the regulation on notifiable animal diseases, there is an obligation to notify rabies in animals in Germany . To combat fox rabies, in addition to a population reduction through increased hunting of the fox, vaccination baits for oral immunization of the foxes were dropped from planes in the endangered areas over a large area. These measures were supplemented by hand displays of bait. Germany has been considered rabies-free (i.e. free from terrestrial rabies) since April 2008 according to the criteria of the World Organization for Animal Health (OIE), but not according to the stricter WHO criteria (free from all rabies viruses, including bat rabies). While a total of 6,800 cases were reported in 1980, in 1991 there were still 3,500, in 1995 only 855, in 2001 still 50 and 2004 still 12 reported cases. With five cases in 2004, the fox was most affected by rabies . From the 2nd quarter of 2006 to December 2008, no more cases of rabies in wild animals or domestic animals were reported in Germany. On December 29, 2008, however, rabies was officially diagnosed in a dog imported from Croatia in the district of Lörrach . Another case of a dog was officially established in Neustadt an der Aisch in March 2010 after the three-month-old animal, illegally imported from Bosnia, bit a person. In July 2013, rabies was found in a puppy imported from Morocco in the Haßberge district in Lower Franconia.

Since 2001, a total of six human rabies cases have been reported in Germany, four of which were related in 2005. This affected a 26-year-old woman who had been in India and who had organs removed for transplantation after her brain death , as there was no evidence of rabies disease at that time, as well as three of her organ recipients. The last human rabies case in Germany occurred in 2007 in a man who was bitten by a stray dog ​​in Morocco.

Although classic (terrestrial) rabies no longer occurs in Germany, bat rabies cannot be eradicated for the time being. Its pathogens -  European bat lyssaviruses (EBLV) 1 and 2 - are closely related to the classic rabies virus, but it is independent of classic rabies, but just as dangerous for humans. The rabies vaccines currently available are also effective against these viruses. An average of around 20 cases per year have been registered since 2010 (as of the end of 2018).

Austria

Due to the measures implemented since the 1990s, rabies is considered to be eradicated in Austria. Two suspected rabies cases in foxes in 2004 and 2006 were refuted. The World Health Organization (WHO) and the International Organization of Animal Diseases declared Austria a rabies-free area on September 28, 2008.

Switzerland

The Switzerland applies since 1999 as rabies-free. The freedom from disease was achieved through a targeted fox vaccination campaign.

Great Britain

In the UK , dog licenses, street dog killing, the muzzle, strict quarantine and total ban on animals and other measures all helped eradicate rabies in the early 20th century.

The island still has strict regulations on the importation of animals. In 1996, a single water bat was discovered that was infected with the European bat Lyssavirus 2 (EBL2). Another water bat tested positive for EBL2 in Lancashire in September 2002 . A bat protector who had been bitten by the infected bat received post-exposure treatment and did not become ill. Bat rabies is also triggered by a virus of the Lyssavirus genus, which is not, however, identical to the rabies virus ; see the section on pathogens .

Bali / Indonesia

In 2009, several deaths were reported among people from the vacation island. The island was previously considered rabies-free. Since the rabies outbreak began in 2008, 45 patients have visited GeoSentinel or EuroTravNet facilities for post-exposure prophylaxis. That is 12.6% of the travelers who came to clinics of the network for post-exposure prophylaxis. The data collected show that the majority of animal injuries were caused by monkeys rather than bites or scratches from dogs.

United States

Since the development of effective human vaccines and immunoglobulin treatments, the rabies death toll in the United States has fallen from 100 or more per year at the beginning of the 20th century to one or two per year, largely from bat bites. However, infected, stray raccoons are also becoming increasingly important as vectors. These are attracted by the food in overflowing garbage cans in human settlements.

Australia

Australia is one of the few parts of the world where rabies has never been introduced. However, the Australian Bat Lyssavirus occurs naturally in most mainland states. It affects both insectivorous bats the way saccolaimus flaviventris and the four domestic Australian species of bats that feed on vegetable.

India

India is the country on earth where most of the known cases of rabies in humans are known. The transmission takes place there mainly through the bites of mostly free running dogs. Since immunoglobulin treatment is often not available, the post-exposure method is used almost exclusively , which may not have as good a cure chance as the combined method. If you are staying for a longer period, you should think about an active vaccination beforehand ( travel medicine ). There are 18,000 to 20,000 human rabies cases in India each year. Since stray dogs are not allowed to be killed in India, they are caught, vaccinated against rabies, labeled and sterilized. It is estimated that only around 15% of stray dogs are vaccinated in 2015, while it should be 70% for effective prevention of the spread of rabies.

People's Republic of China

Absolute numbers and incidence of human rabies in the People's Republic of China 1960–2014
Human rabies cases in China in 2007 by provinces

Next to India, China is most affected by rabies. Between 1960 and 2014, 120,913 cases of human rabies were registered in the People's Republic of China, corresponding to an average of 2,198 cases per year. In the decade between 2004 and 2014 there were 32,932 cases. The year with the highest incidence and number of cases was 1981 (0.7 / 100,000, 7037 cases). The frequency of rabies decreased significantly from the 1980s onwards, initially due to official measures such as the containment of stray dogs, vaccination of dogs and post-exposure prophylaxis and reached an absolute minimum in 1996 with 159 reported cases (incidence 0.01 / 100,000), but increased afterwards again up to a second peak in 2007 with 3300 cases (incidence 0.3 / 100,000). Since then the numbers have fallen again and in 2014 stood at 924 cases with a mortality of 92%. In 2014, rabies was the third leading cause of death (after AIDS and tuberculosis) among all reportable infectious diseases in the PRC.

Mostly farmers are affected and the number of rabies cases shows a clear seasonal variation with a maximum in the summer months. Dogs are carriers for more than 95%. However, there is also a reservoir of viruses in certain wild animal species.

Nearly 50% of the cases were recorded in Guangxi , Hunan and Guizhou provinces . Of 315 cases examined in these provinces, 66.3% of the patients received no and 27.6% inadequate post-exposure prophylaxis . Only 6% received full rabies prophylaxis. In these provinces the infection rate in dogs was also very high at 2.3%. The vaccination rate in dogs in 60% of the cities studied was below 70%.

Rabies after organ transplant

In 2004, in the United States, rabies was transmitted from an organ donor to the recipient. Three patients who had been transplanted with organs contaminated with rabies died of the disease. The US disease control agency CDC found that the organ donor had contracted the virus from a bat .

In Germany, too, three people died of rabies transmitted through organ donation , and three others survived with organs from the same donor. The donor, who died in December 2004, was infected undetected by a dog bite in October 2004 while on vacation in India.

Outdated names, myth and history

In the past, the terms hydrophobia and aquaphobia were also common, translated as “water aversion” as a typical symptom of the disease. The names Hundswut and St. Hubertus Disease were also in use well into the 19th century and beyond . The current name rabies has only been documented in writing since 1810 .

François Boissier de Sauvages de Lacroix , Della natura e causa della rabbia ( Dissertation on the nature and cause of rabies ), 1777

It was already known in antiquity (in the Corpus Hippocraticum ) that it can be transmitted through the bite of infected dogs . In earlier times, rabies was surrounded by myths, superstitions and errors and, as the disease inevitably led to death, fueled people's fears and fantasies. The fact that the rabies was supposedly transmitted by wolves also contributed to the creation of the legend. For example, the origin of the werewolf belief may have roots in a person's rabies disease. In ancient times, Aristotle and Euripides also dealt with the disease. In the Greek world of gods , Artemis , Hecate , Aktaion and Lykaon were heralds, spreaders or victims of rabies. Sirius , the main star in the constellation of the Big Dog , was considered the pioneer of the plague in ancient Greece. In the Middle Ages, starting with Augustine , the origin of rabies was sought in the devil ; the holy Hubertus is considered since that time as the patron saint against rabies. Rabies was treated with the Hubertus key. The rabies was also described by Galen and Celsus .

Both the special hunting privileges of the nobility and protracted wars caused an increase in the wolf population and thus also in rabies in the late Middle Ages . From the time of the Hundred Years War it is reported from Paris that infected wolves that had invaded the city were killed on a daily basis. In addition to various miracle drugs, religious and magical acts of defense against rabies were in use. For example, wearing a sator square as a rabies amulet is documented.

The Austrian military doctor Matthäus Mederer (1739–1805) worked a. a. intensively with the fight against rabies, which is why Emperor Joseph II raised him to the hereditary nobility in 1789, with the predicate Edler von Wuthwehr . His son, General Conrad von Mederer Edler von Wuthwehr (1781–1840), was the best-known bearer of this title of nobility, reminiscent of rabies.

Around 1884 Pasteur created the prophylactic-therapeutic vaccination against rabies.

Reporting requirement

In Germany, human rabies is a reportable disease according to Section 6 (1) of the Infection Protection Act . The obligation to report by name does not only apply in the event of suspicion, illness and death, but also in the event of "injury to a person by an animal that is infected, suspected or suspected of being infected with rabies, or touching such an animal or animal body". In the case of animals, it is a notifiable animal disease in Germany in accordance with Section 4 of the Animal Health Act in conjunction with Section 1 of the Ordinance on Notifiable Animal Diseases .

In Austria it is a notifiable disease in humans according to Section 1 (1) of the 1950 Epidemic Act . The obligation to notify relates to suspected cases, illnesses and deaths as well as "bite injuries caused by animals that are ill or suspicious of anger". As a rage disease , it must be reported to animals in Austria according to Section 16 of the Animal Disease Act.

In Switzerland, rabies must be reported as an epidemic to be eradicated within the meaning of Article 3 of the Animal Diseases Ordinance (TSV) with very extensive obligations under Articles 142–149 TSV. In humans, rabies is also a notifiable disease in Switzerland in accordance with the Epidemics Act (EpG) in conjunction with the Epidemics Ordinance and Appendix 1 of the EDI Ordinance on the reporting of observations of communicable diseases in humans . Clinical suspicion must be reported.

literature

Web links

Commons : Rabies  - Collection of pictures, videos and audio files
Wiktionary: rabies  - explanations of meanings, word origins, synonyms, translations
 Wikinews: Rabies Transmission in Organ Transplantation  - Message

Individual evidence

  1. ^ WHO Technical Report Series 1012, WHO Expert Consultation on Rabies (Geneva), Third Report. (PDF; 4.139 MB) World Health Organization, 2018, accessed on March 22, 2019 .
  2. ↑ a b K. Hampson, L. Coudeville, T. Lembo, M. Sambo, A. Kieffer, M. Attlan, J. Barrat, JD Blanton, DJ Briggs, S. Cleaveland, P. Costa, CM Freuling, E. Hiby, L. Knopf, F. Leanes, FX Meslin, A. Metlin, ME Miranda, T. Müller, LH Nel, S. Recuenco, CE Rupprecht, C. Schumacher, L. Taylor, MA Vigilato, J. Zinsstag, J Dushoff; Global Alliance for Rabies Control Partners for Rabies Prevention: Estimating the global burden of endemic canine rabies. In: PLoS Negl Trop Dis. Volume 9, No. 4, 16 Apr 2015, p. E0003709. doi: 10.1371 / journal.pntd.0003709
  3. ↑ a b R. Steffen: Rabies: After the bite is shortly before death? (PDF; 11 kB) Germany: Foreign Office, April 15, 2005, accessed on July 20, 2012 .
  4. ↑ a b c Fact Sheet No 99: Rabies. WHO, September 2011, accessed July 20, 2012 .
  5. ^ A b R. E. Willoughby Jr., KS Tieves, GM Hoffman, NS Ghanayem, CM Amlie-Lefond, MJ Schwabe, MJ Chusid, CE Rupprecht: Survival after Treatment of Rabies with Induction of Coma . In: The New England Journal of Medicine . tape 352 , 2005, pp. 2508-2514 , PMID 15958806 .
  6. ↑ FH Kayser u. a .: Pocket textbook Medical Microbiology . 11th edition. Thieme Verlag, 2005, ISBN 3-13-444811-4 .
  7. ↑ Barbara I. Tshisuaka: Negri, Adelchi. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1029.
  8. ↑ AA Albertini, G. schöhn, W. Weiss Horn, RW Ruigrok: Structural Aspects of Rabies Virus Replication . In: Cellular and Molecular Life Sciences . tape 65 , no. 2 , January 2008, p. 282-294 , doi : 10.1007 / s00018-007-7298-1 , PMID 17938861 .
  9. ^ A b Centers for Disease Control and Prevention: Investigation of Rabies Infections in Organ Donor and Transplant Recipients - Alabama, Arkansas, Oklahoma, and Texas . In: MMWR Morbidity and Mortality Weekly Report . tape 53 , no. 26 , 2004, p. 586-589 , PMID 15241303 ( cdc.gov ).
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