October 5, 2022

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Ukraine and the Danger of Anger: A Problem to Know

Of zoonotic and viral origin, with a mortality rate of close to 100%, rabies is a disease that we have almost forgotten in Italy. In fact, our country has been free since 2013, after a period of a few years in which cases of infection due to wild animals were reported from Slovenia and the Balkans. And as far as Europe is concerned, it is the countries of the East that still suffer from the disease today; Among them, Ukraine has the largest number of animals infected with rabies.

The movement of refugees fleeing the conflict with Russia, who brought their pets with them when possible, combined with the work of animal welfare organizations trying to recover stray animals or those left abandoned on Ukrainian soil, has brought back the attention of veterinarians and experts to the potential risks that could arise. , even in Italy, cases of rabies. This risk should not be underestimated, precisely because of the large number of cases of the disease in this war-torn country: We talked about it with Paula Dallara, MD, professor of canine infectious diseases in the cat in the Department of Veterinary and Animal Medicine. Science (DIVAS) of Milan State University, which organized a conspiracy On a topic dedicated to veterinarians, health professionals working in the sector and animal welfare societies.

What is anger and its history in Italy

Rabies is a disease caused by viruses of the genus Lyssavirus. It is not particularly contagious, in the sense that infection almost never occurs in ways other than direct contact with an infected animal: through a bite, for example, or scratches or even by licking (in other words, if you lick) of mucous membranes or improper skin . In short, it is relatively difficult to take, but it is almost always fatal once symptoms appear. The incubation period can be quite long (ranging from a few weeks to 2 years, with an average of 3 months). The initial symptoms of anger in humans are nonspecific (fever, headache, malaise), but within a few days, characteristic signs appear related to typical encephalitis (the so-called “angry” anger in 80% of cases) or paralysis (no – so called “stupid” anger) in the remaining 20%). Brain inflammation because I am Confusion, agitation, hallucinations and altered behaviors, the patient with rabies unfortunately shows famous water aversion with excessive salivation and inability to drink due to painful contractions of the muscles responsible for swallowing.

Sudden changes in behavior also occur in a dog with rabies, in some cases it tends to be aggressive and biting, and in other cases it is accompanied by disorientation and dullness. Characteristic of rabies in wild animals Typical loss of confidence towards the human being.

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And the course of the disease, as mentioned, leads to the death of the patient. However, the “good news” is that rabies is completely preventable through vaccination – moreover, one of the first vaccines to be developed, thanks to the work of Louis Pasteur, who developed the first rabies vaccine for humans at the end of the 19th century. At that time, serial attenuated rabies virus was used in rabbits, while current vaccines are prepared with virus inactivation and, depending on the vaccine used, have variable coverage (in humans 2-5 years, in dogs and in cats 1, 2 or 3 years).

In our country, anger was absent from the 1990s until the end of the 2000s. Then in 2008, after a series of cases reported in the regions closest to the border with Slovenia (Friuli Veneto Giulia, Veneto and the Autonomous Provinces of Trento and Bolzano), it was necessary to issue a series of containment measures. These obligations include vaccinating dogs and herbivores for the population in the respective areas and for those who have entered, for example for tourism; Intensification of surveillance and oral vaccination of wild animals (through bait spread throughout the territory). The high commitment to implementing containment measures meant that the last rabies case in Italy was reported in February 2011; Two years later, in 2013, the country was deemed disease-free again.

It should be noted that, in fact, another case of rabies was recorded in 2020 in Arezzo: it was a cat, most likely infected because it had preyed on a bat, yet his case is considered to be “quite episodic and sporadic.”, such as Reports Ministry of Health.

Anger in Europe and the risk of spreading from Ukraine

However, anger remains a serious health problem in many other regions of the world. according to Data from the World Health OrganizationEvery year tens of thousands of people die, especially children and young adults, probably because they are more likely to come close to infected animals. Globally, the hardest-hit areas include South America, India, other Asian countries and some African countries; In Europe, it is the eastern countries that have the largest number of cases.

According to official data from the European Rabies Surveillance System (Politen rabies Europe), of the more than 40,000 cases reported in Europe from 2012 to today, more than 14,000 are in Ukraine and the same number is in the Russian Federation,” explains Dall’Ara. “The Ukrainian situation is more worrying if we consider only the past year. : With more than 500 cases, Ukraine is the country with the highest number of rabies cases in domestic and wild animals. The reason is the large number of stray dogs, which act as a reservoir of the virus and represent its main vector, and the lack of vaccination coverage for owned animals, which takes priority in reported cases (perhaps due to the most important veterinarians and major diagnostic assertions, not always possible in a stray animal). This aspect is almost paradoxical precisely because, by virtue of the fact that direct contact is necessary for infection, the relatively low vaccination coverage (70% of the population) would be sufficient to prevent the spread of the virus.”

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In order to contain the spread of the virus, and possibly eradicate it (this will be the goal of the initiative zero in 30 The World Organization for Animal Health (OIE) which aims to eliminate cases of canine transmitted rabies by 2030), in Europe Regulation 576/2013 is in effect, according to which there is an obligation for owners of dogs, cats or rodents who want to leave the national territory With their animals to provide them with a valid passport, an electronic chip and a rabies vaccine. Furthermore, for non-European countries that are rabies-free or where strict control measures are in place due to the large number of rabies cases, antibody titration is also provided – an assessment of the quantity of specific rabies antibodies that shows that an animal has been successfully vaccinated. : “Before February 24, 2022, the start date of the war, this measure was also necessary for those from Ukraine who wanted to go to Italy,” explains Dallara. But on humanitarian grounds, with the outbreak of war, the European Union waived control measures, in order to facilitate the entry of pets that follow refugee families into member states, and in preference to animal welfare protection. Even the Italian Ministry of Health with one Noticeable On February 28, he agreed not to defer; These concessions, well understood from a human point of view, go hand in hand with a decrease in health checks and thus an increased risk of rabies spreading across borders.”

However, the problem is not limited to owned animals. Even if the extent of the problem is still unknown, because there is no official data regarding dogs and cats that entered Italy after their owners or were rescued and brought in by protective societies, since the outbreak of the conflict, many animal welfare organizations have committed themselves to activists not only through Providing support, for example through food groups, medicines, etc., or by supporting those who arrive in Italy with their animals, but also to try to bring in stray animals or animals left abandoned after the flight. Owners to Italy (some examples [https://guidominciotti.blog.ilsole24ore.com/2022/03/21/ucraina-leidaa-porta-italia-cani-gatti-scampati-alla-guerra/?refresh_ce=1″>qui). «Dallo scoppio del conflitto è passato un certo tempo prima che il Ministero della salute si adeguasse alle misure previste nel resto dell’UE, che vietano l’ingresso di animali randagi o provenienti da rifugi, per cui molti animali sono entrati in Italia prima del divieto. Non sapendo se sono infetti (e ricordiamo che la rabbia ha un periodo d’incubazione molto lungo), questi animali non possono essere dati subito in adozione, ma devono essere tenuti sotto controllo in isolamento per un certo periodo di tempo e sottoposti alle misure di controllo stabilite dal Ministero e dalle singole regioni (per esempio vaccinazione antirabbica e titolazione anticorpale)», commenta la professoressa.

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Per tutte queste ragioni, continua Dall’Ara, è fondamentale oggi sensibilizzare tutti i medici veterinari e tutte le associazioni animaliste impegnate in attività a supporto di cani e gatti in Ucraina affinché possano operare in modo corretto e consapevole. A questo scopo, è necessaria una comunicazione a 360 gradi sul rischio rabbia da parte di tutte le figure del settore (veterinari pubblici e privati, medici, tecnici veterinari, studenti di area sanitaria, ecc.) in modo che tutti abbiano una corretta percezione del rischio e possano agire di conseguenza.

«Il rischio di riportare la rabbia in Italia è purtroppo dietro l’angolo. Proprio per evitare un’emergenza sanitaria, il mio dipartimento (DIVAS), in collaborazione con la Federazione nazionale ordini veterinari italiani (FNOVI) ha recentemente organizzato un convegno che affronta questo tema», conclude la professoressa. «Abbiamo bisogno che tutti coloro che operano nel settore lavorino con la massima consapevolezza del rischio. “United against rabies” è il nome della storica collaborazione di WHO, OIE e FAO unite nell’ambizioso progetto Zero by 30, e anche noi, solo se saremo tutti uniti, riusciremo a evitare che la rabbia diventi un’emergenza anche nel nostro paese, indenne ormai da nove anni».