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Workshop "Rabies - out of sight, not out of mind"

On 9 November 2015, the first joint event of the Zoonoses Platform and the Academy for Public Health Düsseldorf was the workshop "Rabies - Out of sight, not out of mind" in Berlin. The aim of the event was to bring together representatives from research and the public health service (ÖGD) on a very specific topic, to inform them and to identify research gaps and needs for both sides through intensive discussions.

The varied program gave an up-to-date overview of rabies research up to rabies as a travel disease. The speakers as well as the participants consisted of staff from research, public health services and veterinary authorities. An intensive exchange on rabies arose around the lectures.
At the beginning of the event, Prof. Martin Groschup, one of the three directors of the zoonoses platform (Friedrich-Loeffler-Institute, Greifswald - Insel Riems), welcomed those present and outlined the new event format, which is intended to bring scientists and ÖGD together.

Researching and combating rabies - a topic for human and veterinary medicine

Dr. Freuling from the National Reference Laboratory for Rabies at the Friedrich-Loeffler-Institute, Greifswald, Germany, explained the genetic diversity of rabies viruses and the virus reservoir in the first technical lecture. Rabies is one of the oldest zoonoses and at the same time one of the most unexplored. He summarised that a cure in the case of an infection is still practically impossible today. Therefore, the vaccination of animals and humans, which can contain rabies and thanks to which Germany and large parts of Europe are free of terrestrial rabies, is all the more important. The One Health concept, which takes into account the close relationship between animal and human health, can be exemplified in the case of rabies. Reintroduction and unnoticed spread of rabies by so-called neozoa (animals not originally present in a habitat) is one of the remaining risks - vigilance against rabies and research into rabies should therefore not be allowed to slacken, Freuling said.
The bat rabies, which also occurs in numerous countries that have declared themselves rabies-free, must be distinguished from terrestrial rabies. Mrs. Eggerbauer (Friedrich-Loeffler-Institute, Riems) gave detailed insights into this. Thanks to a BMBF-funded project, many bats have been examined for rabies viruses in recent years. The result is that many known, but also many new bat rabies viruses could be determined. However, transmission of bat rabies to humans is only known for a few viruses, such as EBLV-1 (European Bat Lyssa Virus 1). For further research on bat rabies, it is necessary to establish reliable diagnostic systems that allow e.g. serological testing. Furthermore, little is known about the pathogenesis of bat rabies in bats or in laboratory animals.

Rabies control in practice

Dr. Rodriguez Dorendorf from the border inspection post at Tegel Airport reported on legal regulations and the handling of animal transports from third countries to Germany. Against the background of the risk of rabies being introduced, she explained exactly what precautions are taken and what guidelines animal owners and veterinarians must follow.
Dr. Schönfeld (travel medical outpatient clinic and rabies counselling of the Institute for Tropical Medicine and International Health, Berlin) gave a detailed overview of rabies as a travel disease. He clearly limited the risk to infection by dogs, which make up 99% of (suspected) cases, and gave practical tips on how to behave after a dog bite and subsequent suspicion of rabies. He explained the advantages and disadvantages of vaccination, showed the different vaccination schemes and vaccines that are available worldwide. The rabies vaccination is above all a psychological support, as one does not have to be nervous in case of a bite abroad and above all one is not dependent on dubiously produced vaccines and serums. He contrasted this scenario with clear rules of conduct and forms of travel with which an infection could be virtually ruled out and for which vaccination was not necessary.
Dr. Rieke, who is a specialist in internal medicine, tropical medicine, infectiology and travel medicine and has practical experience in the treatment of people infected with rabies, then described the procedure after bite wounds and the procedure for post-exposure prophylaxis. He also described very clearly the clinical picture of rabies sufferers, of whom there are an estimated 50,000 to 70,000 annually worldwide. Dr. Rieke also described the last cases of rabies in humans in Germany, which occurred in 2004 and 2005 as a result of an undiscovered rabies disease in an organ donor.

Interdisciplinary exchange of the workshop participants

Nach den Vorträgen, in den Pausen und am Schluss der Veranstaltung wurde jeweils intensiv diskutiert und Wissen ausgetauscht. Dabei profitierten alle von den spezifischen Fachkenntnissen des heterogen zusammengesetzten Teilnehmerkreises. Neben konkreten Fragestellungen im Tollwut-Verdachtsfall, zur Impfprophylaxe und zu Übertragungs- und Ansteckungsrisiken in Deutschland und auf Reisen wurde diskutiert, ob die Tollwutforschung „Opfer ihres eigenen Erfolges“ geworden sei – da Tollwut in Deutschland als ausgerottet und somit nicht mehr als Gefahr gelte. Die Teilnehmer*innen waren sich jedoch einig, dass die Forschung an Tollwut – in Bezug auf Diagnostik (v.a. bei Fledermäusen), Pathogenese und Therapie (v.a. bei Menschen) – nicht nachlassen dürfe, um wichtige, nicht erforschte Fragestellungen zu klären. Diese Botschaft müsse auch an Politik und Förderer verstärkt herangetragen werden.
Ergänzend müssten Fortbildungen für Ärzte und Tierärzte in Wissenschaft, Veterinärämtern und dem ÖGD stattfinden, um das Wissen über Tollwut wach zu halten, und eine Ausbreitung zu bemerken, falls sie durch Import oder sonstige Einschleppung auftreten sollte. Einige wünschten sich auch einen engeren Austausch zwischen Fledermausschützern, Veterinärämtern und Forschung. Zudem sollten – gerade für Personen, die Kontakt zu Fledermäusen hätten – aktuelle Fachinformationen zur Verfügung gestellt werden und das Wissen über Tollwut und das mögliche Ansteckungsrisiko durch Fledermäuse durch sensible und sachliche Öffentlichkeitsarbeit verbreitet werden.
Zusammenfassend kann diese erste Fachveranstaltung zur Vernetzung von Wissenschaft und Praxis als gelungen bezeichnet werden. Weitere Veranstaltungen – mit den Schwerpunkten Salmonellen, Lebensmittelinfektionen und Antibiotikaresistenzen – sollen im kommenden Jahr folgen.

The program of the workshop can be read here.

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