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we calculated the risk that a given pet in western europe is contagious for rabies on a given day by the equation   we describe factors associated with rabid pets ( https://zenodo.org/record/49670 # ) and define pet transport as any noncommercial movement of a live cat , dog , or ferret and its owner or an authorized person across an administrative border . during 20012013 ,
a total of 21 animal rabies cases attributed to pets from rabies - enzootic countries were reported in western europe ( https://zenodo.org/record/49670 # ) , which represented 1.6 pets / year and 23 days / year of potential contagiousness .
all owners except 1 ( a spanish man living in a van ) were official residents of western europe .
circumstances that led to pet examination and rabies diagnosis were clinical suspicion ( 14 pets ) , bitten humans ( 3 pets ) , border quarantine ( 2 pets ) , and retrospective data ( 2 pets with indigenous secondary cases during the alert in france in 2008 ) .
average contagious period was 16 days / pet : 14 days in western europe ( 8 days without signs of rabies and 6 days with signs of rabies ) and 2 days before arriving in western europe . for 1 dog , signs of rabies appeared before the animal entered western europe .
for each rabid animal , an average of 34 ( range 0187 ) persons and other animals received peps .
the maximum value of this range corresponds to an alert in france in 2004 . after this alert ,
human and pet vaccinations led to vaccine shortages that required importing of vaccines not authorized for use in france ( 5 ) .
we identified animal origin and mode of entry into western europe ( table 1 ) .
three cases were imported from eastern europe to germany , 1 from the gambia to france , and 1 from sri lanka to the united kingdom .
customs officials could not identify any of 11 cases in animals transported mainly by road ( e.g. , after a ferry trip from morocco to spain , portugal , or france ) .
seven pets were transported through other countries in western europe before arriving in the country of diagnosis ( https://zenodo.org/record/49670 # ) .
six puppies and 1 kitten were transported by air , of which only 2 were identified by customs officials ( in the united kingdom and germany ) . * na , not applicable . 
we considered only countries in western europe with a population > 1 million persons . 
pa , calculated risk that a given pet is rabid on a given day in a country in western europe relative to pet transport .   pac , calculated risk that a given cat is rabid on a given day in a country in western europe relative to pet transport . 
pad , calculated risk that a given dog is rabid on a given day in a country in western europe relative to pet transport .  # pad was lower if the dog had no signs of rabies ( 9.25 x 101.03 x 10 for dogs with no signs of rabies and 6.44 x 106.44 x 10 for dogs with signs of rabies assuming that 90%99.99% had no signs of rabies on a given day ) . of 19 transported rabid pets , 8 ( 42% ) had no rabies vaccination , pet passport , or health certificate . only 6 were vaccinated ( 0/2 infected in france , 3/3 imported but raised in western europe , 3/7 imported by air , and 0/8 imported by road ) .
most vaccinated pets did not comply with recommended age for vaccination ( > 12 weeks of age ) or time between vaccination , serologic analysis , and transport .
no reports mentioned valid rabies serologic analysis included in european pet movement policy ( figure ) for unlisted third countries ( e.g. , morocco , the gambia , sri lanka , or azerbaijan ) ( 6 ) .
using data for 20012013 , we calculated that , for contact on a given day with a pet in western europe , the probability of the pet being contagious for rabies attributed to pet transport was 7.52  10 ( table 2 ) .
576/2013 , http://eur-lex.europa.eu/legal-content/en/txt/?uri=celex:32013r0576 ) on movement of cats , dogs , and ferrets , 20032013 .
before 2003 , national rules applied ( e.g. , animal checked at destinations , rabies vaccination , animal identification , quarantine , health certification ) .
a health certificate provided by an official veterinarian is mandatory for pets transported from outside the eu . we observed a significant correlation between number of contagious days for dogs in a country and number of tourists traveling from this country to morocco (  =  0.73 , p = 0.017 ) .
we found no correlation with other variables tested ( total dog population , dog population density , number of dogs per inhabitant ) .
risk for indigenous rabies has decreased in western europe . during 20012013 , because of appropriate control of imported rabid pets , only 4 indigenous cases of human rabies were reported ( 3 in recipients of organs from a donor infected in india and 1 from a rabid bat in scotland ) ( https://zenodo.org/record/49670 # ) . since 2011 ,
no indigenous rabies cases have been reported in terrestrial mammals in western europe . because of increased travel ( 7 ) , rabies imported by trips to rabies - enzootic countries has increased , and travel became the main source of rabies in humans ( 1.46 patients / year ) ( 8) and pets ( 1.6 rabid pets / year ) in 20012013 .
however , because of improved surveillance , although the number of imported rabies cases increased , the number of secondary cases decreased ( https://zenodo.org/record/49670 # ) .
illegal importation of rabid animals is not limited to western europe ( 9 ) or dogs and cats ( 10 ) .
this finding highlights the need for a global approach for regulation of animal movement worldwide and strengthening real - time reporting for animal and human rabies .
risk for dog rabies being reintroduced into the european union from morocco was estimated as 0.21 cases / year ( 11 ) .
however , we estimate that 1.1 pets / year are entering western europe after being infected in morocco .
morocco has become the main source of pet rabies in western europe , often through ceuta and melilla ( spanish enclaves in northern morocco ) .
because no prophylaxis or specific vaccinations are needed for travel to northern africa , few travelers seek pretravel advice and most have little knowledge of pet rabies ( 12,13 ) .
lack of awareness also increases importation of human rabies . despite an efficient policy for preventing entry of rabid pets ,
the united kingdom reported the highest number of patients with imported rabies during the study period ( https://zenodo.org/record/49670 # ) .
patients returning to this country did not believe that a correct pep was needed after exposure abroad .
none of the transported rabid pets fully satisfied european pet movement policy , which raised questions about how to improve the current regulation application .
increasing international travel , expansion of the schengen area ( 26 countries in europe that have a common visa policy ) into rabies - enzootic countries in eastern europe , and development of internet animal trade ( source of illegal importation ) ( 14 ) are new challenges for ensuring compliance . because bat rabies is more difficult to control than dog rabies , and some developing countries still have difficulties controlling rabies , eradication of rabies is not a realistic objective .
awareness should be increased , and current regulations for pet transport should be applied to reduce rabies importation and ensure that risk in western europe remains low . to avoid unnecessary and costly pep and optimize resource allocation ,
it should be clearly stated which who recommendations , public health england recommendations , or other practices most relevant after pet exposure should be applied .
low risks ( < 10-6 ) are usually considered acceptable or essentially 0 ( 3,15 ) . the risk of a fatal car crash while traveling to pep consultations was higher than the risk of rabies after exposure to a pet in france in 20012011 ( 3 ) .
the most pertinent policy in areas at low risk for rabies is probably that of the united kingdom ( i.e. , no pep outside alert areas that do not have asymptomatic animals or exposure to bats ) ( https://zenodo.org/record/49670 # ) .
in 2015 , countries in western europe were declared free of rabies in nonflying mammals . 
 surveillance data for 20012013 indicate that risk for residual rabies is not 0 because of pet importation from countries with enzootic rabies . 
 however , the risk is so low ( 7.52  1010 ) that it probably can be considered negligible .