Epidemiological Profiles of Human Rabies Cases in Tunisia Between 2000 and 2022
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Collection
- −
- Protocol A1: Day 0 (D0): Rabies Immunoglobulin (RIG) by wound infiltration +1 dose Rabies Vaccine (RV) via IntraMuscular Route, D3: 1 RV, D7: depends on animal observation
- −
- Protocol A2: D0: 2 doses RV, D7: depends on animal observation
- −
- Protocol B1: D0: RIG + 1 RV, D3: 1 RV, D7: 1 RV, D14: 1 RV, D28: 1 RV
- −
- Protocol B2: D0: 2 RV, D7: 1 RV, D21: 1 RV
2.2. Data Analysis
2.3. Statistical Analysis
3. Results
3.1. Epidemiological Profile of Human Rabies in Tunisia (2000–2022)
3.1.1. Temporal Distribution of Human Rabies
- Incidence and Annual Distribution
- Seasonality
- Monthly Distribution
3.1.2. Geographic Distribution of Human Rabies
- By Governorates
- By Type of Environment
3.1.3. Sociodemographic Distribution of Human Rabies
- Gender
- Age
- Gender and Age
3.1.4. Distribution of Human Rabies by Characteristics of the Exposing Animal
- Animal Species
- Presence or Absence of an Owner
- Outcome of the Exposing Animal
3.2. Clinical Profile of Human Rabies During the Period 2000–2022
3.2.1. Distribution of Human Rabies According to Clinical Characteristics
- Nature and Site of Contact with the Exposing Animal
- Nature, Site of Exposure, and Age of Affected Patients
- Incubation Period of Human Rabies
- Incubation Period and Site of Contact with the Exposing Animal
- Clinical Manifestations of Human Rabies
3.2.2. Post-Exposure Measures
- Wound Washing and Disinfection
- Healthcare Facility Consultation
- Utilization of Post-Exposure Prophylaxis (PEP)
- Time Interval Between Exposure and Post-Exposure Prophylaxis Administration
- Post-Exposure Prophylaxis Protocol
3.2.3. Disease Progression and Outcome
- Time from Symptom Onset to Death
- Laboratory Diagnosis
- Time from Clinical Diagnosis to Sample Collection
- Time from Sample Collection to Laboratory Confirmation
4. Discussion
4.1. Temporal Distribution
4.2. Geographical Distribution
4.3. Characteristics of Exposed Patients
4.4. Characteristics of the Exposing Animal
4.5. Clinical Characteristics
4.6. Post-Exposure Prophylaxis (PEP)
4.7. Response and Diagnostic Challenges
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CSF | CerebroSpinal Fluid |
FAO | Food and Agriculture Organization |
FAT | Fluorescent Antibody Test |
FAVN | Fluorescent Antibody Virus Neutralization test |
GARC | Global Alliance for Rabies Control |
IBCM | Integrated Bite Case Management |
IPT | Pasteur Institute in Tunis |
PEP | Post-Exposure Prophylaxis |
RFFIT | Rapid Fluorescent Focus Inhibition Test |
RIG | Rabies ImmunoGlobulin |
RTCIT | Rabies Tissue Culture Infection Test |
RT-PCR | Reverse-Transcription Polymerase Chain Reaction |
RV | Rabies Vaccine |
WHO | World Health Organization |
WOAH | World Organization of Animal Health |
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Nature of Exposure | Cases Number (%) |
---|---|
Single bite | 32/58 (55%) |
Bites and scratches | 12/58 (20%) |
Scratches | 5/58 (9%) |
Multiple bites | 3/58 (5%) |
Handling of a sick animal | 1/58 (2%) |
Unknown (not apparent or not reported) | 5/58 (9%) |
Site of Exposure | Cases Number (%) |
Head, neck | 11/58 (19%) |
Upper limbs | 9/58 (16%) |
Lower limbs | 2/58 (3%) |
Multiple sites | 1/58 (2%) |
Unknown (not apparent or not reported) | 35/58 (60%) |
Clinical Sign | Cases Number (%) |
---|---|
Hydrophobia | 34/51 (67%) |
Behavioral disturbances | 33/51 (65%) |
Fever | 18/51 (35%) |
Altered consciousness, coma | 11/51 (22%) |
Vomiting | 11/51 (22%) |
Aerophobia | 9/51(18%) |
Psychiatric symptoms (hallucinations, anxiety disorders, insomnia) | 9/51 (18%) |
Hypersalivation | 7/51 (14%) |
Paresthesia, paralysis, pain at exposure site | 7/51 (14%) |
Dysphagia | 6/51 (12%) |
Dyspnea | 5/51 (10%) |
Asthenia | 4/51 (8%) |
Chest–abdominal pain | 4/51 (8%) |
Headache | 3/51 (6%) |
Arthralgia, myalgia | 3/51 (6%) |
Photophobia | 3/51 (6%) |
Tremors | 2/51 (3%) |
Cutaneous hyperesthesia | 1/51 (2%) |
Convulsions | 1/51 (2%) |
Conjunctival hyperemia | 1/51 (2%) |
Hematemesis | 1/51 (2%) |
Vertigo | 1/51 (2%) |
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Ayachi, A.; Benabdallah, R.; Bouratbine, A.; Aoun, K.; Bensalem, J.; Basdouri, N.; Benmaiz, S.; Bassalah, F.; Nouioui, C.; Soltani, M.; et al. Epidemiological Profiles of Human Rabies Cases in Tunisia Between 2000 and 2022. Viruses 2025, 17, 966. https://doi.org/10.3390/v17070966
Ayachi A, Benabdallah R, Bouratbine A, Aoun K, Bensalem J, Basdouri N, Benmaiz S, Bassalah F, Nouioui C, Soltani M, et al. Epidemiological Profiles of Human Rabies Cases in Tunisia Between 2000 and 2022. Viruses. 2025; 17(7):966. https://doi.org/10.3390/v17070966
Chicago/Turabian StyleAyachi, Amal, Rym Benabdallah, Aida Bouratbine, Karim Aoun, Jihen Bensalem, Nourhen Basdouri, Samia Benmaiz, Farah Bassalah, Chaima Nouioui, Mohamed Soltani, and et al. 2025. "Epidemiological Profiles of Human Rabies Cases in Tunisia Between 2000 and 2022" Viruses 17, no. 7: 966. https://doi.org/10.3390/v17070966
APA StyleAyachi, A., Benabdallah, R., Bouratbine, A., Aoun, K., Bensalem, J., Basdouri, N., Benmaiz, S., Bassalah, F., Nouioui, C., Soltani, M., Ghouili, K., Bouslema, Z., Kharmechi, H., & Handous, M. (2025). Epidemiological Profiles of Human Rabies Cases in Tunisia Between 2000 and 2022. Viruses, 17(7), 966. https://doi.org/10.3390/v17070966