Rabies, a very sporadic disease in animals and exceptional in humans in Spain

Spain has been rabies-free since 1978 , although sporadically , cases occur in animals in Ceuta and Melilla, and very rarely in humans , all of them imported. Mass migration or travel to endemic countries without taking the necessary precautions constitute the main risk today.

Cases like that of the Valencian tourist, who died this Friday , are unusual in Spain, where only two other cases of human rabies have been reported since 2000 , all imported from Morocco: one in Madrid in 2014 and another in the Basque Country in 2019. Both died. In 2004, another case was documented in an Austrian tourist, also imported from Morocco, but it was finally reported in Austria, according to the Carlos III Health Institute.

The appearance of these cases, and other sporadic ones in animals—mainly in Ceuta and Melilla— have not stripped Spain of its status as a rabies- free country , which it achieved in 1978 and which it only lost for 6 months in 2013 due to a case in a dog illegally brought in from Morocco.

Thus, the main risk of importation, as detailed by Carlos III in the document Situation of terrestrial rabies in Spain in the 21st century , is tourism, cooperation or business trips to countries with endemic rabies without taking the appropriate measures.

If any cases arise, they would not represent any risk to the general population , although close contacts should be monitored and the type of contact they may have had should be assessed in order to evaluate the administration of rabies vaccine or immunoglobulin, the Ministry of Health clarifies to EFE .

Rabies: what it is

It is a highly fatal zoonosis caused by several types of lyssavirus . It is present in 150 countries on all continents, except Antarctica. Half of the world's population lives in endemic areas, with Africa and Asia accounting for 95% of fatal cases. In Europe, the main reservoirs are the red fox, followed by small wild carnivores such as the raccoon dog in Central Europe and the Baltic Sea, and the bat in Spain.

The incubation period is usually 2 to 3 months , although it can be as long as a year. The virus enters through peripheral nerves and spreads through neurons, so it depends on the location of the wound, the amount of nervous tissue affected, and the distance from the central nervous system.

Early symptoms include fever, headache, and itching at the site of entry; when the virus moves to the central nervous system, other symptoms develop, ranging from confusion, agitation, or hypersensitivity to light and sound to delirium and progressive paralysis , eventually leading to death.

Transmission occurs primarily through the bite of a sick animal , or when its saliva comes into close contact with fresh, open wounds . The risk of infection is higher if there are multiple bites, if the bites occur on the face, or if the area is not covered by clothing.

What do I do if I've been bitten by an animal?

The first thing to do when traveling to endemic areas is to avoid contact with wild animals or animals whose health status is unknown. After a bite, The wound should be thoroughly washed for a few minutes with plenty of running water and soap, and then urgently sought out by a health center.

Regarding human rabies vaccination, it is not routine in Spain, so it is not included in the common vaccination schedule . However, in certain circumstances (laboratory workers, zoologists, veterinarians, etc.), vaccination is recommended before exposure to the virus (pre-exposure prophylaxis) or afterward (post-exposure prophylaxis). Before making any decision and if you have any questions, consult the Public Health Services.

Treatment is based on preventing the spread of the virus through the nervous system with early administration of post-exposure prophylaxis. Once neurological symptoms develop, it is primarily symptomatic and supportive, but the prognosis is grim: virtually all cases end in coma, respiratory paralysis, and death.