Containing Rabies Outbreak in South Africa’s KwaZulu-Natal Province

Jun 20, 2012 | Robyn Correll Carlyle | Outbreak News

The KwaZulu-Natal (KZN) Provincial Government of South Africa says it is moving quickly to respond to a recent of outbreak of rabies.

There have been three rabies deaths confirmed in the province so far this year, but officials say a multidisciplinary task team will conduct a survey of deaths to determine the true extent of rabies-related fatalities.

The task team will also develop an intervention strategy to deal with rabies in the region, centered on a massive vaccination campaign in high-risk areas and providing rabies education in schools. The veterinary services department in the province has also received 100 additional staff members in the animal rabies vaccination program.

The rabies virus is transmitted to humans via saliva from an infected mammal. The infected saliva can enter the human body through wounds (such as bites or scratches) or through the mouth, nose or eyes. Over 90 percent of rabies cases in humans are transmitted by dogs, but bats and other mammals can also transmit the disease.

Symptoms usually begin to appear one to three months following exposure to the rabies virus. Typical symptoms include fever and discomfort or pain at the infection site. Once inside the human body, the virus attacks the central nervous system, causing inflammation of the spinal cord and brain. Those with furious rabies are often hyperactive and exhibit excited behavior and hydrophobia. Death occurs after a few days due to cardio-respiratory arrest. In roughly one- third of all cases, paralytic rabies causes gradual paralysis that starts at the site of infection and results in a coma and eventual death. This form of rabies is often misdiagnosed, which contributes to underreporting of cases.

Postexposure prophylaxis, when available, is highly effective in combating the rabies virus. This treatment consists of rabies immune globulin and a thorough cleaning of the site of infection. However, there are no tests available to detect rabies in humans prior to the onset of symptoms. Animals suspected of being rabid are diagnosed using the direct fluorescent antibody test, which identifies rabies virus antigens in the brain. In order to examine the brain tissue, the animal must first be killed – potentially complicating the decision to conduct the test. In the United States, testing is usually carried out despite the complication due to the danger posed to humans.

Indeed, if left untreated, rabies is highly fatal. More than 55,000 people – or one person every 10 minutes – die of rabies each year in over 150 countries and territories worldwide. The vast majority of cases occur in Asia and Africa.

Despite the high numbers, rabies is preventable. Many countries, particularly in Latin America, have greatly diminished the presence of rabies through vaccination campaigns in animals, particularly domestic dogs. Safe and effective preexposure vaccines are also available for humans.

Following their lead, the KZN government has announced a project to eradicate rabies in the province. The five-year, R16.5 million (roughly $2 million) project is a joint effort between the agriculture department and the Bill and Melinda Gates Foundation. Premier Dr. Zweli Mkhize called on the people of KwaZulu-Natal Province to participate in the effort.

"We ask everybody, in particular dog owners, to comply with the directives by authorities. The danger posed by one affected dog that has not been vaccinated is simply a matter of life and death," said Mkhize.

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