Human rabies in Avignon, France, following exposure in Morocco, 2025

In early 2025, a patient died in the South of France with confirmed rabies following a dog bite while traveling in Morocco to visit relatives. This report summarizes the patient's clinical course and the subsequent public health investigation.

Demographics, epidemiological, and medical data from the infected patient and from contacts at risk of exposure were retrospectively retrieved from medical files.

The patient presented with fever, cardiac and neurological symptoms. Initial clinical presentation mimicking psychiatric disorders and suggesting a myocarditis led to multiple exposures of family members and health care workers (HCWs). Rabies virus was retrieved from saliva, skin biopsy, and post-mortem brain biopsy. A total of 44 potentially exposed persons were identified among family and community contacts and among HCWs who cared for the patient, and received rabies post-exposure prophylaxis (RPEP). Most family members shared food and drinks with the patient, notably during a large family meal with potential mucosal exposure to infected saliva. Several HCWs had a contact with the patient's body fluids without application of standard of isolation precautions.

Recommendations for RPEP in contacts with a human rabies case differ between countries, and practices differ between teams. The dramatic nature of the disease often leads to irrational fear that may compromise the strict application of recommendations. Travelers to North African countries, including those visiting friends and relatives should be informed about the risk for rabies when injured by dogs or cats and about the need to receive an adequate RPEP.