Rabies in South Africa

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World Rabies Day is celebrated every year on September 28, to raise awareness and strengthen the commitment to strategic interventions for the elimination of human rabies in endemic countries by the year 2030. Rabies is a deadly disease, and more often affect poor and vulnerable communities, claiming 59 000 human lives globally per year. This implies that a person dies of rabies every ten minutes in affected countries.

In South Africa, a total of 13 human rabies cases have been confirmed in 2018 and to date, of which seven cases were from KwaZulu-Natal Province and six from the Eastern Cape Province. Two additional cases from Eastern Cape could not be confirmed through laboratory testing, but are considered probable cases.  This represents the highest number of cases reported in South Africa in the past ten years. The rise in the number of human rabies cases is associated with the outbreak of rabies in dogs in the KwaZulu-Natal and Eastern Cape Provinces.

Rabies is a zoonotic disease which means it is spread from animals to humans. Domestic dogs are most responsible for transmission of the virus to humans. The virus affects the brain and it is transmitted through direct animal contact involving scratches, bites or licks on mucous membranes of the lips or eyes. Importantly, transmission cannot happen through intact skin, meaning that touching, petting or being close to animals is not a risk factor for transmission. It is important to remember that animals also get sick from rabies, and animals that transmit rabies are ill and would exhibit strange behaviours (such as a friendly pet becoming aggressive).

Rabies can be prevented, but not treated. Rabies can be controlled in dogs (and cats) through rabies vaccination. This does not only provide protection to the animal but will ensure that the animal cannot contract the disease and spread it to other animals or humans. Where rabies is still reported from animals (most importantly dogs), rabies infection can be prevented through post-exposure prophylaxis. This includes thorough washing (with soap and water) of wounds and the provision of rabies vaccine and rabies antibody therapy. Rabies post-exposure prophylaxis is lifesaving.  Importantly, none of the human cases confirmed in South Africa this year sought medical intervention after being bitten by a dog or cat. Creating awareness of the risks of rabies is crucial in dog-rabies affected communities.

The World Health Organisation’s (WHO) Global Strategic Plan set three objectives for affected countries, development partners, and key stakeholders: (1) to effectively use vaccines, medicines, tools, and technologies that will stop dog rabies transmission and reduce the risk of human rabies deaths; (2) to generate evidence-based guidance and high-quality data to measure impact and inform policy decisions; and (3) to harness multi-stakeholder engagement to sustain commitment and resources.

The National Institute for Communicable Diseases recognises the importance of public health information sharing through laboratory-based findings and outbreaks management. Thus, playing a leading role in surveillance, laboratory testing and biomedical research is of paramount importance in response to ending human rabies by 2030.  Knowledge and expertise are vital in saving lives.