Miscellaneous articles

Non-travel-related monkey bites in Marseille, France

P. Gautret¹ , E. Adehossi², J.-C. Gérard³, and P. Parola¹ 

¹Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France; philippe.gautret@club-internet.fr
²Faculté des Sciences de la Santé, Université de Niamey, Niger.
³Espace Zoologique, 42800 Saint Martin La Plaine, France.

 

On 01/07/2008, a 19 year-old woman while walking along the streets in Marseille, was attacked by a free roaming monkey which ran away after biting her. She took a picture of the animal with her mobile phone and noticed that the animal had a necklace and a lead. She consulted her general practitioner and was referred to the Rabies Vaccination Centre, 2 days later. On admission, she presented 4 minor wounds on her arms, one foot and her face. The wounds were washed and disinfectant was applied on the day of injury. Amoxicillin-clavulanic acid based antibiotherapy was ongoing. Rabies post exposure prophylaxis (PEP) by vaccination only was applied with a 2.1.1 intra-muscular regimen, using Vero-cell cultured vaccine. The patient remained well over the 3 month-follow up. On examination of the picture, the monkey was identified as a young Barbary macaque (Macaca sylvanus). On 10/07/2008, a 2 year-old female Barbary macaque with necklace and lead was captured on a Marseille beach and transferred to a zoo on 17/07/2008 (figure 1). The monkey’s clinical examination was normal and the animal remained safe over the 3 following months. Serologic test for rabies resulted positive (7.92 UI/ml) suggesting that the animal had been very likely vaccinated previously against rabies, given its absence of neurological symptoms and the high titre of antibodies. However antibodies resulting from a preventive vaccination cannot be distinguished from antibodies resulting from rabies infection and the animal was therefore kept under quarantine for 6 month duration to comply with French legislation. Serologic tests against common viruses in macaques were performed. They were not reactive for herpes B virus (Cercopithecine Herpesvirus 1), hepatitis A and B viruses, simian immunodeficiency virus (SIV), simian T-cell lymphotrophic virus and type D retrovirus (SRV). Like hepatitis A and B viruses, herpes B virus, SIV and SRV can infect humans.

Discussion

Rabies cases in humans resulting from transmission by rabid non-human primate (NHP) are rare [1-3] but 8 human fatal rabies cases related to Brazilian white-tufted-ear rabid marmoset-related injuries (Callithrix jacchus) were recently published [4]. WHO and CDC provide no guidelines regarding rabies PEP following NHP-related injuries. We consider that NHP living in rabies endemic countries could potentially be infected by the rabies virus. A rabies PEP treatment should be offered when the involved animal cannot be kept under veterinarian surveillance or tested for rabies. This is in accordance with practice in canine rabies-endemic areas where NHP-related injuries are common [5,6]. Barbary macaque is a unique species that occurs in Morocco and Algeria and settled a colony in Gibraltar. Therefore, the Marseille monkey had been very likely imported from these countries which are endemic for rabies.

A total of 50 patients injured by NHP were seen in our centre from March 2001 through December 2008, involving travellers injured abroad in 83% of cases. Among NHP-related injuries acquired abroad, 33% occurred in Thailand, 20% in other Asian countries, 32% in sub-Saharan Africa, 10% in North Africa and 5% in Latin America. Ten cases were acquired near Marseille involving principally pet-Barbary macaques from Morocco and pet-capuchin monkeys from Brazil.

We report here the first fully documented case of monkey-related injury occurring in Marseille where free-roaming NHP are not expected. The Barbary Macaque has been facing a decline in numbers over recent decades, fuelled in large part by their demand for the illegal pet trade. An estimated 300 animals are caught from the wild annually for the illegal trade into Europe, mainly in Morocco. Although most of the trade concerns France, it exists in several other European countries such as Belgium, Germany, the Netherlands and Italy [7]. Barbary macaque have never been found infected with B virus [8], a naturally occurring infectious agent that is endemic among macaque monkeys from Asia [9] but is naturally infected with simian foamy virus which does not seem to cause any illness in humans [8].

Conclusion

NHP account for 20% of animal-related injuries in travellers [10] and the illegal introduction of exotic monkey-pets in Europe will contribute to expose the population to increasing monkey-human interactions and potential dangerous zoonosis transmission like rabies and herpes B virus infection.

References

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2. Centers for Diseases Control (CDC). Imported human rabies--Australia, 1987.  MMWR Morb Mortal Wkly Rep. 1988 Jun 10; 37(22):351-3.

3. Summer R, Ross S, Kiehl W. Imported case of rabies in Germany from India. Euro Surveill. 2004;8: 2585.

4. Favoretto SR, de Mattos CC, Morais BB, Alves FA, Araujo AA, de Mattost CA. Rabies in Marmosets (Callithrix jacchus), Ceara, Brazil. Emerg Infect Dis. 2001;7:1062-1065.

5. Pandey P, Shlim D, Cave W, Springer MFB. Risk of possible exposure to rabies among tourist and foreign visitors in Nepal. J Travel Med. 2002; 9: 127-131.

6. Sriaroon C, Jaijaroensup W, Tantawichien T, Benjawongkunchai M, Supich C, Wilde H. Common dilemmas in managing rabies exposed subjects. Travel Med Infect Dis. 2005;3:1-7.

7. van Lavieren E. The illegal trade in Barbary macaques from Morocco and its impact on the wild population. Traffic bull. 2008; 21:81-88. Available from www.traffic.org/bulletin/

8. Engel GA, Pizarro M, Shaw E, Cortes J, Fuentes A, Barry P, Lerche N, Grant R, Cohn D, Jones-Engel L. Unique Pattern of Enzootic Primate Viruses in Gibraltar Macaques. Emerg Infect Dis. 2008;14:1112-1115.

9. Cohen JI, Davenport DS, Stewart JA, Deitchman S, Hilliard JK, Chapman LE; B Virus Working Group. Recommendations for prevention of and therapy for exposure to B virus (cercopithecine herpesvirus 1). Clin Infect Dis. 2002;35:1191-203.

10. Gautret P, Schwartz E, Shaw M, Soula G, Gazin P, Delmont J, Parola P, Soavi MJ, Matchettt E, Brown G and Torresi J. Animal-associated injuries and related diseases among returned travelers: A review of the GeoSentinel Surveillance Network. Vaccine. 2007; 25:2656-2663.

Acknowledgements

We thank the Société Française de Primatologie (http://www-sfdp.u-strasbg.fr/) for the identification and localization of the monkey.

Contents of this Bulletin

• The Journal
• Editorial
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• Surveillance of Rabies
• Rabies Dynamics
• Trend Tables
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