This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright Author's personal copy Author's personal copy R E V I E W / ABCD guidelines on feline rabies The number of human rabies deaths is estimated at 40,000–100,000 worldwide each year, and an estimated 10 million people receive post-exposure treatment. Epidemiology Developing countries Organisation for Animal Health (OIE) and the World Health Organization (WHO) (Fig 1).1 The number of human rabies deaths is estimated at 40,000–100,000 worldwide each year, and an estimated 10 million people receive postexposure treatment.2 Dog rabies is still important in many parts of the world and is the principal cause of human cases. Wildlife rabies has increased in importance as a threat to domestic animals and humans, and transmission by vampire bats is a significant issue in Latin America. The red fox and the raccoon/skunk are the main reservoir species for terrestrial rabies in Europe and the Americas, respectively. agencies cannot be afforded by many developing countries, progress is being made. For example, a substantial decrease in the incidence of rabies has been reported recently from China, Thailand and Sri Lanka, after implementation of dog vaccination programmes and improved post-exposure prophylaxis of humans. Similarly, rabies cases decreased in Latin America after the Pan American Health Organization had implemented a vaccination programme to eliminate urban dog rabies from the southern hemisphere. A dreaded disease In most countries of Asia, Latin America Rabies is one of the oldest and most dreaded diseases of humans and Rabies occurs worldwide, with geoand Africa, dog rabies is endemic, causanimals – it was recognised in Egypt before graphical exceptions. Large regions of ing considerable mortality in domestic 2300 BC, and well described by Aristotle in Europe are now free of terrestrial ancient animals and man. Many people are Greece. Rabies also has stimulated one rabies as a result of wildlife vaccina- of the great early discoveries in biomedical vaccinated, and there is a continuing tion programmes. The rabies situation science: in 1885, before the nature of viruses was need for comprehensive, professionaland the regulations are continuously understood, Louis Pasteur developed, tested and ly organised and publicly supported updated on the websites of the World applied a rabies vaccine, thereby heralding the rabies control agencies. Though such modern era of infectious disease prevention. Rabies-free countries Strictly enforced quarantine for dogs and cats has kept rabies from entering Japan, the United Kingdom (UK), Australia, New Zealand and other islands. Rabies was never endemic in wildlife in the UK and was eradicated in 1902, and again in 1922 after it had become established in the dog population in 1918. Since then, there has been no rabies in the UK. Isolated reports of bats infected with EBL-2 have not altered the terrestrial rabies-free status of the UK. In contrast, rabies was not recognised in Australia until the recent discovery of Australian bat lyssavirus, which was subsequently found to be endemic in southeast Australia. a 586 FIG 1 Incidence maps showing (a) terrestrial rabies cases in 2008; and (b) bat rabies cases between 1997 and 2008. Source WHO b JFMS CLINICAL PRACTICE Industrialised countries In most industrial countries, even in those with a modest disease burden, publicly supported rabies control agencies undertake: ✜ Oral vaccination of wildlife – in Europe, the red fox; ✜ Stray dog and cat removal and control of pet movement (quarantine is used rarely in epidemic circumstances); ✜ Immunisation of dogs and cats, to break the chain of virus transmission; ✜ Laboratory diagnosis, to confirm clinical observations and obtain accurate incidence data; ✜ Surveillance, to measure the effectiveness of all control measures; ✜ Public education programmes to assist cooperation. Author's personal copy R E V I E W / ABCD guidelines on feline rabies Though fewer persons obtain post-exposure prophylaxis after cat bites, as compared with dog bites, the treatment is justified more often. The cat is considered as being a high-risk species for rabies transmission to humans in some European countries: of more than 20,000 inhabitants in Switzerland that had to be vaccinated after exposure to rabies between the 1960s and 1990s, around 70% had been either bitten by, or in close contact with, cats.3 Even if feline rabies is considered a ‘by-product’ of canine or wildlife rabies, feline behavioural characteristics and clinical aspects make it important for public health reasons. In fact, though fewer persons obtain post-exposure prophylaxis after cat bites, as compared with dog bites, the treatment is justified more often.4 Although unvaccinated cats may become infected with rabies following contact with rabid wildlife, such cases have become rare in Western Europe. Instead, most recent cases of terrestrial rabies have been traced to illegally imported, infected pets from rabies-endemic regions of Africa. Veterinary practitioners should therefore remain alert for signs of rabies in cats, even in rabies-free areas. Pathogenesis Rabid animals are the only source of infection. Virus is shed in the saliva some days before the onset of clinical signs and transmitted through a bite or a scratch to the skin or mucous membranes (eyes, nose, mouth). Rabid animals are not viraemic, and their Why is the incubation blood is not infectious. The averperiod so variable? age incubation period in cats is The variability in the incubation period 2 months, but may vary from is explained by the pathogenic behaviour of 2 weeks to several months, or the virus, which moves along peripheral nerves, with the normal axoplasmic flow, from the inocueven years, depending on the transmitted virus dose, lation site to the central nervous system (CNS). The greater the distance from the CNS, the longer the the severity of the wound incubation period; and the greater the density of and its localisation.5,6 This innervation of the inoculated tissue, the shorter the must be taken into account incubation period.7 Very long incubation periods observed in some experimental when evaluating the wound have been cases.8 history, especially when freeroaming cats exhibit sudden behavioural changes and/or signs of motor neuron dysfunction that may herald the clinical phase. The virus replicates in striated muscle and connective tissue at the site of inoculation, and from there enters the peripheral nerves through the neuromuscular junction.9 Alternatively, it can infect peripheral nerves directly, spreading to the CNS via the axonal route. It then travels via the retrograde axonal route to reach the salivary glands, at which time the animal becomes infectious, usually about 3 days before clinical signs appear. Virus becomes widely disseminated throughout the organs. In most cases, death occurs within 5 days – an infected cat will therefore be shedding the virus in saliva for about 8 days in total. Most of the clinical signs are related to central and peripheral nervous system dysfunction, and abnormalities in neurotransmission, rather than to neuronal death.5 Immunity Passive immunity acquired via colostrum Kittens from vaccinated queens obtain maternally derived antibodies (MDA) via the colostrum, their titres depending on both the antibody titre of the queen and the amount of colostrum ingested during the first day of life. In most kittens, MDA will not persist for longer than 12 weeks. Maternally derived antibodies may neutralise vaccine antigens, thereby inhibiting adaptive immunoglobulin production and interfering with the immunisation process during the first weeks of life. It is therefore recommended that vaccination of kittens should not start before 12 weeks of age. Active immune response Rabies virus antigens are highly immunogenic and can elicit the full spectrum of protective immune responses. However, the virus is not very cytopathic – cell lysis hardly occurs during replication and maturation, and little antigen is therefore presented to the immune system. Neither humoral nor cellmediated responses can be detected during the early stages of viral movement from the site of the bite to the CNS.10 Hence, infection of naive animals with rabies virus invariably results in death. Fortunately, this can be averted by prompt post-exposure immunisation, because anti-rabies viral immunity before extensive infection of neurons is protective. Most recent cases of terrestrial rabies in Western Europe have been traced to illegally imported, infected pets from rabies-endemic regions of Africa. Veterinary practitioners should therefore remain alert for signs of rabies in cats, even in rabies-free areas. JFMS CLINICAL PRACTICE 587 Author's personal copy R E V I E W / ABCD guidelines on feline rabies Virus neutralising antibody is crucial in this immunity. Rabies is an example of a ‘Th-2 healing disease’ in which activation of B lymphocytes, with the help of CD4 T cells, mediates protection.11 When activated, primarily by the nucleocapsid (N) protein, CD4 T cells produce cytokines that stimulate B cells to produce antibodies. In contrast, rabiesspecific CD8 T cells cause neuronal damage when a Th-1 response predominates.12,13 However, vaccinated animals without detectable virus neutralising antibody did survive a challenge infection, which hints at still other protective mechanisms.14,15 After intramuscular infection, the virus replicates locally in the myocytes or nervous tissue. In vaccinated cats, the invading virus is neutralised early during the incubation period, whereas unvaccinated cats may produce an antiviral immune response, but too late to prevent disease. Laboratory experiments have shown that protection early after infection is provided by the native immune system, with interferon playing a critical role.16 It is not clear how effective these mechanisms are Clinical signs Typical clinical picture for rabid cats infected with rabies virus History and clinical signs reported by the owner ✜ Dramatic changes from normal behaviour ✜ Very aggressive: biting people and/or animals with no apparent reason General appearance and clinical signs at presentation ✜ 90% of rabid cats show clinical signs of the furious form ✜ Thin body condition (the cat does not eat) ✜ Ruffled and dirty coat (the cat does not clean itself) ✜ Mucous membranes, tongue, nose and footpads are reddish pink (high fever) ✜ The chin and front legs are wet from salivation ✜ Perpetual movement and excitement (restlessness) ✜ Imbalanced gait due to paresis of the hind legs ✜ Pupil dilation unresponsive to light ✜ Abnormal water uptake (water runs back out of mouth) Courtesy of Veera Tepsumethanon a FIG 2 Any aggressive behaviour expressed by a cat should lead to a suspicion of rabies. Courtesy of (a) Andy Sparkes; (b) AFSSA/ERZ b in naturally exposed naive cats. Morbiditydetermining factors include the amount of virus transmitted, the strain, and the age and immunocompetence of the cat. A young, unvaccinated animal that has been bitten severely in the head, with a large saliva deposit in the wound, has a higher risk of developing rabies (with a shorter incubation period) than an adult cat bitten in a limb, especially after extensive bleeding.17 In natural infections, neutralising antibody usually appears after the virus has entered the CNS. Hence, once symptoms are evident, recovery is exceedingly rare.18 However, antibodies to lyssaviruses have been detected occasionally in domestic and wild cats with no history of vaccination, consistent with a non-fatal disease or subclinical infection.19 Clinical signs Any unexplained aggressive behaviour or sudden behavioural change in cats should be considered suspicious (Fig 2). Rabies should be suspected not only when there has been a recent history of a bite or exposure to a rabid animal, but also where a cat has had contact with wildlife, particularly bats. Indeed, a cat in France died of rabies as the result of an infection with bat lyssavirus. However, Rabies should be suspected not only when there has been a recent history of a bite or exposure to a rabid animal, but also where a cat has had contact with wildlife, particularly bats. 588 JFMS CLINICAL PRACTICE Author's personal copy R E V I E W / ABCD guidelines on feline rabies a b c FIG 3 Cats in the paralytic phase of rabies. Note the anisocoria. Courtesy of (a) Artur Borkowski; (b) AFSSA/ERZ; (c) Merial although rabid bats have been reported in the UK, and the Mammal Society has estimated that British cats kill about 230,000 bats a year, no cases of cat rabies are on record.20,21 These findings indicate a low risk of cats becoming infected with lyssaviruses from bats. Two disease manifestations have been identified in cats: the furious and the dumb form. The furious form has three clinical phases (prodromal, mad or psychotic, and paralytic) but these are not always distinct in cats. In the dumb form, the ‘mad’ phase is lacking. During the short (12–48 h) prodromal phases of both forms, non-specific clinical signs (fever, anorexia, vomiting, diarrhoea) occur, sometimes accompanied by neurological signs. Behavioural changes may be the first to be noticed, such as unusually friendly manners, a shy or irritated conduct, or increased vocalisation. These indicate forebrain involvement and are later associated with other neurological signs. Cranial nerve involvement may produce depressed or absent reflexes (palpebral, corneal, pupillary), strabism, dropped jaw, inability to move whiskers forward, dysphagia, laryngeal paralysis, voice change and tongue paralysis (Fig 3). Forebrain Minimising public health risks involvement is The substantial public health risk (particularly for veterinarians) requires that the differential diagnoses for responsible for seizures, mus- CNS diseases characterised by sudden-onset and rapidly evolving clinical signs should always include rabies for freecular twitch- roaming, unvaccinated cats living or travelling in endemic ing or tremors, areas. Indeed, rabies should be included in the differential aimless pac- diagnosis for any cat with suspected encephalitis. Safety ing, exaggerat- must always be the overriding priority. Manipulation and of the cat may provoke biting at a time when the ed emotional restraint salivary glands are already infected. The ABCD stipuresponses (irrilates that the differential diagnosis should be based tability, rage, on the cat’s history (see box on page 590), and observation of the animal inside the fearfulness, photocarrier, with a view to reducing the phobia, attacking risks of exposure to veterinary inanimate objects). personnel. The tendency to bite indiscriminately may be due to loss of inhibitory control by cortical neurons over the subcortical bite reflex; these cats turn and snap at anything that touches them around the mouth, without warning or showing any emotion. Pruritus at the bite site has been observed.22 If a limb was bitten, then neurological signs start from the spinal cord, with an ascending lower motor neuron paralysis occurring before the brain signs. The encephalitis rapidly spreads throughout the CNS producing ataxia, disorientation, paralysis, seizures and status epilepticus, ultimately followed by coma and death from respiratory arrest. The furious form is more often seen in cats, which show behavioural abnormalities, as described above.23 The paralytic phase (paraparesis, incoordination, generalised paralysis, coma and death) usually begins a few days after the first clinical signs. Isolated case reports of rabies survival have been published for cats, dogs and humans, but death usually occurs after a clinical course of 1–10 days.18,24 Cats often die within 3–4 days25 (25% of fatalities occur within 4 days), while progression in dogs is more rapid (2 days).26 Atypical forms with a chronic course have been described in cats after experimental infection.8 Vaccine-induced rabies in cats was observed in the past when modified-live virus vaccines were used. Neurological signs occurred several weeks after vaccination and were characterised mostly by progressive upper motor neuron limb paralysis and cranial nerve deficits. Diagnosis A definitive rabies diagnosis is obtained by post-mortem laboratory investigation. However, serological tests are used for postvaccinal control, especially in the context of international movements. JFMS CLINICAL PRACTICE 589 Author's personal copy R E V I E W / ABCD guidelines on feline rabies Assessing the likelihood of rabies Is the cat from or near to an endemic area, or travelling from there? rabbit tissue culture inoculation test. The mouse inoculation test can be used only if rabbit tissue culture is not available; ✜ PCR is presently not recommended for routine diagnosis but may be useful for epidemiological studies or for confirmatory diagnosis only in reference laboratories. The list of reference experts and laboratories can be found on the OIE website (www.oie.int). NO YES or unknown Does the cat have outdoor access? NO YES or unknown Has the cat been vaccinated against rabies? YES NO or unknown Is the cat less than 1 month of age? YES RABIES UNLIKELY NO or unknown NO Is the cat sick? YES or unknown Has the onset been sudden (<1 day)? YES NO or unknown Have the clinical signs progressed (worsened) in the past 3–5 days? NO YES or unknown Does the cat show at least one of the following clinical signs? ✜ Behavioural changes ✜ Cranial nerve deficits ✜ Seizures ✜ Muscular twitching or tremors ✜ Aimless pacing ✜ Tendency to bite ✜ Lower motor neuron paralysis ✜ Severe ataxia ✜ Depressed sensorium NO YES Adapted from Tepsumethanon et al46 OIE recommendations The following are recommendations from experts at the OIE First International Conference ‘Rabies in Europe’ (Kiev, 15–18 June 2005): ✜ Routine laboratory diagnosis should be undertaken using only the techniques specified by the OIE (Terrestrial Manual) and the WHO (Laboratory Techniques in Rabies); ✜ The fluorescent antibody test is the primary method recommended; 590 JFMS CLINICAL PRACTICE ✜ Confirmation should be based on the RABIES POSSIBLE Virus and antigen detection To confirm rabies in people and animals, only direct virus or antigen detection methods are used. Brain tissue (especially thalamus, pons and medulla) is preferred for post-mortem diagnosis, but other organs (eg, salivary glands) are also used. Samples should be shipped according to the national and international regulations, and care should be taken to avoid contamination. The specimens should be shipped refrigerated for virus isolation or at room temperature in 50% glycerol/ phosphate-buffered saline. ✜ Fluorescent antibody test The fluorescent antibody test (FAT) is recommended by the WHO and OIE for fresh or glycerol samples.27 On fresh samples, FAT provides a reliable diagnosis in 95–99% of all lyssavirus cases; on formalin-fixed tissue the test is less sensitive. It can also be used to detect virus in cell culture and in brain tissue of mice that had been inoculated with homogenates of suspected material. ✜ Immunochemical tests Other suitable methods include immunochemical tests using the avidin–biotin peroxidase system, ELISA, and direct blot enzyme immunoassay. The rapid rabies enzyme immunodiagnosis is an alternative to FAT but detects only the ‘classical’ rabies virus; agreement with the FAT is between 96 and 99%.28 ✜ Inoculation to laboratory animals and cell cultures Inoculation techniques and cell cultures are used to confirm inconclusive results obtained with FAT on organs or negative results when human exposure has been reported. Newborn or 3–4-week-old mice are inoculated intracerebrally, and FAT is used to detect the virus 5–11 days later. Animal inoculation tests should be replaced by cell culture tests, which are as sensitive, less time consuming and ethically acceptable. Rabies virus replicates in mouse neuroblastoma cell lines, and the presence of antigen is revealed by FAT, with results available within 2–4 days. ✜ Histology and immunohistochemistry Histological and immunohistochemical methods to detect Negri bodies are of low sensitivity, especially in autolysed tissues, and are not recommended for routine diagnosis. Author's personal copy R E V I E W / ABCD guidelines on feline rabies ✜ Other direct methods Monoclonal ✜ ELISA ELISA kits for the detection of antibodies, nucleic acid probes or PCR and sequencing can be used by reference laboratories to identify rabies virus, especially some variants. These techniques can distinguish vaccine and field strains and may identify the geographic origin of the strain. antibodies in sera from vaccinated cats and dogs are commercially available. Test results can be obtained within 4 h. The sensitivity and specificity of these tests need to be assessed before they can be officially accepted.29–31 Disease management Antibody detection ✜ Seroneutralisation tests Techniques such as fluorescent antibody virus neutralisation (FAVN) or rapid fluorescent focus inhibition (RFFIT) are widely used. The former test is based on the neutralisation of a given concentration of rabies virus (CVS strain) in vitro before inoculating BHK-21 C13 cells. The antibody concentration is determined by titration; however, it is not expressed as a titre value (reciprocal of serum dilution) but in International Units per millilitre (IU/ml), by comparison with an OIE standard serum of dog origin (OIE Reference Laboratory for Rabies, Nancy, France). A value of 0.5 IU/ml has been defined as the minimum to correlate with immune protection. The two techniques, RFFIT and FAVN, give equivalent results. Va c c i n a t i o n General considerations Post-exposure treatment Post-exposure vaccination of cats depends on the national public health regulations. It is forbidden in many countries and usually not authorised in cases of clinical suspicion. Supportive or specific treatment is ineffective in rabid cats, and treatment is not considered, likewise for public health reasons.7 Preventive vaccination Because of the public health risk, rabies vaccines are core vaccines in countries where rabies is endemic (see box below), and they must be administered in accordance with local or state regulations. In countries without rabies, vaccination is optional; it is recommended if a cat should move into a rabies-endemic area. Core/optional vaccine traditional vaccines: they are innocuous, Because of the public health risk, induce adequate humoral immune responsFeline rabies is controlled mostly by inactivatrabies vaccines are core vaccines in es and do not require rabies virus to be ed vaccines.30 Several products containing countries where rabies is endemic, and they must be administered in accordance with local handled.37 They also induce less inflamthe rabies virus are on the market, which or state regulations. In countries without rabies, mation at the site of injection.41 induce protection after a single injection.33 In vaccination is optional; it is recommended if Fortunately, current vaccines crosscats and dogs, rabies neutralising antibodies the cat should move into a rabies-endemic protect against other lyssaviruses. All cat generally peak between 4–6 weeks after the area. and dog sera containing >5 IU/ml neutralise first immunisation. The available vaccines are EBL-1 and EBL-2, regardless of vaccine/virus very efficient: cats and dogs with neutralisation strain; of sera with values between 0.5–5 IU/ml, values higher than 0.5 IU/ml – regardless of the 87% neutralise EBL-1 and 53% EBL-2 (AR Fooks, time elapsed since vaccination – have a high probapersonal communication). However, depending on the bility of surviving a rabies virus infection. Cats respond genetic distance between novel isolates from bats in Eurasia better than dogs; >97% of cats have been shown to develop antiand ‘classical’ rabies virus, protection may not be sufficient.42 body concentrations *0.5 IU/ml after the first vaccination, many 33 even >5 IU/ml. Only a tiny proportion of cats that succumbed to rabies had a vaccination history of one injection or more.7 Since Primary course In contrast to all other inactivated vaccines, a single rabies vaccina1993, when the new EU regulations on pet movement were put in place, no single case of vaccine failure has been documented.33 tion induces long-lasting immunity. Kittens should be vaccinated at 12–16 weeks of age to avoid Rabies vaccines are generalinterference from MDA, and ly considered to be safe, revaccinated 1 year later even in neonatal kittens. Cats respond better than dogs; >97% of (depending on the data sheet Inactivated vaccines may cats developed antibody concentrations recommendations for the carry a risk of incomplete respective brand of vaccine). virus inactivation, but this is *0.5 IU/ml after the first vaccination, National or regional legislation very small.34 They have also regarding vaccination type and been associated with the many even >5 IU/ml. intervals should be adhered to. development of injection site sarcomas in cats.35 These considerations led to continued efforts to develop safer Booster vaccination rabies vaccines. New products include recombinant subunit pro- Although some vaccines protect against virulent rabies virus teins, recombinant viral vectors and DNA-based vaccines.36–40 challenge for 3 years and upwards, national or local legislation Recombinant live vector vaccines have some advantages over may call for annual boosters.43 JFMS CLINICAL PRACTICE 591 Author's personal copy R E V I E W / ABCD guidelines on feline rabies KEY POINTS ✜ Rabies occurs worldwide, with geographical exceptions. Large regions of Europe are now free of terrestrial rabies as a result of wildlife vaccination programmes. ✜ The cat is considered as being a high-risk species for rabies transmission to humans in some European countries. ✜ Virus is shed in the saliva some days before the onset of clinical signs. ✜ The average incubation period in cats is 2 months, but may vary from 2 weeks to several months, or even years. ✜ Due to the presence of colostral antibodies, it is recommended that vaccination of kittens is not started earlier than 12 weeks of age. ✜ There is a low risk of cats becoming infected with rabies virus or other lyssaviruses from bats. ✜ Two disease manifestations have been identified in cats: the furious and the dumb form. Nearly all rabid cats (90%) show the furious form. ✜ Death usually occurs after a clinical course of 1–10 days. Cats often die within 3–4 days. ✜ Feline rabies is controlled mostly by adjuvanted inactivated vaccines, which induce protection after a single injection. ✜ Cats respond better than dogs, with more than 97% developing antibody concentrations *0.5 IU/ml after the first vaccination. ✜ Kittens should be vaccinated at 12–16 weeks of age and revaccinated 1 year later. ✜ Some vaccines protect against virulent rabies virus challenge for 3 years and upwards, but national or local legislation may call for annual boosters. Disease control in specific situations Shelters In rabies-endemic areas, stray cats should always be approached with caution. Handling and nursing of rescued animals should be considered hazardous, even if they appear healthy. Breeding catteries Breeding catteries are not at risk, because pedigree cats are usually kept strictly indoors; their vaccination may be required under local or state regulation. Immunocompromised cats ✜ Feline leukaemia virus (FeLV) or feline immunodeficiency virus (FIV) positive cats In rabies-endemic areas, FIVseropositive cats should be kept indoors. Though this is an effective preventive measure, national or regional legislation must be adhered to. For outdoor cats with a risk of exposure to rabies virus, vaccination is strongly advised. Feline leukaemia viruspositive cats may not be able to mount adequate immune responses to some rabies vaccines.44 If FeLV-infected cats are allowed to roam in rabies-endemic areas (this is not recommended), more frequent vaccinations (eg, every 6 months) are justified. ✜ Cats with concurrent disease Cats with any acute illness should not be vaccinated. Those with chronic conditions, such 592 JFMS CLINICAL PRACTICE as renal disease, diabetes mellitus or hyperthyroidism, should be vaccinated regularly if they are at risk of exposure. ✜ Cats receiving corticosteroids or other immunosuppressive drugs In cats receiving corticosteroids or other immunosuppressive drugs, the need for vaccination should be considered carefully. Depending on dosage and duration of treatment, corticosteroids may cause functional suppression of (particularly cellmediated) immune responses, but studies for rabies vaccines are lacking. In dogs, corticosteroids do not appear to result in ineffective immunisations if given for short periods at moderate doses.45 In general, concurrent use of corticosteroids and vaccines should be avoided. Acknowledgements The European Advisory Board on Cat Diseases (ABCD) is indebted to Dr Karin de Lange for her judicious assistance in organising this special issue, her efforts at coordination, and her friendly deadline-keeping. The tireless editorial assistance of Christina EspertSanchez is gratefully acknowledged. The groundwork for this series of guidelines would not have been possible without financial support from Merial. The ABCD particularly appreciates the support of Dr Jean-Christophe Thibault, who respected the team’s insistence on scientific independence. Author's personal copy R E V I E W / ABCD guidelines on feline rabies References 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 World Health Organization (WHO). http://www.who.int/ rabies/epidemiology/en/ and http://www.who-rabiesbulletin.org/Queries/Default.aspx. World Health Organization (WHO). Fact sheet on rabies. http://www.who.int/mediacentre/factsheets/fs099/en/ (revised September 2006). Hohl P, Burger R, Vorburger C, Steck F. Zum wiederauftreten der humanen rabies in der Schweiz. Ein kasuistischer Bericht. Schweiz Med Wochenschr 1978; 108: 589–92. Blancou J, Pastoret P-P. La rage du chat et sa prophylaxie. 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