Epidemiology of human rabies in Turkey: 1992-2007

Aim: Rabies continues to be a public health problem in Turkey; however, the number of reported cases has decreased in recent years and 1-2 cases of human rabies are reported annually to the Ministry of Health (MoH). Epidemiological and demographic features, clinical findings, and prophylaxis of human rabies reported to the MoH between 1992 and 2007 were evaluated. Materials and Methods: Rabies has been reported in Turkey since 1930. Data on human rabies have been available from the MoH since 1992. In this study, data on human rabies were analyzed retrospectively. The provinces, rabies risk exposure date, age, gender, type of animal, and prophylaxis program of the patients were recorded. Diagnoses of the cases were made based on clinical or laboratory findings. Results: Thirty-nine human rabies cases (31 male, 8 female) were reported to the MoH between 1992 and 2007. Diagnosis of 17 rabies cases was confirmed by pathological findings or detection of the viral genome by PCR. The remaining 22 cases were confirmed according to epidemiological data and clinical findings. Mean age of the patients was 28.6 ± 19.3 years (range: 5-69 years). The 3 provinces that most frequently reported human rabies were Istanbul (11 cases), Şanliurfa (5 cases), and Izmir (4 cases). Among the 39 cases, 29 were attributable to dog bites, 3 were related to wild animal exposure, and in 2 cases there was a history of contact with foxes. Twenty-two of the 39 patients did not receive post-exposure prophylaxis. In the remaining 17 patients the first dose of vaccine was administered 15 days after exposure to 5 patients, 12 patients were vaccinated on the day of rabies risk exposure, but 7 of these 12 patients did not receive any rabies immunoglobulin. In 5 patients the immunoglobulin was administered 3 days after exposure. Vaccination and immunoglobulin administration were performed at the appropriate time in 2 patients. Conclusions: According to these results, dogs were most responsible for the development of rabies. Among the 39 patients, 37 either did not receive post-exposure prophylaxis or were inappropriately administered vaccine and immunoglobulin. Human rabies developed in 2 patients despite the fact that vaccination and immunoglobulin administration were performed at the appropriate time and dosage.