title: Update on human rabies in a dog- and fox-rabies-free country.
abstract: Rabies is responsible for 50,000 deaths per year worldwide. Mainland France has been officially freed from rabies in non-flying animals since 2001.
  
  
  METHODS
  We wanted to provide an update on the French situation, using published data, and describe possible options since official guidelines are lacking.
  
  
  RESULTS
  Post-exposure prophylaxis (PEP) (early and careful cleaning and dressing of the wound, vaccination, and in case of high-risk exposure, injection of specific anti-rabies immunoglobulins) is known to be efficient except in rare cases. It is recommended after grade II contact (+specific immunoglobulins in immunodepressed patients), or grade III contact (vaccination+immunoglobulins).
  
  
  CONCLUSIONS
  Mainland France being rabies-free, 3 options may be considered in case of bite by a dog or a cat that cannot be monitored in France: (a) consider the risk of rabies as null, so no PEP should be administrated, whatever the severity of bites; (b) consider there is a weak but lethal risk, so the international recommendations should be applied, using immunoglobulins in some cases; (c) consider that the risk is extremely low but cannot be excluded, and that the patient should be vaccinated to be protected, but without adding immunoglobulins (whether in case of grade II or III bites).
  
  
  CONCLUSIONS
  There are no national guidelines for rabies in France, and so the physician managing the patient is the one who will decide to treat or not.
authors.affiliation: Maladies infectieuses et centre antirabique, CHU, BP 217, 38043 Grenoble, France. Electronic address: jpstahl@chu-grenoble.fr.
authors.forename: J-P
authors.initials: JP
authors.lastname: Stahl
authors.affiliation: Centre antirabique, CHU Nord, 13915 Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Gautret
authors.affiliation: Centre national de référence sur la rage, Institut Pasteur, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Ribadeau-Dumas
authors.affiliation: Groupe Courlancy, cabinet d'infectiologie, clinique Saint-André, 51100 Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: Strady
authors.affiliation: Service des maladies infectieuses et centre antirabique, hôpital la Milétrie, 86021 Poitiers, France.
authors.forename: G
authors.initials: G
authors.lastname: Le Moal
authors.affiliation: Centre antirabique, CHU Ponchaillou, 35033 Rennes, France.
authors.forename: F
authors.initials: F
authors.lastname: Souala
authors.affiliation: SLB JsBio, laboratoire espace santé du Golfe de Saint-Tropez, 83580 Gassin, France.
authors.forename: J
authors.initials: J
authors.lastname: Maslin
authors.affiliation: Service des admissions et des urgences, centre antirabique, centre hospitalier, 55107 Verdun, France.
authors.forename: B
authors.initials: B
authors.lastname: Fremont
authors.affiliation: Centre national de référence sur la rage, Institut Pasteur, 75015 Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Bourhy
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000835:Animals, Wild / Q000821:virology; D000914:Antibodies, Viral / Q000008:administration & dosage / Q000627:therapeutic use; D001733:Bites and Stings / Q000628:therapy / Q000821:virology; D002685:Chiroptera / Q000821:virology; D004197:Disease Reservoirs; D004285:Dogs; D005589:Foxes; D005602:France / Q000453:epidemiology; D005616:French Guiana / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D007116:Immunization, Passive; D018114:Lyssavirus / Q000235:genetics / Q000472:pathogenicity; D008318:Malpractice; D057805:Pets / Q000821:virology; D056990:Post-Exposure Prophylaxis / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D011818:Rabies / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission / Q000662:veterinary / Q000821:virology; D011819:Rabies Vaccines / Q000627:therapeutic use; D011820:Rabies virus / Q000235:genetics / Q000276:immunology; D018353:Rhabdoviridae Infections / Q000453:epidemiology / Q000662:veterinary / Q000821:virology; D012306:Risk; D014195:Travel; D014611:Vaccination / Q000379:methods / Q000662:veterinary; D014944:World Health Organization; D015047:Zoonoses
chemical_list: D000914:Antibodies, Viral; D011819:Rabies Vaccines
keywords: Anti-rabies immunoglobulins; Immunoglobulines antirabiques; Post-exposure prophylaxis; Prophylaxie post exposition; Rabies; Rage