Bat rabies in the United Kingdom
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《英国医生杂志》
Until 2002 the United Kingdom had the luxury of being free of rabies. Worldwide as many as 70 000 deaths occur per year, half of which are in children.1 In 2002 the first death from indigenously acquired rabies occurred in over 100 years. A naturalist and licensed bat handler died, not from classical rabies but from European bat lyssavirus type 2a (EBLV-2), acquired in Scotland.2 European bat lyssaviruses are closely related to the classical rabies virus. Hundreds of these infections have been confirmed in bats in continental Europe, mainly in Denmark, the Netherlands, Germany, Poland, France, and Spain.3 Most of these isolates were confirmed as EBLV-1 and predominantly associated with the serotine bat (Eptesicus serotinus) whereas EBLV-2 seems to be associated with Myotis species—principally the Daubenton's bats (Myotis daubentonii) and pond bats (Myotis dasycneme).
Passive surveillance for European bat lyssaviruses in bats in the United Kingdom over the past 18 years by the Veterinary Laboratories Agency has never discovered a case of EBLV-1 but has identified a total of four cases of EBLV-2, all isolated from Daubenton's bats. These have been found in various parts of England—Newhaven, Sussex, in 1996; Lancashire in 2002 and 2003; and Staines, Surrey, in 2004.4-7 In addition preliminary data from a study to assess the presence of European bat lyssaviruses in bat populations in the United Kingdom confirmed the presence of antibodies to EBLV-2, but not virus, in 6-15% of Daubenton's bats.8
With the evolving epidemiology of European bat lyssaviruses in the United Kingdom and its emergence as an increasingly important zoonotic infection, this is an opportune time to highlight current public health policy for the management of people who have had close exposure to bats. General practitioners and emergency departments may still be unaware of this risk of rabies from bat exposures in the United Kingdom and offer tetanus boosters or antibiotics to patients instead of rabies vaccination after they have been exposed. Any bat exposure will require expert assessment, and close cooperation is required between clinicians, laboratory experts, and human and animal public health experts. General practitioners and other clinicians need to be aware that anyone who has been scratched or bitten by a bat or whose eyes, broken skin, or mucous membrane have come in contact with bat saliva or neural tissue from a bat should be offered post-exposure rabies vaccination as soon as possible. Immunoglobulin may also be given if the bat is known or strongly suspected to be rabid. Detailed advice on post exposure prophylaxis is now available for clinicians in the revised Green Book's chapter on rabies and also advice on the public health management of a case of human rabies.9 10 The Department for Environment Food and Rural Affairs has also published a draft rabies contingency plan for consultation.11
The risk to public health needs to be put in context. Only licensed or volunteer bat handlers will routinely come into contact with bats. Current advice from the Department of Health says that all bat handlers should be vaccinated before exposure and should wear bite proof gloves when handling bats. Daubenton's bats are one of 16 species of bats in the United Kingdom and, unlike pipistrelles (Pipistrellus species) and long eared bats (Plecotis auritus), rarely roost in houses or come in contact with people. In the United Kingdom, pipistrelles and long eared bats have to date not been found to harbour European bat lyssaviruses. Therefore the likelihood of a member of the public coming into contact with an infected bat is small. Bats excreting European bat lyssaviruses in saliva are more than likely to show abnormal behaviour such as flying during daylight or being grounded or paralysed. A sick or injured bat should therefore never be handled by a member of the public but rather reported to either the Bat Conservation Trust (tel 0845 1300228), the Scottish Society for the Protection of Cruelty to Animals (tel 0870 7377722), or the relevant animal health divisional office.
We need to raise awareness in the general public of this small risk to human health without creating a fear of bats, which are a protected species under the Wild-life and Countryside Act 1981. Similarly, awareness among health professionals of current post exposure regimens also needs to be raised as rabies due to European bat lyssaviruses seems to be similar to classical rabies in being incurable but completely preventable.12
Alan Smith, specialist registrar in public health medicine
Health Protection Agency, Centre for Infections, London NW9 5HT (alan.smith@hpa.org.uk)
Jill Morris, specialist registrar in public health medicine, Natasha Crowcroft, consultant epidemiologist
Health Protection Agency, Centre for Infections, London NW9 5HT
Competing interests: None declared.
References
Rupprecht CE, Hanlon CA, Hemachudha T. Rabies re-examined. Lancet Infect Dis 2002;2: 327-43.
Fooks AR, McElhinney L, Pounder DJ, Finnegan CJ, Mansfield K, Johnson N, et al. Case report. Isolation of a European Bat Lyssavirus Type 2a from a fatal human case of rabies encephalitis. J Med Virol 2003;71: 281-9.
Muller WW. Review of reported rabies case data in Europe to the WHO collaborating centre Tübingen from 1977 to 2000. Rabies Bull Eur 2000;24; 11-9.
Whitby JE, Heaton PR, Black EM, Woodbridge M, McElhinney LM, Johnson P. First isolation of a rabies-related virus from a Daubenton's bat in the United Kingdom. Vet Rec 2000;147: 385-8.
Johnson N, Selden D, Parsons G, Fooks AR. European bat lyssavirus type 2 in a bat in Lancashire. Vet Rec 2002;151: 455-6.
Fooks AR, Selden D, Brookes SM, Johnson N, Martson DA, Joliffe TA, et al. Identification of a European bat lyssavirus type 2 ini a Daubenton's bat found in Lancashire. Vet Rec 2004;155: 606-7.
Fooks AR, McElhinney LM, Marston DA, Selden D, Jolliffe TA, Wakeley PR, et al. Identification of a European bat lyssavirus type 2 in a Daubenton's bat found in Staines, Surrey, UK. Vet Rec 2004;155: 434-5.
Fooks A, Brookes S, Healy D, Smith GC, Aegerter J, Harris SL. Detection of antibodies to EBLV-2 in Daubenton's bats in the UK. Vet Rec 2004;154: 245-6.
Department of Health. Rabies. In: Immunisation against infectious disease. DOH;2004. www.dh.gov.uk/assetRoot/04/09/79/03/04097903.pdf (accessed 18 Jan 2005).
Health Protection Agency. The public health management of a suspected case of human rabies. A standard operating procedure for communication & action. www.hpa.org.uk/infections/topics_az/rabies/final_rabies_SOP_301004.pdf (accessed 18 Jan 2005).
Department for Environment, Food, and Rural Affairs. Draft rabies contingency plan (RCP). www.defra.gov.uk/animalh/rabies/rabies_contingency/index.htm (accessed 11 Jan 2005).
Hemachuda T, Laothamatas J, Rupprecht C. Human rabies: a disease of complex neuropathogenic mechanisms and diagnostic challenges. Lancet Neurol 2002;1: 101-9.
Passive surveillance for European bat lyssaviruses in bats in the United Kingdom over the past 18 years by the Veterinary Laboratories Agency has never discovered a case of EBLV-1 but has identified a total of four cases of EBLV-2, all isolated from Daubenton's bats. These have been found in various parts of England—Newhaven, Sussex, in 1996; Lancashire in 2002 and 2003; and Staines, Surrey, in 2004.4-7 In addition preliminary data from a study to assess the presence of European bat lyssaviruses in bat populations in the United Kingdom confirmed the presence of antibodies to EBLV-2, but not virus, in 6-15% of Daubenton's bats.8
With the evolving epidemiology of European bat lyssaviruses in the United Kingdom and its emergence as an increasingly important zoonotic infection, this is an opportune time to highlight current public health policy for the management of people who have had close exposure to bats. General practitioners and emergency departments may still be unaware of this risk of rabies from bat exposures in the United Kingdom and offer tetanus boosters or antibiotics to patients instead of rabies vaccination after they have been exposed. Any bat exposure will require expert assessment, and close cooperation is required between clinicians, laboratory experts, and human and animal public health experts. General practitioners and other clinicians need to be aware that anyone who has been scratched or bitten by a bat or whose eyes, broken skin, or mucous membrane have come in contact with bat saliva or neural tissue from a bat should be offered post-exposure rabies vaccination as soon as possible. Immunoglobulin may also be given if the bat is known or strongly suspected to be rabid. Detailed advice on post exposure prophylaxis is now available for clinicians in the revised Green Book's chapter on rabies and also advice on the public health management of a case of human rabies.9 10 The Department for Environment Food and Rural Affairs has also published a draft rabies contingency plan for consultation.11
The risk to public health needs to be put in context. Only licensed or volunteer bat handlers will routinely come into contact with bats. Current advice from the Department of Health says that all bat handlers should be vaccinated before exposure and should wear bite proof gloves when handling bats. Daubenton's bats are one of 16 species of bats in the United Kingdom and, unlike pipistrelles (Pipistrellus species) and long eared bats (Plecotis auritus), rarely roost in houses or come in contact with people. In the United Kingdom, pipistrelles and long eared bats have to date not been found to harbour European bat lyssaviruses. Therefore the likelihood of a member of the public coming into contact with an infected bat is small. Bats excreting European bat lyssaviruses in saliva are more than likely to show abnormal behaviour such as flying during daylight or being grounded or paralysed. A sick or injured bat should therefore never be handled by a member of the public but rather reported to either the Bat Conservation Trust (tel 0845 1300228), the Scottish Society for the Protection of Cruelty to Animals (tel 0870 7377722), or the relevant animal health divisional office.
We need to raise awareness in the general public of this small risk to human health without creating a fear of bats, which are a protected species under the Wild-life and Countryside Act 1981. Similarly, awareness among health professionals of current post exposure regimens also needs to be raised as rabies due to European bat lyssaviruses seems to be similar to classical rabies in being incurable but completely preventable.12
Alan Smith, specialist registrar in public health medicine
Health Protection Agency, Centre for Infections, London NW9 5HT (alan.smith@hpa.org.uk)
Jill Morris, specialist registrar in public health medicine, Natasha Crowcroft, consultant epidemiologist
Health Protection Agency, Centre for Infections, London NW9 5HT
Competing interests: None declared.
References
Rupprecht CE, Hanlon CA, Hemachudha T. Rabies re-examined. Lancet Infect Dis 2002;2: 327-43.
Fooks AR, McElhinney L, Pounder DJ, Finnegan CJ, Mansfield K, Johnson N, et al. Case report. Isolation of a European Bat Lyssavirus Type 2a from a fatal human case of rabies encephalitis. J Med Virol 2003;71: 281-9.
Muller WW. Review of reported rabies case data in Europe to the WHO collaborating centre Tübingen from 1977 to 2000. Rabies Bull Eur 2000;24; 11-9.
Whitby JE, Heaton PR, Black EM, Woodbridge M, McElhinney LM, Johnson P. First isolation of a rabies-related virus from a Daubenton's bat in the United Kingdom. Vet Rec 2000;147: 385-8.
Johnson N, Selden D, Parsons G, Fooks AR. European bat lyssavirus type 2 in a bat in Lancashire. Vet Rec 2002;151: 455-6.
Fooks AR, Selden D, Brookes SM, Johnson N, Martson DA, Joliffe TA, et al. Identification of a European bat lyssavirus type 2 ini a Daubenton's bat found in Lancashire. Vet Rec 2004;155: 606-7.
Fooks AR, McElhinney LM, Marston DA, Selden D, Jolliffe TA, Wakeley PR, et al. Identification of a European bat lyssavirus type 2 in a Daubenton's bat found in Staines, Surrey, UK. Vet Rec 2004;155: 434-5.
Fooks A, Brookes S, Healy D, Smith GC, Aegerter J, Harris SL. Detection of antibodies to EBLV-2 in Daubenton's bats in the UK. Vet Rec 2004;154: 245-6.
Department of Health. Rabies. In: Immunisation against infectious disease. DOH;2004. www.dh.gov.uk/assetRoot/04/09/79/03/04097903.pdf (accessed 18 Jan 2005).
Health Protection Agency. The public health management of a suspected case of human rabies. A standard operating procedure for communication & action. www.hpa.org.uk/infections/topics_az/rabies/final_rabies_SOP_301004.pdf (accessed 18 Jan 2005).
Department for Environment, Food, and Rural Affairs. Draft rabies contingency plan (RCP). www.defra.gov.uk/animalh/rabies/rabies_contingency/index.htm (accessed 11 Jan 2005).
Hemachuda T, Laothamatas J, Rupprecht C. Human rabies: a disease of complex neuropathogenic mechanisms and diagnostic challenges. Lancet Neurol 2002;1: 101-9.