More Moroccan rabies

While rare, Morocco continues to be a source of rabies in European animals. The latest case involved a puppy imported into the Netherlands. The (somewhat) brief version of what happened goes like this:

  • On Jan 28, 2012, a Dutch couple bought an 8-week-old puppy in a parking lot in Morocco. The puppy was taken to a local veterinarian, microchipped and given a certificate of good health. It would have been too young to vaccinate against rabies.
  • On Feb 4, the couple travelled from Morocco to Spain by car and ferry. They then obtained a European pet passport from a Spanish vet, despite the fact that the dog was not vaccinated against rabies (an EU requirement for a pet passport).
  • On Feb 11, they returned to the Netherlands. Customs officials "cuddled" with the puppy but apparently didn't ask about rabies vaccination. When they got home, the couple exposed the puppy to many family and friends.
  • On Feb 14, the puppy started to become aggressive. They contacted a veterinary practice, and it was assumed the problem was stress, so a sedative was given. (It's not clear whether the puppy was actually examined. If not, that's a pretty big mistake.)
  • On Feb 15, the puppy was uncontrollable. The report states "When they realized that the puppy originated from Morocco, the veterinarians contacted the Netherlands Food and Consumer Product Safety Authority (NVWA)." The puppy's history should have been a basic question asked when the couple first contacted the veterinary practice about the animal. Regardless, the concern about rabies came to the forefront with that information, and the puppy was euthanized. Rabies was confirmed that evening (a pretty impressive turnaround time for rabies testing).
  • As is typical, an investigation was launched, and a search for people who had contact with the puppy during the period when it was potentially infectious was started. That's not easy when it involves multiple countries, as was the case here, since the potentially infectious period is 10-14 days prior to the onset of clinical abnormalities. The potential contacts included the Moroccan veterinarian, some friends in Spain, the Spanish veterinarian, three customs officials, a couple of unknown people in a Spanish restaurant and at the Malaga airport, and 43 people after arrival in the Netherlands (plus an unknown number of people who petted the puppy on the street).
  • Contact doesn't mean exposure, since rabies isn't transmitted by casual contact, so the type of contact was queried further. The risk is from bites or contact between the dog's saliva and broken skin or mucous membranes (e.g. mouth, eyes). Because of concerns that kids don't accurately recall the type of contact they have (meaning they might fail to mention a little nip or some other high risk contact), all nine children who had contact with the puppy were given post-exposure prophylaxis. The Dutch friends in Spain reported high risk exposure and were also treated, however they had to return to Amsterdam for full treatment since anti-rabies immunoglobulin (antibody) was not available in Spain. Information was provided to Moroccan officials but information about what happened there wasn't available.
  • Overall, it is stated that 45 people needed post-exposure treatment (although who those 45 were isn't really clear). That's a pretty large exposure, resulting is much angst and expense.
  • Two cats and a dog were also exposed to the puppy. The dog had been vaccinated, and received a booster. (It would also be standard protocol to quarantine them for 45 days as well, but that's not stated.) The cats were euthanized because a "suitable quarantine place was not available," a rather strange statement since quarantine isn't a very high tech procedure. 

Obviously, this is of relevance to people that live in Morocco or are going to get a dog from Morocco. Those people need to be aware of rabies, be careful when getting a pet, ensure their pets are properly vaccinated against rabies and be careful around stray animals. This report also highlights a couple of other issues:

  • A parking lot isn't a good place to buy a puppy, for many reasons. A reputable breeder isn't going to sell a puppy there, and there are lots of good, well-evaluated puppies available through good breeders and shelters.
  • Pet importation requirements are pretty weak in a lot of ways, especially if no one actually pays attention to them. That seems to be a recurring theme as well with these imported rabies cases. Here, the puppy was given a European dog passport without the required rabies vaccination, and was not kept in quarantine after arrival. It also went through no less than three customs points in transit, where no one queried rabies vaccination status. The mandatory 3 month quarantine would have prevented exposure of most of the people that required post-exposure treatment.
  • Visitors to areas where rabies is endemic in the dog population need to be aware of it. Encountering stray dogs isn't exactly rare in many countries, and while staying away from strays is a good general rule everywhere, people should be particularly careful in areas where the risk of rabies is high. Travelers also need to be aware of what to do if they are bitten by a stray animal.
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