Prevalence of rabies in Lithuania

Introduction

Rabies surveillance in Lithuania is conducted according to regulations approved by the Minister of Health. Rabies immunoprophylaxis and emergency medical aid are provided for all persons injured by identified or unidentified animals and also for persons injured while performing veterinarian procedures, processing carcasses or dissecting animals with rabies.

Methods

After providing medical aid, the staff at health care units informs public health centres about every registered person injured by a rabid animal or animal suspected of having rabies. Other persons in contact with suspected rabid animals are traced and given rabies immunoprophylaxis. Public health centres also send a quarterly report including information on the number of injured persons, animal species, immunoprophylaxis provided and the amount of rabies vaccines and immunoglobulin administered to the Centre for Communicable Diseases Prevention and Control. Data are summarised and provided to the public health centres and Ministry of Health.
Wild and domestic animals suspected of having rabies are sent to one of 10 national veterinarian laboratories for investigation. Rabies virus is detected by immunofluorescence method. Results are sent for epidemiologists at public health supervision institutions where recommendations for preventive measures are determined.

Results

During recent years the epidemiological and epizootological rabies situation has been worsening in Lithuania. Rabies cases in wild and domestic animals are registered in all the territory. Every year various wild and domestic animals injure a great number of people, and the spread rabies virus is an increasing threat for humans.
In 2002, 10 944 persons (3 503 children below 15 years and 7 441 adults) injured by various animals were registered in health care units. Among these persons 6 219 (56.8%) were bitten, scratched and/or had contact with saliva from healthy animals  (observed and remained healthy after incubation period), 2 845 (26.0%) by animals with unknown health status, and 1 880 (17.2%) by rabid animals. The corresponding figures for 2001 were 10 966 persons (3 901 children and 7 065 adults), of whom 6 201 persons (56.5%) were injured by healthy animals, 3 266 (29.8%) by animals with unknown health status and 1 499 (13.7%) by rabid animals.  In 2000, 12 800 persons (4 582 children and 8 218 adults) were registered; 6 913 persons (54.0%) injured by healthy animals, 3 640 (28.4%) by animals with unknown health status and 2 247 (17.6%) by rabid animals.
The majority of persons seeking medical attention at health care units received post-exposure rabies immunoprophylaxis. In 2002 rabies vaccines were administered to 6 064 adults and children (55.4% of health-care seekers), in 2001 to 6 306 (57.5%) and in 2000 to 8021 (62.7%) (Table 1).

Table 1. Animal bites of humans and postexposure rabies immunoprophylaxis in 1997-2002 in Lithuania

Year	1997	1998	1999	2000	2001	2002
Number of persons who took medical advice due to animal injuries	8 866	8 754	9 794	12 800	10 966	10 944
Number of persons who underwent postexposure immunoprophylaxis	4 461	4 409	5 310	8 021	6 306	6 064
%	50.3	50.4	54.2	62.6	57.5	55.4
Costs (in Litas)	507 235	476 520	570 359	867 679	747 312	899 771
Costs (in Euros)	146 905	138 010	165 187	251 297	216 437	260 592

According to data from the State Food and Veterinarian Agency for 2002 933 cases of rabies among animals were registered throughout all territories in Lithuania (an increase of 256 cases as compared to 2001). There were 251 cases of rabies among domestic animals and 682 cases among  wild animals registered in 2002 (Table 2).

Table 2. Data on animal  bites in 2002

Animals	Number of people injured by animals
	Total	Healthy animals		Animals with unknown health status		Rabid animals
		Number	%	Number	%	Number	%
Dogs	7 645	5 313	69,4	2 032	26,6	300	4,0
Cats	1 416	677	47,8	442	31,2	297	21,0
Rats	108	27	25,0	79	73,1	2	1,9
Cattle	494	66	13,4	19	3,8	409	82,8
Other domestic animals	215	82	38,1	6	2,8	127	59,1
Wild animals	1 066	54	5,0	267	25,0	745	70,0
Total	10 944	6 219	56,8	2 845	26,0	1 880	17,2

Annual reports showed that the majority of injured were bitten by dogs. However, according to data from the State Food and Veterinarian Agency there were only 48 cases (5.1%) of animal rabies with dogs as a source of infection. In 2002 dogs bit 2 734 children below 15 years and 4 911 adults. Most people (5 313) were bitten by healthy dogs, 2 032 by dogs with unknown health status and only 300 by rabid dogs (Table 3).

Table 3. Cases of rabies in wild animals in 2002

Animals	Number of cases	%
Foxes	273	29,2
Racoon-dogs	317	33,9
Martens	61	6,5
Polecats	20	2,1
Reindeers	2	0,2
Badgers	6	0,6
Otters	1	0,1
Wolves	1	0,1
Beavers	1	0,1
Total	682	73

Table 4. Animal cases of rabies in 2002 in Lithuania by territories

County	Number of animal cases
Alytaus	117
Kauno	82
Klaipedos	105
Marijampoles	29
Panevezio	109
Siauliu	151
Telsiu	17
Taurages	78
Utenos	141
Vilniaus	104
Total / Всего	933

In 2002 rabies was detected in 70 cats (7.5% of all animal rabies) in different territories of Lithuania. 434 children (4.0%) and 982 adults were registered as injured by cat bites and scratches. 677 (47.8%) persons were injured by healthy cats, 442 (31.2%) by cats with unknown health status and 297 (21.0%) by rabid cats. The number of patients injured by cats was similar in 2001 and 2002.
Rabies was also detected in other domestic animals (cattle, horses, and sheep) in all counties of the territory. A total of 133 cases were registered. 709 persons were injured by cattle, sheep, goats and horses. Healthy domestic animals injured 148 people (20.8%), domestic animals with unknown health status 25 (3.6%) and rabid domestic animals 536 adults and children (75.6%).
In 2002 mice and rats injured 65 children and 43 adults. The majority of the adults were from rural areas and were caring for farm animals when they were pounced on by rodents. Domestic rodents or wild mice and rats pounced on sleeping children. Healthy rodents bit 27 adults and children (25.0%), mice and rats with unknown health status 79 persons (73.2%) and rabid rodents 2 persons (1.8%).
In 2002 682 cases of rabies in wild animals (73.0% of all rabies cases) were registered in Lithuania. Racoon-dogs were clearly dominant; there were 317 cases (33.9%) of racoon-dogs and 273 (29.2%) cases of foxes (Table 3).
Wild animals bit and scratched 1 066 adults and children (9.7% of all bites and scratches). 54 persons (5.1%) were injured by healthy wild animals, 267 (25.0%) by wild animals with unknown health status and 745 (69.9%) by rabid wild animals. The number of people injured by wild animals was stable during last 3 years.
In 2002 the State Food and Veterinarian Agency registered foci of rabies in all counties of the territory of Lithuania (Table 4). People injured by various domestic and wild animals were registered in different counties of the territory (Table 5).
Animal rabies cases were most often registered in the third and fourth quarter, with cases of wild animals more often than domestic ones (Table 6).
People injured by various animals called for help throughout the year, but most often during the second and third quarter (Table 7).
Unfortunately, Lithuania has not escaped human deaths from rabies during recent decades. Between 1960 and 2000 there were ten human deaths; seven of these patients were in contact with wild and three with domestic rabid animals (Table 8). None of these persons took medical advice.

Discussion

Wild animals migrate freely through the geographical territories of Lithuania that border on the wooded areas of Latvia, Belarus, Poland and Kaliningrad oblast of Russia in the North, South and the East. Another reason for easy spread rabies is the oral vaccination irregular (not applied periodically and not in all territories) of wild animals. In addition, not all domestic animals receive rabies immunoprophylaxis. Every year the number of injured people increases.

Table 5. Animal bites of humans in 2002 in Lithuania by territories

Counties	Number	%
Alytaus	569	5,2
Kauno	1 906	17,4
Klaipedos	1 332	12,2
Marijampoles	434	4
Panevezio	825	7,5
Siauliu	978	8,9
Telsiu	406	3,7
Taurages	420	3,8
Utenos	687	6,3
Vilniaus	3 194	29,2
Traku distr.	193	1,8
Total / Всего	10 944	100

Table 6. Epizootological foci of rabies in 2002, by quarters

Table 7. Number of  animal bites of humans in 2002, by quarter

Table 8. Human rabies cases in Lithuania, 1960-2002

In 2002, the Lithuanian Ministry of Health approved a Rabies Epidemiological and Epizootological Surveillance and Control Programme. According to this programme, funding was provided for the vaccination against rabies wild fauna and domestic animals in all territories of Lithuania. In addition, funding was provided for all emergency medical aid and immunoprophylaxis for injured people. The implementation of the programme will prevent the spread of rabies virus among the populations of wild and domestic animals and thus decrease the threat of rabies to humans.