Rabies in nonhuman primates and potential for transmission to humans: a literature review and examination of selected French national data.
BACKGROUND
The nonhuman primate (NHP)-related injuries in rabies-enzootic countries is a public health problem of increasing importance. The aims of this work are to collect data concerning rabies transmission from NHPs to humans; to collate medical practices regarding rabies postexposure prophylaxis (PEP) in different countries, and to provide an evidence base to support the decision to apply rabies PEP in this context.


METHODS
To retrieve information, we conducted a literature search from 1960 to January 2013. All reports of rabies in NHPs and rabies transmission to humans by infected NHPs were included. Also included were studies of travelers seeking care for rabies PEP in various settings. Data collected by the French National Reference Centre for Rabies concerning NHPs submitted for rabies diagnosis in France and human rabies exposure to NHPs in travelers returning to France were analyzed for the periods 1999-2012 and 1994-2011, respectively.


RESULTS
A total of 159 reports of rabies in NHPs have been retrieved from various sources in South America, Africa, and Asia, including 13 cases in animals imported to Europe and the US. 134 were laboratory confirmed cases. 25 cases of human rabies following NHP-related injuries were reported, including 20 from Brazil. Among more than 2000 international travelers from various settings, the proportion of injuries related to NHP exposures was about 31%. NHPs rank second, following dogs in most studies and first in studies conducted in travelers returning from Southeast Asia. In France, 15.6% of 1606 travelers seeking PEP for exposure to any animal were injured by monkeys.


CONCLUSIONS
Although less frequently reported in published literature than human rabies, confirmed rabies cases in NHPs occur. The occurrence of documented transmission of rabies from NHPs to human suggests that rabies PEP is indicated in patients injured by NHPs in rabies-enzootic countries.
Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, Marseille, France.
Philippe
P
Gautret
Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Jesse
J
Blanton
Institut Pasteur, Unité Dynamique des lyssavirus et adaptation à l'hôte, National Reference Centre for Rabies, WHO Collaborating Centre for Reference and Research on Rabies, Paris, France.
Laurent
L
Dacheux
Institut Pasteur, Unité Dynamique des lyssavirus et adaptation à l'hôte, National Reference Centre for Rabies, WHO Collaborating Centre for Reference and Research on Rabies, Paris, France.
Florence
F
Ribadeau-Dumas
Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, Marseille, France.
Philippe
P
Brouqui
Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, Marseille, France.
Philippe
P
Parola
Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Douglas H
DH
Esposito
Institut Pasteur, Unité Dynamique des lyssavirus et adaptation à l'hôte, National Reference Centre for Rabies, WHO Collaborating Centre for Reference and Research on Rabies, Paris, France.
Hervé
H
Bourhy
D000818:Animals; D001733:Bites and Stings; D016208:Databases, Factual; D005602:France / Q000453:epidemiology; D006801:Humans; D056990:Post-Exposure Prophylaxis; D011323:Primates; D011818:Rabies / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission* / Q000662:veterinary; D014195:Travel