Vital role of vaccines in South Africa’s dog and human rabies outbreak

Human and dog rabies in South Africa
Image credit: Flickr/GovernmentZA

The last few months has seen an increase in the number of human rabies cases.1,2 This is particularly worrying as with a 99.9 percent fatality rate, rabies is one of the deadliest diseases on earth.3

As of 9 November, there have been 14 confirmed human rabies cases in South Africa (six in the Eastern Cape, four in Kwa-Zulu Natal, four in Limpopo) and a further three probable cases in Kwa-Zulu Natal, according to Medical Scientist at NICD Dr Jacqueline Weyer. That’s a 100 percent increase compared to the seven cases reported in 2020.1

Unlike most other vaccine-preventable diseases, rabies vaccines can be given for both pre- and post-exposure to rabies.

Don’t underestimate rabies

The biggest misconception the public appears to have is that “Rabies is not my problem!” says Dr Weyer. “People don’t consider rabies something that happens in an urban or metropolitan setting,” explains the Technical Lead for rabies in Sub-Saharan Africa for the Global Alliance for Rabies Control (GARC) Dr Andre Coetzer. “They falsely believe it’s only a problem in rural areas.”

Dr Weyer says the situation in the Western Cape illustrated this perfectly: “Dog rabies has not been reported in the Western Cape for decades, but due to raging epidemics in other parts of the country, and low dog rabies vaccination coverage, the disease spilled over from the affected areas in the country to parts of the Western Cape. You just need one rabid dog to come into contact with an unvaccinated dog to set off a new outbreak.”

This is especially concerning as fewer lockdown restrictions have seen South Africans flocking to parks and beaches over the weekends to enjoy the warm weather. “With families getting ready to travel across provincial boarders over the upcoming holidays, it’s never been more important to understand the risks and dangers of rabies,” says Marais.

In South Africa dog-transmitted rabies is an ongoing problem, the use of post-exposure prophylaxis is vital in exposed human rabies cases.4,8

“Almost always fatal once clinical symptoms manifest,9 full post-exposure prophylaxis is essential after someone has potentially been exposed to rabies,” said Dr Thinus Marais, Sanofi Medical Head: Africa Zone & Algeria. “This includes thorough wound washing, followed by the appropriate use of rabies vaccine and rabies immunoglobulin.10

While the increase in the number of dog rabies cases has hit the Eastern Cape and Kwa-Zulu Natal hardest, to-date outbreaks have also been reported in Limpopo and Gauteng.2,6 “The Eastern Cape dog rabies outbreak is disastrous and one of the largest dog rabies outbreaks we have seen in South Africa for decades,” says Dr Weyer.

Human rabies symptoms

Early symptoms of rabies in humans may be very similar to those of the flu including general weakness or discomfort, fever, or headache, as well as pain and tingling, pricking, or burning sensation at the wound site.10,11 “Rabies is fatal if not treated before symptoms appear,4,7,8 warns Dr Marais. “The good news is that with timeous PEP the infection can be prevented in almost 100 percent of exposed people.”8

What to do

If you’ve been bitten or scratched by a potentially rabid animal, Dr Coetzer says it’s important to do the following:

  • Wash the wound thoroughly with soap and running water for at least 15 minutes.
  • Apply a disinfectant to prevent secondary infection.
  • Seek urgent medical attention. You need to start post-exposure prophylaxis as soon as possible.

“Modern vaccines are the only way to prevent the onset of rabies after exposure and even if you have already had pre-exposure prophylaxis, you still need further treatment,” says Dr Marais.

If you or someone you know has possibly been exposed to rabies, go directly to your doctor or seek urgent assistance at your nearest clinic.

Extra info: Rabies in numbers

  • 300 exposures every 15 minutes.12
  • 44 percent of rabies deaths occur in Africa.12
  • 59,000 rabies cases worldwide each year.9,12
  • Every 15 minutes someone dies due to rabies.12
  • Rabies incubation period is typically 20-90 days.9
  • Rabies affects the brain and is fatal once symptoms appear.9
  • Dog bites contribute to 99 percent of all rabies transmissions to humans.5
  • 40 percent of people bitten by rabid animals are children under 15 years.5
  • Rabies is an infectious viral disease that occurs in more than 150 countries.5 

References

  1. NICD Zoonotic and vector-Borne Diseases. An update on rabies in SA. January 2021, Vol.20(1). Available from: https://www.nicd.ac.za/wp-content/uploads/2021/01/An-update-on-rabies-in-South-Africa.pdf. Last accessed 28 October 2021.
  2. NICD Zoonotic and vector-Borne Diseases. An update on rabies in SA. October 2021, Vol.20(10). Available from: https://www.nicd.ac.za/wp-content/uploads/2021/02/An-update-on-rabies-in-South-Africa.pdf. Last accessed 8 November 2021.
  3. Global Alliance for Rabies Control. Rabies FAQs – Treatment and prevention. Available from: https://rabiesalliance.org/resources/search?type=912#teaser-6020. Last accessed 28 October 2021.
  4. World Health Organization. WHO Expert Consultation on Rabies. Second Report. Available from: https://apps.who.int/iris/bitstream/handle/10665/85346/9789240690943_eng.pdf?sequence=1&isAllowed=y. Last accessed 1 November 2021.
  5. World Health Organization. Rabies. Available from https://www.who.int/news-room/fact-sheets/detail/rabies. Last accessed 28 October 2021.
  6. NICD Zoonotic and vector-Borne Diseases. An update on rabies in SA. July 2021, Vol.20(7). Available from: https://www.nicd.ac.za/wp-content/uploads/2021/07/An-update-on-rabies-in-South-Africa-2.pdf. Last accessed 28 October 2021.
  7. Package Insert, South Africa, July 2013.
  8. NICD. Diseases A-Z Index. Rabies. Available from: https://www.nicd.ac.za/diseases-a-z-index/rabies/. Last accessed 1 November 2021.
  9. Global Alliance for Rabies Control. Rabies FAQs – What is rabies and where is it found? Available from: https://rabiesalliance.org/resources/search?type=912#teaser-6020. Last accessed 28 October 2021.
  10. Weyer J, Blumberg L. Management of rabies. South African Family Practice. 2019;61(3):63-66.
  11. Centers for Disease Control and Prevention. What are the signs and symptoms of rabies? Available from: https://www.cdc.gov/rabies/symptoms/index.html. Last accessed 28 October 2021.
  12. South African Government. World Rabies Day 2021. Available from: https://www.gov.za/speeches/world-rabies-day-2021-13-oct-2020-0000. Last accessed 28 October 2021.

Article published courtesy of BooST Communications. For more information, visit the NICD website here and the Global Alliance for Rabies Control (GARC) website here.

Be the first to comment

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.