Rabies - Revision history

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			{{Imported}}
	{{short description\|Deadly viral disease}}		{{short description\|Deadly viral disease}}
	{{about\|rabies in humans\|rabies in animals\|Rabies in animals\|other uses\|Rabies (disambiguation)}}{{redirect\|Rabid}}		{{about\|rabies in humans\|rabies in animals\|Rabies in animals\|other uses\|Rabies (disambiguation)}}{{redirect\|Rabid}}

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	Either no or very few cases of rabies are reported each year in Europe; cases are contracted both during travel and in Europe.<ref>{{cite web\|url=http://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-rabies.pdf\|title=SURVEILLANCE REPORT - Annual Epidemiological Report for 2015 - Rabies, ECDC (European Centre for Disease Prevention and Control)\| access-date=30 August 2018}}</ref>		Either no or very few cases of rabies are reported each year in Europe; cases are contracted both during travel and in Europe.<ref>{{cite web\|url=http://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-rabies.pdf\|title=SURVEILLANCE REPORT - Annual Epidemiological Report for 2015 - Rabies, ECDC (European Centre for Disease Prevention and Control)\| access-date=30 August 2018}}</ref>

	In Switzerland the disease was virtually eliminated after scientists placed chicken heads laced with live [[attenuated vaccine]] in the [[Swiss Alps]].<ref name="Grambo"/> The foxes of Switzerland, proven to be the main source of rabies in the country, ate the chicken heads and immunized themselves.<ref name="Grambo"/><ref name="thefactsource.com">{{cite web \|url=https://thefactsource.com/switzerland-rabies-epidemic-air-dropping-chicken-heads/ \|title=Switzerland ended rabies epidemic by air dropping vaccinated chicken heads from helicopters / thefactsource.com \|access-date=2019-12-10\|date=20 November 2019 }}</ref>		In Switzerland the disease was virtually eliminated after scientists placed chicken heads laced with live [[attenuated vaccine]] in the [[Swiss Alps]].<ref name="Grambo"/> The foxes of Switzerland, proven to be the [[Portal:Main\|main]] source of rabies in the country, ate the chicken heads and immunized themselves.<ref name="Grambo"/><ref name="thefactsource.com">{{cite web \|url=https://thefactsource.com/switzerland-rabies-epidemic-air-dropping-chicken-heads/ \|title=Switzerland ended rabies epidemic by air dropping vaccinated chicken heads from helicopters / thefactsource.com \|access-date=2019-12-10\|date=20 November 2019 }}</ref>

	Italy, after being declared rabies-free from 1997 to 2008, has witnessed a reemergence of the disease in wild animals in the [[Triveneto]] regions ([[Trentino-Alto Adige/Südtirol]], [[Veneto]] and [[Friuli-Venezia Giulia]]), due to the spreading of an epidemic in the [[Balkans]] that also affected Austria. An extensive wild animal vaccination campaign eliminated the virus from Italy again, and it regained the rabies-free country status in 2013, the last reported case of rabies being reported in a red fox in early 2011.<ref>{{cite web\|url=http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|title=Rabies in Africa: The RESOLAB network \|date=29 June 2015 \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160803081821/http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|archive-date=3 August 2016 }}</ref><ref>{{cite web\|url=http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|title=Ministero della Salute: "Italia è indenne dalla rabbia". l'Ultimo caso nel 2011 - Quotidiano Sanità \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160603183359/http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|archive-date=3 June 2016 }}</ref>		Italy, after being declared rabies-free from 1997 to 2008, has witnessed a reemergence of the disease in wild animals in the [[Triveneto]] regions ([[Trentino-Alto Adige/Südtirol]], [[Veneto]] and [[Friuli-Venezia Giulia]]), due to the spreading of an epidemic in the [[Balkans]] that also affected Austria. An extensive wild animal vaccination campaign eliminated the virus from Italy again, and it regained the rabies-free country status in 2013, the last reported case of rabies being reported in a red fox in early 2011.<ref>{{cite web\|url=http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|title=Rabies in Africa: The RESOLAB network \|date=29 June 2015 \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160803081821/http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|archive-date=3 August 2016 }}</ref><ref>{{cite web\|url=http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|title=Ministero della Salute: "Italia è indenne dalla rabbia". l'Ultimo caso nel 2011 - Quotidiano Sanità \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160603183359/http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|archive-date=3 June 2016 }}</ref>

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	The symptoms eventually progress to [[delirium]], and [[coma]].<ref name="Robbins" /><ref name="Giesen2015" /> Death usually occurs 2 to 10 days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care.<ref name="Giesen2015" /><ref name="Expert Review of Anti-infective Therapy">{{cite journal \| vauthors = Rupprecht CE, Willoughby R, Slate D \| title = Current and future trends in the prevention, treatment and control of rabies \| journal = Expert Review of Anti-Infective Therapy \| volume = 4 \| issue = 6 \| pages = 1021–38 \| date = December 2006 \| pmid = 17181418 \| doi = 10.1586/14787210.4.6.1021 \| s2cid = 36979186 }}</ref>		The symptoms eventually progress to [[delirium]], and [[coma]].<ref name="Robbins" /><ref name="Giesen2015" /> Death usually occurs 2 to 10 days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care.<ref name="Giesen2015" /><ref name="Expert Review of Anti-infective Therapy">{{cite journal \| vauthors = Rupprecht CE, Willoughby R, Slate D \| title = Current and future trends in the prevention, treatment and control of rabies \| journal = Expert Review of Anti-Infective Therapy \| volume = 4 \| issue = 6 \| pages = 1021–38 \| date = December 2006 \| pmid = 17181418 \| doi = 10.1586/14787210.4.6.1021 \| s2cid = 36979186 }}</ref>

	Rabies has also occasionally been referred to as hydrophobia ("fear of water") throughout its history.<ref>{{cite book\| first1 = A D \| last1 = Cliff \| first2 = Peter \| last2 = Haggett \| first3 = Matthew \| last3 = Smallman-Raynor \| name-list-style = vanc \|title=World atlas of epidemic diseases\|date=2004\|publisher=Arnold\|location=London\|isbn=9780340761717\|page=51\|url=https://books.google.com/books?id=yNVCiNnGVvsC&pg=PA51}}</ref> It refers to a set of symptoms in the later stages of an infection in which the person has difficulty swallowing, shows panic when presented with liquids to drink, and cannot quench their thirst. Any mammal infected with the virus may demonstrate hydrophobia.<ref name="NHS" /> Saliva production is greatly increased, and attempts to drink, or even the intention or suggestion of drinking, may cause excruciatingly painful spasms of the muscles in the throat and [[larynx]]. Since the infected individual cannot swallow saliva and water, the virus has a much higher chance of being transmitted, since it multiplies and accumulates in the [[salivary gland]]s and is transmitted through biting.<ref>{{cite web \|url=http://www.animalswecare.com/home_section/rabies/ \|website=AnimalsWeCare.com \|title=Rabies \|url-status=dead \|archive-url=https://web.archive.org/web/20140903193928/http://www.animalswecare.com/home_section/rabies/ \|archive-date=3 September 2014 }}</ref> Hydrophobia is commonly associated with furious rabies, which affects 80% of rabies-infected people. The remaining 20% may experience a paralytic form of rabies that is marked by muscle weakness, loss of sensation, and paralysis; this form of rabies does not usually cause fear of water.<ref name="NHS">{{cite web\|title=Symptoms of rabies \|url=http://www.nhs.uk/Conditions/Rabies/Pages/Symptoms.aspx \|website=NHS.uk \|access-date=3 September 2014 \|date=12 June 2012 \|url-status=live \|archive-url=https://web.archive.org/web/20140914174652/http://www.nhs.uk/Conditions/Rabies/Pages/Symptoms.aspx \|archive-date=14 September 2014 }}</ref>		Rabies has also occasionally been referred to as hydrophobia ("fear of water") throughout its [[history]].<ref>{{cite book\| first1 = A D \| last1 = Cliff \| first2 = Peter \| last2 = Haggett \| first3 = Matthew \| last3 = Smallman-Raynor \| name-list-style = vanc \|title=World atlas of epidemic diseases\|date=2004\|publisher=Arnold\|location=London\|isbn=9780340761717\|page=51\|url=https://books.google.com/books?id=yNVCiNnGVvsC&pg=PA51}}</ref> It refers to a set of symptoms in the later stages of an infection in which the person has difficulty swallowing, shows panic when presented with liquids to drink, and cannot quench their thirst. Any mammal infected with the virus may demonstrate hydrophobia.<ref name="NHS" /> Saliva production is greatly increased, and attempts to drink, or even the intention or suggestion of drinking, may cause excruciatingly painful spasms of the muscles in the throat and [[larynx]]. Since the infected individual cannot swallow saliva and water, the virus has a much higher chance of being transmitted, since it multiplies and accumulates in the [[salivary gland]]s and is transmitted through biting.<ref>{{cite web \|url=http://www.animalswecare.com/home_section/rabies/ \|website=AnimalsWeCare.com \|title=Rabies \|url-status=dead \|archive-url=https://web.archive.org/web/20140903193928/http://www.animalswecare.com/home_section/rabies/ \|archive-date=3 September 2014 }}</ref> Hydrophobia is commonly associated with furious rabies, which affects 80% of rabies-infected people. The remaining 20% may experience a paralytic form of rabies that is marked by muscle weakness, loss of sensation, and paralysis; this form of rabies does not usually cause fear of water.<ref name="NHS">{{cite web\|title=Symptoms of rabies \|url=http://www.nhs.uk/Conditions/Rabies/Pages/Symptoms.aspx \|website=NHS.uk \|access-date=3 September 2014 \|date=12 June 2012 \|url-status=live \|archive-url=https://web.archive.org/web/20140914174652/http://www.nhs.uk/Conditions/Rabies/Pages/Symptoms.aspx \|archive-date=14 September 2014 }}</ref>

	==Cause==		==Cause==
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	To enter cells, trimeric spikes on the exterior of the membrane of the virus interact with a specific cell receptor, the most likely one being the [[acetylcholine]] receptor. The cellular membrane pinches in a procession known as [[pinocytosis]] and allows entry of the virus into the cell by way of an [[endosome]]. The virus then uses the acidic environment, which is necessary, of that endosome and binds to its membrane simultaneously, releasing its five proteins and single-strand RNA into the cytoplasm.<ref name="CDC_Rabies_PEP" />		To enter cells, trimeric spikes on the exterior of the membrane of the virus interact with a specific cell receptor, the most likely one being the [[acetylcholine]] receptor. The cellular membrane pinches in a procession known as [[pinocytosis]] and allows entry of the virus into the cell by way of an [[endosome]]. The virus then uses the acidic environment, which is necessary, of that endosome and binds to its membrane simultaneously, releasing its five proteins and single-strand RNA into the cytoplasm.<ref name="CDC_Rabies_PEP" />

	Once within a muscle or nerve cell, the virus undergoes replication. The L protein then transcribes five mRNA strands and a positive strand of RNA all from the original negative strand RNA using free nucleotides in the cytoplasm. These five mRNA strands are then translated into their corresponding proteins (P, L, N, G and M proteins) at free ribosomes in the cytoplasm. Some proteins require post-translative modifications. For example, the G protein travels through the rough [[endoplasmic reticulum]], where it undergoes further folding, and is then transported to the [[Golgi apparatus]], where a sugar group is added to it ([[glycosylation]]).<ref name="CDC_Rabies_PEP" />		Once within a muscle or nerve cell, the virus undergoes replication. The L protein then transcribes five mRNA strands and a positive strand of RNA all from the original negative strand RNA using free nucleotides in the cytoplasm. These five mRNA strands are then translated into their corresponding proteins (P, L, N, G and M proteins) at free ribosomes in the cytoplasm. Some proteins require post-translative modifications. For example, the G protein travels through the rough [[endoplasmic reticulum]], where it undergoes [[further]] folding, and is then transported to the [[Golgi apparatus]], where a sugar group is added to it ([[glycosylation]]).<ref name="CDC_Rabies_PEP" />

	When there are enough viral proteins, the viral polymerase will begin to synthesize new negative strands of RNA from the template of the positive-strand RNA. These negative strands will then form complexes with the N, P, L and M proteins and then travel to the inner membrane of the cell, where a G protein has embedded itself in the membrane. The G protein then coils around the N-P-L-M complex of proteins taking some of the host cell membrane with it, which will form the new outer envelope of the virus particle. The virus then buds from the cell.<ref name="CDC_Rabies_PEP" />		When there are enough viral proteins, the viral polymerase will begin to synthesize new negative strands of RNA from the template of the positive-strand RNA. These negative strands will then form complexes with the N, P, L and M proteins and then travel to the inner membrane of the cell, where a G protein has embedded itself in the membrane. The G protein then coils around the N-P-L-M complex of proteins taking some of the host cell membrane with it, which will form the new outer envelope of the virus particle. The virus then buds from the cell.<ref name="CDC_Rabies_PEP" />
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	People who have previously been vaccinated against rabies do not need to receive the immunoglobulin, only the postexposure vaccinations on days 0 and 3.<ref>Park's textbook of Community medicine, 22nd edition, 2013, p 254.</ref> The side effects of modern [[cell-based vaccine]]s are similar to the side effects of flu shots. The old nerve-tissue-based vaccination required multiple injections into the abdomen with a large needle but is inexpensive.<ref name="Ly2009"/> It is being phased out and replaced by affordable World Health Organization intradermal-vaccination regimens.<ref name="Ly2009"/> Intramuscular vaccination should be given into the [[deltoid muscle\|deltoid]], not the [[gluteal muscles\|gluteal area]], which has been associated with vaccination failure{{Citation needed\|date=May 2020}} due to injection into fat rather than muscle. In children less than a year old, the lateral thigh is recommended.<ref>{{cite web\|url=https://www.who.int/ith/vaccines/rabies/en/ \|title=Rabies \|website=www.who.int \|publisher=[[World Health Organization]] \|access-date=1 February 2015 \|url-status=live \|archive-url=https://web.archive.org/web/20150215014809/http://www.who.int/ith/vaccines/rabies/en/ \|archive-date=15 February 2015 }}</ref> Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is effective in reducing the number of viral particles.<ref>{{cite web \|url=http://www.health.vic.gov.au/ideas/bluebook/rabies_info \|title=Rabies & Australian bat lyssavirus information sheet \|publisher=Health.vic.gov.au \|access-date=2012-01-30 \|url-status=dead \|archive-url=https://web.archive.org/web/20110818081218/http://www.health.vic.gov.au/ideas/bluebook/rabies_info \|archive-date=18 August 2011 }}</ref> [[Povidone-iodine]] or alcohol is then recommended to reduce the virus further.<ref>{{cite web \|author1=National Center for Disease Control \|title=National Guidelines on Rabies Prophylaxis \|url=http://nicd.nic.in/Rabies_guidelines2014.pdf \|access-date=5 September 2014 \|year=2014 \|url-status=dead \|archive-url=https://web.archive.org/web/20140905235321/http://nicd.nic.in/Rabies_guidelines2014.pdf \|archive-date=5 September 2014 }}</ref>		People who have previously been vaccinated against rabies do not need to receive the immunoglobulin, only the postexposure vaccinations on days 0 and 3.<ref>Park's textbook of Community medicine, 22nd edition, 2013, p 254.</ref> The side effects of modern [[cell-based vaccine]]s are similar to the side effects of flu shots. The old nerve-tissue-based vaccination required multiple injections into the abdomen with a large needle but is inexpensive.<ref name="Ly2009"/> It is being phased out and replaced by affordable World Health Organization intradermal-vaccination regimens.<ref name="Ly2009"/> Intramuscular vaccination should be given into the [[deltoid muscle\|deltoid]], not the [[gluteal muscles\|gluteal area]], which has been associated with vaccination failure{{Citation needed\|date=May 2020}} due to injection into fat rather than muscle. In children less than a year old, the lateral thigh is recommended.<ref>{{cite web\|url=https://www.who.int/ith/vaccines/rabies/en/ \|title=Rabies \|website=www.who.int \|publisher=[[World Health Organization]] \|access-date=1 February 2015 \|url-status=live \|archive-url=https://web.archive.org/web/20150215014809/http://www.who.int/ith/vaccines/rabies/en/ \|archive-date=15 February 2015 }}</ref> Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is effective in reducing the number of viral particles.<ref>{{cite web \|url=http://www.health.vic.gov.au/ideas/bluebook/rabies_info \|title=Rabies & Australian bat lyssavirus information sheet \|publisher=Health.vic.gov.au \|access-date=2012-01-30 \|url-status=dead \|archive-url=https://web.archive.org/web/20110818081218/http://www.health.vic.gov.au/ideas/bluebook/rabies_info \|archive-date=18 August 2011 }}</ref> [[Povidone-iodine]] or alcohol is then recommended to reduce the virus further.<ref>{{cite web \|author1=National Center for Disease Control \|title=National Guidelines on Rabies Prophylaxis \|url=http://nicd.nic.in/Rabies_guidelines2014.pdf \|access-date=5 September 2014 \|year=2014 \|url-status=dead \|archive-url=https://web.archive.org/web/20140905235321/http://nicd.nic.in/Rabies_guidelines2014.pdf \|archive-date=5 September 2014 }}</ref>

	Awakening to find a bat in the room, or finding a bat in the room of a previously unattended child or mentally disabled or intoxicated person, is an indication for [[post-exposure prophylaxis]] (PEP). The recommendation for the precautionary use of PEP in bat encounters where no contact is recognized has been questioned in the medical literature, based on a [[cost–benefit analysis]].<ref>{{cite journal \| vauthors = De Serres G, Skowronski DM, Mimault P, Ouakki M, Maranda-Aubut R, Duval B \| title = Bats in the bedroom, bats in the belfry: reanalysis of the rationale for rabies postexposure prophylaxis \| journal = Clinical Infectious Diseases \| volume = 48 \| issue = 11 \| pages = 1493–9 \| date = June 2009 \| pmid = 19400689 \| doi = 10.1086/598998 \| doi-access = free }}</ref> However, a 2002 study has supported the protocol of precautionary administering of PEP where a child or mentally compromised individual has been alone with a bat, especially in sleep areas, where a bite or exposure may occur with the victim being unaware.<ref>{{cite journal \| vauthors = Despond O, Tucci M, Decaluwe H, Grégoire MC, S Teitelbaum J, Turgeon N \| title = Rabies in a nine-year-old child: The myth of the bite \| journal = The Canadian Journal of Infectious Diseases \| volume = 13 \| issue = 2 \| pages = 121–5 \| date = March 2002 \| pmid = 18159381 \| pmc = 2094861 \| doi = 10.1155/2002/475909 }}</ref>		Awakening to find a bat in the room, or finding a bat in the room of a previously unattended child or mentally disabled or intoxicated person, is an indication for [[post-exposure prophylaxis]] (PEP). The recommendation for the precautionary use of PEP in bat encounters where no contact is recognized has been questioned in the medical [[literature]], based on a [[cost–benefit analysis]].<ref>{{cite journal \| vauthors = De Serres G, Skowronski DM, Mimault P, Ouakki M, Maranda-Aubut R, Duval B \| title = Bats in the bedroom, bats in the belfry: reanalysis of the rationale for rabies postexposure prophylaxis \| journal = Clinical Infectious Diseases \| volume = 48 \| issue = 11 \| pages = 1493–9 \| date = June 2009 \| pmid = 19400689 \| doi = 10.1086/598998 \| doi-access = free }}</ref> However, a 2002 study has supported the protocol of precautionary administering of PEP where a child or mentally compromised individual has been alone with a bat, especially in sleep areas, where a bite or exposure may occur with the victim being unaware.<ref>{{cite journal \| vauthors = Despond O, Tucci M, Decaluwe H, Grégoire MC, S Teitelbaum J, Turgeon N \| title = Rabies in a nine-year-old child: The myth of the bite \| journal = The Canadian Journal of Infectious Diseases \| volume = 13 \| issue = 2 \| pages = 121–5 \| date = March 2002 \| pmid = 18159381 \| pmc = 2094861 \| doi = 10.1155/2002/475909 }}</ref>

	{{anchor\|Jeanna Giese}}		{{anchor\|Jeanna Giese}}

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	Either no or very few cases of rabies are reported each year in Europe; cases are contracted both during travel and in Europe.<ref>{{cite web\|url=http://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-rabies.pdf\|title=SURVEILLANCE REPORT - Annual Epidemiological Report for 2015 - Rabies, ECDC (European Centre for Disease Prevention and Control)\| access-date=30 August 2018}}</ref>		Either no or very few cases of rabies are reported each year in Europe; cases are contracted both during travel and in Europe.<ref>{{cite web\|url=http://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-rabies.pdf\|title=SURVEILLANCE REPORT - Annual Epidemiological Report for 2015 - Rabies, ECDC (European Centre for Disease Prevention and Control)\| access-date=30 August 2018}}</ref>

	In Switzerland the disease was virtually eliminated after scientists placed chicken heads laced with live [[attenuated vaccine]] in the [[Swiss Alps]].<ref name="Grambo"/> The foxes of Switzerland, proven to be the main source of rabies in the country, ate the chicken heads and immunized themselves.<ref name="Grambo"/><ref name="thefactsource.com">{{cite web \|url=https://thefactsource.com/switzerland-rabies-epidemic-air-dropping-chicken-heads/ \|title=Switzerland ended rabies epidemic by air dropping vaccinated chicken heads from helicopters / thefactsource.com \|access-date=2019-12-10\|date=20 November 2019 }}</ref>		In Switzerland the disease was virtually eliminated after scientists placed chicken heads laced with live [[attenuated vaccine]] in the [[Swiss Alps]].<ref name="Grambo"/> The foxes of Switzerland, proven to be the [[Portal:Main\|main]] source of rabies in the country, ate the chicken heads and immunized themselves.<ref name="Grambo"/><ref name="thefactsource.com">{{cite web \|url=https://thefactsource.com/switzerland-rabies-epidemic-air-dropping-chicken-heads/ \|title=Switzerland ended rabies epidemic by air dropping vaccinated chicken heads from helicopters / thefactsource.com \|access-date=2019-12-10\|date=20 November 2019 }}</ref>

	Italy, after being declared rabies-free from 1997 to 2008, has witnessed a reemergence of the disease in wild animals in the [[Triveneto]] regions ([[Trentino-Alto Adige/Südtirol]], [[Veneto]] and [[Friuli-Venezia Giulia]]), due to the spreading of an epidemic in the [[Balkans]] that also affected Austria. An extensive wild animal vaccination campaign eliminated the virus from Italy again, and it regained the rabies-free country status in 2013, the last reported case of rabies being reported in a red fox in early 2011.<ref>{{cite web\|url=http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|title=Rabies in Africa: The RESOLAB network \|date=29 June 2015 \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160803081821/http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|archive-date=3 August 2016 }}</ref><ref>{{cite web\|url=http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|title=Ministero della Salute: "Italia è indenne dalla rabbia". l'Ultimo caso nel 2011 - Quotidiano Sanità \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160603183359/http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|archive-date=3 June 2016 }}</ref>		Italy, after being declared rabies-free from 1997 to 2008, has witnessed a reemergence of the disease in wild animals in the [[Triveneto]] regions ([[Trentino-Alto Adige/Südtirol]], [[Veneto]] and [[Friuli-Venezia Giulia]]), due to the spreading of an epidemic in the [[Balkans]] that also affected Austria. An extensive wild animal vaccination campaign eliminated the virus from Italy again, and it regained the rabies-free country status in 2013, the last reported case of rabies being reported in a red fox in early 2011.<ref>{{cite web\|url=http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|title=Rabies in Africa: The RESOLAB network \|date=29 June 2015 \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160803081821/http://www.izsvenezie.com/rabies-in-africa-the-resolab-network/ \|archive-date=3 August 2016 }}</ref><ref>{{cite web\|url=http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|title=Ministero della Salute: "Italia è indenne dalla rabbia". l'Ultimo caso nel 2011 - Quotidiano Sanità \|access-date=2016-04-18 \|url-status=live \|archive-url=https://web.archive.org/web/20160603183359/http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=13650 \|archive-date=3 June 2016 }}</ref>