Rabies rampant in South Africa – and kids are at risk this festive season

South Africa is facing a rabies epidemic, with the virus killing far more children than adults.

Cases of rabies are currently prevalent in holiday destinations and worryingly increasing in the Eastern Cape and KwaZulu-Natal.

Rabies is a fatal viral infection of the brain and is spread by contact with the infected saliva of a rabid animal. Humans usually get infected when bitten by an infected animal.

The Eastern Cape, KwaZulu-Natal and Limpopo seem to be the hotspot areas at the moment.

At least six cases of human rabies were confirmed from the Eastern Cape, KwaZulu-Natal and Limpopo between October and November, the National Institute for Communicable Diseases (NICD) announced on Thursday.

The NICD received 17 laboratory-confirmed human rabies cases by 23 November, all reported from the previously mentioned three provinces.

Children killed most by rabies

But the virus has killed 20 people this year, most of whom were children under the age of 13.

One of the victims was Ava van Sensie, a six-year-old from the Eastern Cape who suddenly died from rabies in hospital while waiting for treatment on 13 November, said Didi Claassen, Executive Manager Technical and Marketing Support at animal health company AfriVet.

The youngest child to die from rabies was a one-year-old, she said. Out of the 20 deaths between January and November, 18 were children, she said. 

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“We are concerned about what is happening in KwaZulu-Natal and the Eastern Cape. These deaths are a combination of probable and confirmed deaths. We see human deaths in provinces like Eastern Cape and KwaZulu-Natal, which have always been a problem. It is extremely bad in the Eastern Cape,” said Claassen.

The department of agriculture, land reform and rural development (DALRRD) said cases were also prevalent in the Free State, near the Lesotho border.

In the Free State, however, another six-year-old, Carlie du Plessis, suddenly lost her life in July 2016 after what was initially thought to be flu.

Her aunt Werna Venter said Du Plessis had come down with flu-like symptoms on a Thursday. On Saturday, her chest was wheezing and she had shortness of breath.

“Sunday morning her father took her to hospital to check her lungs. They wanted to make sure it’s not pneumonia. She started telling her father that she was really not feeling well. She had many tests, including for meningitis. But by 9pm that night, her heart stopped and she died.”

“Never in our wildest dreams could we think something like rabies would take her life. We only got the results on the Wednesday after her death that confirmed she had rabies,” said Venter.

The challenge of medical treatment

While treatment for rabies includes excessively cleaning the wound and receiving antibodies from a health practitioner, Claassen said not all medical facilities have the required treatment to stop this deadly virus.

According to a social media post by the family of the recently deceased Van Sensie, the hospital failed to give her the human rabies immunoglobulin to stop the virus.

President of the South African Veterinary Association Dr Leon de Bruyn explained that this treatment inserts antibodies into the wound to prevent the virus from going into the nerves and subsequently into the brain. But this treatment is not always available in provinces such as the Eastern Cape and KwaZulu-Natal.

“If you are in the KZN or Eastern Cape, such facilities are not available. The doctor who suspects rabies would need to get hold of the immunoglobulin from the NICD as soon as possible and have it flown in.”

“We need to have a massive education drive from pet owners to get their pets vaccinated and for healthcare workers to be aware of an outbreak. There is a problem in government as well. The provincial departments do not tell national departments that there are rabies issues,” said De Bruyn.

Rabies on the rise

The NICD confirmed that rabies cases in these provinces have increased compared to the previous years.

Eight confirmed cases were reported in 2020, 10 in 2019, 16 in 2018 and only one in 2016.

“During these years, cases were also mostly reported from the Eastern Cape, KwaZulu-Natal and Limpopo provinces. The increased number of human cases is related to outbreaks of rabies in domestic dogs in the affected provinces,” said NICD spokesperson Sinenhlanhla Jimoh.

Four hundred cases in domestic dogs were reported in Nelson Mandela Bay and Buffalo City districts, and 300 in eThekwini and King Cetshwayo districts as of 18 November.

The increase prompted a warning from the Department of Agriculture, Land Reform and Rural Development to those planning on travelling to these provinces in the upcoming festive holidays.

Rabies was also prevalent in the coastal areas of the Eastern Cape and KwaZulu-Natal, the department said.

“The coastal areas of KwaZulu-Natal and Eastern Cape are a particularly high-risk areas for rabies. The public is advised not to approach or pick up stray dogs and cats from these areas for whatever purpose, and to report such animals to the nearest welfare organisation, SPCA, or the police station,” department spokesperson Reggie Ngcobo said.

Why those provinces?

Rabies is more predominant in rural communities and dense semi-formal urban areas where poverty levels are high, the Department of Agriculture said.

“Generally, these areas also feature high dog populations with limited access to animal welfare or primary healthcare veterinary services. These areas lack dog population management and little or no restrictions are placed on dog movements through the implementation of existing regulations,” said Ngcobo.

As for rural areas, the number of dogs per person is often higher than in urban areas, which also drives the spread of rabies in large dog populations, said Ngcobo.

ALSO READ: Pet owners urged to vaccinate animals for rabies

“In rural and informal settlement areas, lack of infrastructure also makes it easier for dogs to roam large distances. Outbreaks in cities are often as a result of human migration, where infected dogs are translocated,” he said.

rorisangk@citizen.co.za