DURBAN - A total of 19 laboratory-confirmed human rabies cases have been recorded in South Africa since December 14, 2021, according to the National Institute for Communicable Diseases (NICD).
The cases are from the Eastern Cape (nine), KwaZulu-Natal (six) and Limpopo (four) provinces.
An additional four probable human rabies cases were reported from KZN (three) and the Eastern Cape (one).
The NICD said since its last NICD Communiqué report, three cases of human rabies were reported. Two cases were laboratory confirmed while a third is reported as probable. The confirmed cases were reported from KZN.
“The first case involved a 10-year-old boy from eThekwini, reporting a dog bite on the leg in August 2021. The second case involved an 11-year-old boy, also from eThekwini. No dog bites or other animal exposures were reported in this case, but the area is amid a marked outbreak of rabies in dogs. Both cases were confirmed by RT-PCR on ante-mortem collected saliva samples,” the NICD said.
The NICD said the third case, a probable rabies case, involved a four-year-old child from Mapuzi, Mqanduli, OR Tambo District in the Eastern Cape. The child was exposed to a dog at his grandparent’s home. It is reported that no post-exposure management was sought, and only wound cleaning was done at home. The child died in November 2021 following clinical diagnosis of rabies. No samples were available for laboratory investigation.
“Rabies is preventable in humans with prompt rabies post-exposure prophylaxis (PEP). For the 23 rabies cases (19 laboratory-confirmed and four probable) reported in 2021 to date, several issues in the delivery of rabies PEP were noted,” the NICD said.
“For 14 cases (60.9%), apparently, no post-exposure intervention was sought. For nine cases, about a third of cases, post-exposure intervention was noted, but with deviation from recommendations: no rabies immunoglobulin (RIG) provided and series of four vaccinations not completed (three, 33.3%); no RIG but full course of vaccination (one, 11.1%); or received RIG but not full course of vaccination (two, 22.2%).”
“For three cases (33.3%), both RIG and full course of vaccination was provided; for two of these cases, facial wounds were reported. For most cases, the course on wound treatment was not available for analysis.”
The NICD said rabies PEP was considered a life-saving intervention when provided appropriately and according to international guidelines. Wound treatment, including copious washing of all wounds with soap and water, is important to physically and chemically remove the virus from the wound site. This can be performed at home and then repeated at the health care facility.
Rabies vaccination should be provided intramuscularly with one dose administered each on days 0, 3, 7 and 14. Follow-up strategies are important to ensure that patients do not default the full course of vaccination.
The administration of RIG is crucial in providing neutralisation of virus present in and around the wound site whilst the immune response is activated following vaccination. The RIG should be infiltrated, up to the maximum calculated dosage, in and around the wound site/s, ensuring that all wound sites receive RIG. In some cases, sedation/general anaesthesia may be required in order to facilitate proper infiltration, the NICD said.
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