An update on Rabies in South Africa – July 2020
The first laboratory-confirmed rabies case for 2020 was diagnosed in July. The case involved a five-year-old boy who was bitten by a dog in May 2020. He was visiting a relative in Thohoyandou, Limpopo Province. The dog in question died a day after the incident. Following the bite, the child was taken to a healthcare facility where tetanus vaccine and other prescription medication were given. On 29 June, he presented with hallucinations, had trouble swallowing, became weak and was unable to walk normally. His mother took him to a healthcare facility on 4 July and was given some medication. The following day, the child was admitted with hypersalivation and worsening of symptoms. He died that same day. A single ante-mortem collected saliva specimen tested negative for rabies by RT-PCR; however, a post-mortem collected brain sample tested positive by the direct immunofluorescence test for rabies virus antigen, therefore confirming the diagnosis of rabies.
In addition to the confirmed case, two probable cases of rabies have been reported in 2020 to date. One each was reported from the Eastern Cape and KwaZulu-Natal provinces. These cases were not laboratory-confirmed, but presented with clinical and epidemiological histories compatible with a diagnosis of rabies. The second probable case for 2020 involved a three-year-old boy who was bitten by a stray dog on 28 June in Umlazi, KwaZulu-Natal Province. The details of the dog could not be corroborated. The child suffered several deep facial wounds and was given rabies immunoglobulin and one dose of rabies vaccine on the day of the dog attack. The child missed the next three follow-up vaccine appointments. Two weeks later, he was admitted to a Durban hospital on 12 July with fever, headache, malaise and neurological symptoms, including confusion, agitation, depression, insomnia, anxiety, dysphasia, ataxia, seizures and delirium. He died on 13 July. Two cerebrospinal fluid samples and a saliva sample were collected after death, but rabies could not be confirmed or ruled out through laboratory testing on these samples.
Rabies is inevitably fatal once clinical symptoms show, but can be prevented with post-exposure prophylaxis (PEP). In order to avoid rabies disease in humans, animal exposures must be managed appropriately as per the national guidelines. More information on the appropriate delivery of rabies PEP is available from the NICD website (www.nicd.ac.za).
Communicated by: National Institute for Communicable Diseases