NICD: A total of eleven cases of rabies reported in SA

The total number of laboratory-confirmed human rabies cases in South Africa for 2021 is currently eleven.

According to the National Institute for Communicable Diseases (NICD) these cases originate from the Eastern Cape, KwaZulu-Natal, and Limpopo.

It furthermore said the most recent cases have all involved children.

“Probable cases are defined by the World Health Organization as cases that present with clinical disease and outcome compatible with a diagnosis of rabies and an epidemiological link constituting exposure to a possibly rabid animal (for example, a dog bite).”

It said a suspected case is currently under investigation.

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“Since the previous report, three cases of human rabies were confirmed in South Africa.”

The first case:

A 2-year-old boy from Empangeni, King Cetshwayo District (KZN) sustained a deep and jagged laceration to the face and a deep puncture wound when attacked by a dog at the end of August 2021.

The child was taken to a healthcare facility for medical attention the same day as the dog attack and received a rabies vaccine.

“Rabies immunoglobulin therapy was only provided the following day. The child was admitted to the hospital in mid-September with a fever of 39.9°C, tremors, hallucination, poor appetite, muscle spasms, stiffness, and convulsions.

“The case reportedly had a “blank stare” and died a week following admission. A postmortem-collected brain sample tested positive for rabies at the NICD.”

The second case:

An 11-year-old boy from Mdantsane, Buffalo City Metro District (EC) died in hospital after a week of rabies-like symptoms, including visual and auditory hallucinations, abdominal pains, psychotic events, hypersalivation, weakness, and reduced consciousness.

“No dog bite history was recorded for this case and it is likely that no rabies postexposure prophylaxis (PEP) was sought.

“The diagnosis of rabies was confirmed by RT-PCR testing using an antemortem-collected cerebrospinal fluid sample.”

The third case:

A 5-year-old boy from Gqeberha, Nelson Mandela Metro Municipality (EC) was bitten by a dog on the forehead and arm.

“The patient presented with anxiety, aggression, vomiting, confusion, aerophobia, and agitation. Rabies PEP was provided on admission to hospital. Rabies was confirmed by testing of post-mortem-collected brain samples.”

Important observations about these cases:

• 
  Wounds of the head and shoulders are problematic and often associated with shortened incubation periods for rabies. Several cases of human rabies have been recorded in cases that sustained such wounds, and either did not receive PEP, or disease onset commenced before PEP completion.
• Exposure events may go unnoted for many reasons. Even small wounds, contamination of broken skin or contamination of mucosal membranes may provide an avenue of entry for the virus into the body. These may go unnoticed or unreported, especially in small children.
• Rabies PEP is an effective preventive measure for rabies when provided promptly the following exposure and in accordance with guidelines.
• Rabies PEP has no preventive or curative effect when provided to patients on presentation with clinical rabies disease.

The NICD urges pet owners to ensure the vaccination of their pets and to report any animals with suspicious behaviour (i.e. could be rabid) to their local veterinary authorities.

When possible exposures occur, visit a health care facility promptly for assessment for rabies PEP.