Durban - Recent human rabies cases in South Africa have highlighted challenges in the effective delivery of rabies post-exposure prophylaxis (PEP) to prevent human rabies deaths.
That was according to the National Institute for Communicable Diseases (NICD) in its April communiqué.
The NICD said that as of April 21, 2022, four human rabies cases were confirmed in South Africa since the start of the year.
The cases were reported in the Eastern Cape (2 - Nelson Mandela Bay Municipality), KwaZulu-Natal (1) and Limpopo (1).
There were also two probable rabies deaths from the OR Tambo (Mthatha) and Amathole Districts (Fameni) in the Eastern Cape, reported in the first quarter of 2022.
“The latter involved children who were bitten by suspected rabid dogs, and rabies post-exposure prophylaxis was not sought or was incomplete. The clinical course and outcome of both cases were also in keeping with a diagnosis of rabies,” the NICD said.
It said the outbreaks of rabies in domestic dogs in districts of the Eastern Cape and KwaZulu-Natal provinces were ongoing.
The NICD said the recent cases had highlighted challenges in the effective delivery of rabies post-exposure prophylaxis to prevent human rabies deaths.
It said the case from Fameni in the Eastern Cape was an example. The course of the vaccine was not completed, and no rabies immuno-globulin (RIG) was administered. Infiltration of RIG into wound sites is critical for category III rabies virus exposures.
The NICD said the latter included all cases where there is any break in the skin, with any amount of blood drawn. The wounds may also be large and distributed over different parts of the body or small and seemingly benign.
“The challenge with cases that sustained multiple wounds is to identify all wound sites. Failure to infiltrate even one small wound could provide the entry point for the virus, which may lead to the development of rabies virus infection,” the NICD said.
“Facial wounds may be problematic as administration of RIG is painful, yet essential for RIG to have an effect. A number of recent rabies cases have been associated with facial wounds and failure to administer RIG. Facial bites have a high risk of rabies, and the incubation period in such cases may be short. All facial bites should be referred for management to a facility that can manage the RIG administration. It may be required to sedate the patient, often a child, in order to infiltrate wounds with RIG appropriately.”
The NICD said it was critical to provide RIG immediately in all category III cases where there is a rabies risk, and if it is not accessible, it must be sourced as soon as possible from stock available at major South African hospitals.
“The vaccine takes seven days to elicit an immune response. The purpose of RIG is to neutralise the virus at the wound site. The RIG can be given seven days after the first vaccination, according to guidelines, but any delay increases the risk of rabies. It is equally important to follow the complete vaccination regimen for category II and III wounds in order to prevent rabies,” the NICD said.
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