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Medical history of the six new laboratory-confirmed human rabies cases in South Africa

| Silas Camargo Silão Pixabay

| Silas Camargo Silão Pixabay

Published Dec 1, 2021

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DURBAN - The National Institute for Communicable Diseases (NICD) in its November 2021 Communiqué has provided medical background into the six new laboratory-confirmed rabies cases in South Africa.

The NICD said that last month six new cases of human rabies were laboratory confirmed in the Eastern Cape, KwaZulu-Natal and Limpopo provinces.

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The six new human rabies cases brought the South African total, as of November 23, to 17 cases.

The Eastern Cape has nine cases while KZN and Limpopo have four cases each.

In addition, three probably human rabies cases were documented in KZN, in which rabies was suspected on clinical signs and fatal outcome, as well as a history of dog or cat bites, without laboratory confirmation.

The recent cases of human rabies cases:

  • A case of rabies was confirmed in a boy, 7, from Greater Letaba, Mopani District, Limpopo, in the last week of October. He died following hospitalisation with hydrophobia, hypersalivation, and muscle spasms. No animal exposure history or rabies postexposure prophylaxis (PEP) was available for this patient. The case was confirmed by testing of a post-mortem-collected brain sample.
  • An 18-month-old boy from KwaNtabangwangwa, Zululand District, KwaZulu-Natal, was bitten in the face and on the hand by a dog on October 8. He received one dose of rabies vaccine on the same day as the incident, and it was unclear whether rabies immunoglobulin (RIG) was given and if the patient received all doses of vaccine. The child was brought to the hospital two weeks later with fever, shortness of breath, hypersalivation, encephalopathy, and diaphragm paralysis, and died on October 31. The case was confirmed by testing of a post-mortem-collected brain sample.
  • A 44-year-old woman was bitten on the face and hands by a wild animal (details are being investigated) in Ngxingxolo, Amathole, in mid-September. Five weeks later she suffered malaise, nausea, muscle spasms, dysphasia, hydrophobia, hyperactivity and hypersalivation before demising in hospital on October 27. PCR testing on two saliva specimens was positive.
  • On October 17, a 10-year-old child was attacked in the face and abdomen by a dog in Silatsha, Mooiplaas. The child received rabies PEP, which included the full course of vaccine (four doses) although it was unclear whether RIG was administered. Three weeks later, he died in hospital after suffering from fever, malaise, vomiting, muscle spasms, autonomic instability, nausea and localised pain/paresthesia at the bite sites. PCR testing on two saliva samples were positive for rabies.
  • A 6-year-old girl died on November 13 after being bitten by a stray dog in the beginning of the month near her home in Rosendal, Gamble, Kariega, Nelson Mandela Bay. The wounds were inflicted under the eye and in the back, and only rabies vaccination was started but no RIG was reportedly provided. The child presented with fever, nausea, hypersalivation, vomiting, and dysphasia. The case was confirmed by testing of a post-mortem-collected brain sample.
  • A 17-year-old man from Kwazakhele, Gqerberha, Nelson Mandela Bay, was bitten on the hand by a dog in September. The patient was hospitalised with fever, nausea, muscle spasms, anxiety, hypersalivation, aggressiveness, vomiting, disorientation, agitation, localised weakness, headache, anorexia, ataxia, sleeplessness, delirium, hydrophobia, hyperactivity and autonomic instability in the second week of November. The case was confirmed by testing of a post-mortem-collected brain sample.

“In the eastern provinces of South Africa, rabies is a re-emerging public health problem associated with dog rabies. Increases in cases have been reported in the municipalities of Buffalo City, Nelson Mandela Bay and eThekwini, as well as King Cetshwayo and Vhembe districts in 2021. Cases of rabies in dogs were also reported from the Western Cape province, specifically Khayelitsha and Gordon’s Bay, earlier this year. These were the first reports of dog rabies in this province for decades. No new cases have been reported since mid-October 2021. No human cases of rabies have been identified from the Western Cape province,” the NICD said.

The NICD also said mass vaccination campaigns for cats and dogs were under way in affected areas. Vaccination of cats and dogs was the most important intervention for rabies prevention and control.

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In addition, when possible exposure occurs, infection may be prevented through rabies post-exposure prophylaxis. This requires thorough washing of all wound sites with soap and water followed by rabies vaccination and immunoglobulin therapy.

On Monday, the eThekwini Municipality issued a statement urging the public to be aware of the increase in rabies cases and to stay away from animals that have not been vaccinated against rabies.

The municipality said there were seven human rabies cases that were confirmed between January to date. Two cases were reported between November 21 and 25.

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“Pet owners are urged to get their animals vaccinated to curb the spread of rabies,” said municipal spokesperson Msawakhe Mayisela.

“In the city, rabies is prevalent with the south sub-district being mostly affected followed by west sub-district and north sub-district.”

Mayisela added that recently, most of the positive rabid animals were from the Adams, Nsimbini, Umbumbulu, Ezingonyameni, Clare Estate, KwaDabeka, St Wendolins and Inanda areas.

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He also said health and awareness campaigns aimed at improving rabies knowledge in the community has been conducted in most of the affected areas.

In the middle of November, the spike in human rabies cases pushed the NICD to issue a statement on the increase in human rabies cases in South Africa, confirming the six cases of human rabies cases.

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