"update Tollwut" Franz Allerberger - 30-45 min - infektiologie.co.at
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„update Tollwut"
Franz Allerberger
30-45 min
FRAGE:
J Virol. 2014 May; 88(9): 4897–4907.
We found that the highly potent oncolytic
vesicular stomatitis virus (VSV) incorporate
the LCMV GP glycoprotein on the viral
surface.
VSV-GP is the first replication-competent
viral vector vaccine that does not induce
vector-specific humoral immunity, i.e.,
neutralizing antibodies.
Dorothee von Laer. Oncolytic viruses,
Dorothee LAER | Director | Medizinische Universität Innsbruck ...
including the oncolytic rhabdovirus VSV‐GP tested here, selectively infect and kill
cancer cells and are a promising new …
ZUSAMMENFASSUNG:
In Österreich wurde im Jahr 2020 keine humane Erkrankung an Tollwut dokumentiert. Es wurden
auch keine intra vitam oder post mortem gewonnenen humanen Proben (Verdachtsfälle bzw.
Ausschlussuntersuchungen) eingeschickt/analysiert.
Mit den am AGES-Institut für Veterinärmedizinische Untersuchungen in Mödling durchgeführten
Tests wurde im Jahr 2020 kein an Tollwut infiziertes Tier entdeckt. Österreich war im Jahr
2008 am Welt-Tollwuttag (28. September) von der WHO und von der Internationalen
Tierseuchenorganisation (OIE) zum tollwutfreien Gebiet erklärt worden.
Ab 2013 wurde die orale Vakzination der Füchse in Österreich ausgesetzt.
Im Jahr 2020 wurden 392 Tiere untersucht, wobei Füchse mit 126 Einsendungen und
Fledermäuse mit 192 Einsendungen am häufigsten vertreten waren. In Österreich erfolgte bei
Fledermäusen bislang noch nie ein Rhabdoviren-Nachweis.
Im Jahr 2020 wurden 41 Tiere, die einen Menschen gebissen haben, getestet, alle mit negativem
Ergebnis; meist handelte es sich dabei um Hunde und Katzen (17 Hunde, 16 Katzen, 4
Fledermäuse, 3 Marder, 1 Fuchs).
Terrestrische Tollwut wurde auch in den Nachbarländern Österreichs im Jahr 2020 nicht
nachgewiesen.
https://www.ecdc.europa.eu/en/news-events/fourth-travel- related-rabies-case-reported-eu-2019 According to ECDC records, four cases of imported rabies have been notified in the EU/EEA this year. In May, Norway confirmed one rabies-related death following infection in the Philippines. In December, one case was reported in Latvia (returning from India), another one in Spain following infection in Morocco and Italian authorities confirmed the death of a traveller who was bitten by a dog while staying in Tanzania.
Betreff: For your action - Imported cases of rabies - deadline 13 December
Von: Celine Gossner
An: "'franz.allerberger@ages.at“
Datum: 11.12.2019 10:51
To. EVD National Focal Points
cc. National Coordinators
---------------------------------------------
According to TESSy data, there were 3 cases in 2014, 0 in 2015 and one per year between 2016 and 2018. So we suspect
that there might be an increase in number of cases.
In the table below, you can find the information we have so far.
Country of residence Classification Country of infection Outcome Date of onset Date of exposure
Bite/scratches Vacciantion status PEP
Norway Confirmed Philippines Deceased May-19 April-19 ? yes Unvaccinated No
Latvia Confirmed India Deceased Nov-19 May-18 yes Unvaccinated No
Spain Suspected Morocco Hospitalised Dec-19 Aug-19 yes Unvaccinated No
Italy Suspected Tanzania Deceased Dec-19 Sep-19 yes Unvaccinated Yes
Terrestrische Tollwut („erdgebundene Tollwut“, übertragen durch z. B. Hund, Katze, Fuchs) ist seit 2008 in Österreich offiziell ausgerottet. Im Jahr 2002 war es zu einem Tier-Tollwutausbruch in Kärnten gekommen, der auf eine Einwanderung von Füchsen aus Slowenien zurückzuführen war. Zuletzt wurde 2004 und 2006 bei je einem Fuchs Tollwut diagnostiziert. Es stellte sich bei weiterführenden Untersuchungen jedoch heraus, dass es sich um ein Impfvirus handelte, welches von Jungtieren aufgenommen worden war. Seit 2013 ist die orale Impfung der Füchse mittels Köder in Österreich ausgesetzt. Ein Tier- Tollwutfall im Rahmen eines illegalen Haustierimportes trat in Österreich zuletzt 1999 auf. Die urbane Tollwut (Übertragung durch Haustiere, v. a. Hunde) ist in Österreich bereits im Jahr 1950 erloschen. Der letzte Todesfall der durch Wildtiere übertragenen silvatischen Tollwut wurde 1979 in Kärnten nach einem Fuchsbiss verzeichnet. Ein Tollwutfall wurde zuletzt im Jahr 2004 dokumentiert: Ein Mann starb, nachdem er in Marokko von einem tollwütigen Hund gebissen worden war. Seine ungeimpfte Partnerin erkrankte nicht.
https://www.nytimes.com/2019/06/12/health/bats-rabies-cdc.html Bats, Not Dogs, Are the Most Common Source of Rabies In the United States, if you get bitten by a bat, get rabies shots. June 12, 2019
Rabies virus European bat lyssavirus type 1 European bat lyssavirus type 2 Lagos bat virus Mokola virus Duvenhage virus
Rabies vaccines and immunoglobulins: WHO position April 2018 „Pre-exposure prophylaxis (PrEP) Pre-exposure prophylaxis (PrEP) is the administration of several doses of rabies vaccine before exposure to RABV. PrEP is recommended for individuals at higher risk due to occupation. PrEP should be considered in sub-populations living in remote, rabies endemic areas, where access to PEP is difficult, the dog bite incidence is >5% per year or vampire bat rabies is known to be present.” https://www.who.int/immunization/policy/position_papers/pp_rabies_summary_2018.pdf?ua=1 abgefragt: 13.10.2019 “Data from the Pan-American Health Organization (PAHO) revealed 678 reported cases of bat-transmitted human rabies in Latin America from 1990 to 2010. Considering only the 240 human cases transmitted by bats during the period 1996-2010, 74% were transmitted by hematophagous bats, 6.7% by nonhematophagous bats and in 19.6%, identification of the species was not registered.” Rev. Soc. Bras. Med. Trop. vol.44 no.2 Uberaba Mar./Apr. 2011 Epub Apr 01, 2011
Verbrauch Österreich 2013 Rabipur: ca. 40.000 Dosen / Jahr 3.800 Spitäler (/5 = 760 PEP) 6.500 Bundesheer 29.700 Reisemarkt (Ord. X: 2000/Jahr) Berirab: ca. 130 Stück Berirab 2 ml und 170 Stück Berirab 5 ml (1.110 ml/10 ml für 77kgKG = 111 PEP) „Berirab ist in der EU neben Österreich lediglich in Deutschland und Lichtenstein registriert. In Europa (nicht-EU) darüber hinaus noch in der Schweiz.“ © CSL Behring GmbH 26.10.2019
Abefragt: 8.12.2019
Impfplan Österreich 2021
© BMG & AGES Juli 2014
AGES: Version 2013 !
Postexpositionell: https://www.gsk-kompendium.at/pil-rabipur NACH EINEM VERMUTETEN ODER TATSÄCHLICHEN KONTAKT MIT DEM VIRUS Geimpfte Personen Die erste Dosis wird sobald wie möglich nach dem Kontakt gegeben, die zweite 3 Tage später.
Postexpositionell (II): Die postexpositionelle Immunisierung sollte möglichst rasch nach dem suspekten Tierkontakt durchgeführt werden. Ein Zeitlimit für den Beginn gibt es aber nicht, da die Tollwut eine äußerst variable Inkubationszeit hat und daher auch eine späte postexpositionelle Immunisierung Erfolg haben kann. … Schema Essen: aktive Immunisierung am Tag 0, 3, 7, 14, 28 oder Schema Zagreb: 0, 0, 7, 21 (bei logistischen Schwierigkeiten, das Schema Essen umzusetzen). https://www.bmgf.gv.at/home/Impfplan 2018
Berirab ® Gebrauchsinformation
Pre-exposure Prophylaxis (PrEP) Rabiesimmunoglobulin (RIG) WHO No.16 2018
Marshall GS: The Vaccine Handbook: A practical guide for clinicans. Professional Communications, 2010 „the Purple Book“
Marshall GS: The Vaccine Handbook: A practical guide for clinicans. Professional Communications, 2010 „the Purple Book“
https://www.ages.at/themen/krankheitserrege r/tollwut/
2020: 192
2019: 112.
2018: 192
2017: 99
2016: 7
2015: 59
2014: 83
2013: 18
0 positiv!
2012: 17
2011: 104
2010: 80
2009: 360 (Unfall AKH Schacht, gesammelte Tiere sind während des Transports verendet)
2008: 68
2007: 45
2006: 2
Summe: 1.438
Zoltan Bagó ©3/2.2.2.7 Rhabdoviren Norbert Nowotny, Franz Allerberger 2006; pp 340-345
Fledermaus war im gleichen Zimmer:
Rabies-PEP?
MMWR, Sept 1, 1995
„postexposure treatment should be considered“
MMWR, Jan 8, 1999
„postexposure treatment can be considered“
MMWR, May 23, 2008
„These situations should not be considered
exposures if any circumstance suggests it is
unlikely that an undetected exposure occurred.“
- DANKE -Gem. ICTV werden seit 2018 15 Spezies, abgesehen von Rabiesvirus, unterschieden.
• Spezies Aravan-Lyssavirus (en. Aravan lyssavirus, früher Aravan Virus, ARAV)
• Spezies Australisches Fledermaus-Lyssavirus (en. Australian bat lyssavirus, ABLV)
• Spezies Bokeloh-Fledermaus-Lyssavirus (en. Bokeloh bat lyssavirus, BBLV)
• Spezies Duvenhage-Virus (en. Duvenhage lyssavirus, DUVV)
• Spezies Europäisches Fledermaus-Lyssavirus 1 (en. European bat 1 lyssavirus, EBLV 1)
• Spezies Europäisches Fledermaus-Lyssavirus 2 (en. European bat 2 lyssavirus, EBLV 2)
• Spezies Gannoruwa-Fledermaus-Lyssavirus (en. Gannoruwa bat lyssavirus, GBLV)
• Spezies Ikoma-Lyssavirus (en. Ikoma lyssavirus, IKOV)
• Spezies Irkut-Lyssavirus (en. Irkut lyssavirus, früher Irkut virus, IRKV)
• Spezies Khujand-Lyssavirus (en. Khujand lyssavirus, früher Khujand virus, KHUV)
• Spezies Lagos-Fledermausvirus (en. Lagos bat lyssavirus, früher Lagos bat virus, LBV)
• Spezies Lleida-Fledermausvirus (en. Lleida bat lyssavirus, LLEBV)
• Spezies Mokola-Virus (en. Mokola lyssavirus, MOKV)
• (Spezies Rabiesvirus (en. Rabies lyssavirus, RABV))
• Spezies Shimoni-Fledermausvirus (en. Shimoni bat lyssavirus, SHIBV)
• Spezies Westkaukasisches Fledermausvirus (en. West Caucasian bat lyssavirus, früher West Caucasian bat lyssavirus,
WCBV)Knowledge of Bat Rabies and Human Exposure Among United States Cavers Emerg Infect Dis. 2002 May;8(5):532-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732483/
In Finland, rabies in bats was suspected for the first time in 1985 when a bat researcher, who had multiple bat bites …
19.12.2003 https://www.scotsman.com/news/uk-news/rabies-
victim-bit-nurses-in-despair-1-498499
Mr McRae, 55, who lived in Guthrie, Angus,
contracted European bat lyssavirus Type 2a
rabies after being bitten by a Daubenton
bat.
The Englishman, with an international
reputation in his fields, had travelled to the
world’s most dangerous places.
But, in Guthrie, he indulged his love of
bats and monitored the local population for
Scottish Natural Heritage (SNH).
Months before his death, he was bitten on
the ring finger of his left hand, but was
unaware of the danger because the UK is
free of terrestrial rabies.
It is also the reason why he was not
vaccinated against bat bites, which at the
time was the recommendation of SNH.Von Osado - Eigenes Werk, Gemeinfrei, https://commons.wikimedia.org/w/index.php?curid=9445317
Offit PA. Vaccinated: One Man‘s Quest to Defeat the World‘s Deadliest Disease. Smithsonian Books, Washington DC, 2008 „On July 4, 1885, a rabid dog attacked a nine-year-old boy named Joseph Meister in the town of Meissengott. … The owner later killed the dog and cut open ist stomach; out poured straw, hay, and fragments of wood – evidence that the animal had gone mad. Two days after the attack, Joseph Meister and his mother arrived at the front door of 45 rue d‘Ulm in Paris, the home of Pasteur‘s laboratory. Pasteur had not yet immunized people, only animals. But on July 6, 1885, Meister was injected with a rabies-infected rabbit spinal cord that had been dried for fifteen days. Pasteur knew that such a spinal cord didn‘t kill dogs or rabbits. During the next eleven days, Meister was infected twelve more times with rabbit spinal cords that had each been less and less dried out and therefore were more and more likely to cause rabies“ (final dose: spinal cord that had been dried for only one day – deadly for dogs and rabbits).
Offit PA. Vaccinated: One Man‘s Quest to Defeat the World‘s Deadliest Disease. Smithsonian Books, Washington DC, 2008 „Parisians, who had to live every day in fear of rabid dogs prowling their streets, hailed Pasteur‘s vaccine as one of the greated medical triumphs of the ninteenth century. But like Jenner‘s small pox vaccine, Pasteur‘s rabies vaccine came with a price. As his vaccine was injected into more and more people, Pasteur found something that he hadn‘t anticipated: some people – as many as one of every two hundred who used it – became paralyzed and died.“
https://wwwnc.cdc.gov/travel/y ellowbook/2020/travel-related- infectious-diseases/rabies Any animal bite or scratch should be thoroughly cleaned with copious amounts of soap and water, povidone iodine, or other substances with virucidal activity. All travelers should be informed that immediately cleaning bite wounds as soon as possible substantially reduces the risk of rabies virus infection, especially when followed by timely administration of PEP.
https://wwwnc.cdc.gov/travel/y
ellowbook/2020/travel-related-
infectious-diseases/rabies
PEP for an unvaccinated patient consists of
administration of RIG (20 IU/kg for human RIG or
40 IU/kg for equine RIG) and a series of 4
injections of rabies vaccine over 14 days, or 5 doses
over a 1-month period in immunosuppressed
patients (Table 4-18). After wound cleansing, as
much of the dose-appropriate volume of RIG (Table
4-18) as is anatomically feasible should be injected
at the wound site. The intent is to put the RIG in
the areas where saliva may have contaminated
wounded tissue.https://wwwnc.cdc.gov/travel/y ellowbook/2020/travel-related- infectious-diseases/rabies If the wound is small and on a distal extremity such as a finger or toe, the health care provider must use clinical judgment to decide how much RIG to inject to avoid local tissue compression and complications. Any remaining dose should be administered intramuscularly at a site distant from the site of vaccine administration.
CDC Nov. 2019
2020
Luco Girodana (um 1664) „Der Erzengel Michael stürzt die abtrünnigen Engel“ NHM Wien (Nov. 2019) Ausstellung „Caravaggio & Bernini. Entdeckung der Gefühle“ 15.10.2019 bis 19.1.2020 im Kunsthistorischen Museum in Wien.
- DANKE -
Nokireki T., et al. Bat rabies surveillance in Finland. BMC Veterinary Research 2013, 9:174 Man spricht es "Lérida" aus.
Echevarria JE, et al. Current Rabies Viruses Do No Confer Protective Immunity against Divergent Lyssaviruses Circulating in Europe. Viruses 2019, 11, 892 Outbreaks of wildlife rabies in terrestrial mammals caused by bat-associated RABV strains have been well documented in the American continent. However, spillover of other bat lyssaviruses to non-bat mammals has been rarely reported.
Tjørnehøj K, Rønsholt L, Fooks R: Antibodies to EBLV-1 in a domestic cat in Denmark. Vet Rec 2004, 155(18):571–2.
Tjørnehøj K, Rønsholt L, Fooks R: Antibodies to EBLV-1 in a domestic cat in Denmark. Vet Rec 2004, 155(18):571–2.
Echevarria JE, et al. Current Rabies Viruses Do No Confer Protective Immunity against
Divergent Lyssaviruses Circulating in Europe. Viruses 2019, 11, 892
Irkut lyssavirus; Australian bat lyssavirus; Duvenhage lyssavirus;
Lyssavirusaes cause neurological disease in mice when
infected intracranically under laboratory conditions,
but only RABV, EBLV-1, EBLV-2, IRKV, ABLV, DUVV
and MOKV have been reported in cases of human
fatalities. It is plausible that cases in Afrika and Asia
are mised through a lack of laboratory-based human
diagnosis in endemic areas.
Mokola forest in Nigeria
Lagos bat lyssavirus; Mokola lyssavirus
Rabies vaccines are not efficacious against LBV, MOKV
and SHIBV (phylogroup II), nor against IKOV, WCBV
and LLEBV (phylogroup III).
Shimoni bat lyssavirus (Kenia); Ikoma lyssavirus;
West Caucasian bat lyssavirus; Lleida bat lyssavirusMexican free-tailed bat or Brazilian free-tailed bat (Tadarida brasiliensis) Mexikanische Bulldoggfledermaus „Systematic surveillance of apparently healthy adult Brazilian free-tailed bats from maternity colonies in New Mexico has documented variable levels of RABV exposure (12–80%), and low levels of central nervous system infection (
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