DURBAN - Three more cases of human rabies have been confirmed in South Africa since September 17, 2021.
That was revealed by the National Institute for Communicable Diseases (NICD) in the October 2021 issue of its Communicable Diseases Communiqué.
The NICD said two of the cases were from the Eastern Cape and one was from KwaZulu-Natal.
That brought the total number of laboratory-confirmed human cases in South Africa, as of October 25, 2021, to 11.
Five cases were from the Eastern Cape, three in KZN and three in Limpopo.
The NICD said there were also three probable cases (these are 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) reported in KZN.
There was also a suspected case from Limpopo, which was under investigation at the time of the report, which is not reported in the communiqué.
The most recent cases have all involved children, the NICD said.
The first case was that of a two-year-old boy from Empangeni in the King Cetshwayo District. The child sustained a deep and jagged laceration to the face and a deep puncture wound when he was attacked by a dog at the end of August 2021. The child was taken to a health-care 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 post-mortem-collected brain sample tested positive for rabies at the NICD,” read the communiqué.
The NICD said the second case was that of an 11-year-old boy from Mdantsane in the Buffalo City Metro District.
“The child died in hospital after a week of rabies-like symptoms, including visual and auditory hallucinations, abdominal pains, psychotic event, 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,” read the communiqué.
The third case was a five-year-old boy from Gqeberha in the Nelson Mandela Metro Municipality. The boy 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.
The NICD said it made three important observations about the three 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 unnoticed 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 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 urged pet owners to ensure the vaccination of their pets and to report any animals with suspicious behaviour to their local veterinary authorities. When possible exposures occur, visit a health-care facility promptly for assessment for rabies PEP.
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