Rabies deaths highlight importance of awareness

The National Institute of Communicable Diseases (NICD) has reported that there have been five confirmed cases of rabies in humans in South Africa to date in 2019; three in the Eastern Cape and two in Limpopo Province. These have resulted in the deaths of two children.

Commenting on the rabies fatalities and cases, which were reported in the NICD’s latest Communicable Diseases Communiqué, Dr Pete Vincent of Netcare Travel Clinics and Medicross Tokai, reiterated the importance of educating South Africans about this vaccine-preventable infectious disease, which is invariably fatal if it not managed and treated timeously and appropriately.

“If you consider that, according to the World Health Organization (WHO), rabies is still responsible for close on 60 000 deaths globally every year, most of them occurring in Africa and Asia, then our track record of rabies prevention here in South Africa looks relatively impressive,” added Dr Vincent.

“Nevertheless, the threat of rabies, which is contracted from infected animals, is ever present, particularly in our rural areas where many pet dogs are not vaccinated against the virus. In addition, rabies is quite commonly reported among both wild and domestic animals in South Africa.”

• The importance of awareness

“Improved awareness of rabies – including knowledge of what to do in the case of a bite from, or contact with, a rabid animal such as a dog – will go a long way towards assisting in protecting South Africans and our children from rabies. It is important to be aware that post-exposure prophylaxis vaccine and treatment are available to prevent the disease, but it must be administered appropriately and as soon as possible after exposure to rabies to be effective,” he added.

“WHO reports that more than 15 million people worldwide receive this life-saving post-exposure vaccination every year. This is an astonishing number and provides an indication of just how widespread the occurrence of rabies infection in humans is and how important this prophylaxis vaccine has become in preventing this infectious disease. A further important measure in controlling rabies, which attacks the nervous system, is the on-going mass vaccination of dogs, which are responsible for the great majority of infections in humans.”

Dr Vincent recommended that families adopt a three-pronged approach to avoiding infection: as far as possible avoid getting bitten by animals or coming into contact with animals that may be infected; know what to do in order to prevent rabies after a bite; and make sure that you are able to access a medical centre where post-exposure prophylaxis is available.

• Misconceptions

Dr Vincent noted that there are some widely held misconceptions about rabies that need to be set straight. For instance, many people do not realise that it is possible to contract rabies when the saliva from an infected animal comes into contact with an open wound or mucous membrane.

“For example, one of the deaths reported by the NICD this year, was of a child who had no signs of having been bitten but was known to spend a lot of time with the neighbourhood’s dogs. Anyone who interacts with an animal that may be suspected of being rabid, should therefore visit the nearest healthcare facility urgently that has post-exposure prophylaxis available.”

He pointed out that children are especially at risk of coming into contact with animals infected with rabies as they are inclined to want to play with animals. Parents should therefore keep a close eye on their children and discourage them in all circumstances from interacting in particular with wild, stray or unfamiliar animals.

“Another common misconception is that all animals infected with the virus become highly aggressive. In fact there are two different strains of the virus which can cause quite different symptoms, with some rabid animals becoming very docile rather than aggressive. So if you are able to catch a mongoose, for example, then it is highly likely that it has rabies. Also be aware of bats as their bites can transmit rabies.

“One therefore needs to watch for any change in behaviour in an animal, rather than just aggression. Infected wild animals, for example, may lose their fear of humans and become easily approachable. People should stay away from stray dogs or any animal displaying strange and unusual behaviour.”

Dr Vincent said that having your domestic animals, including cats and dogs, vaccinated against rabies is essential and can provide you and your family with an additional level of protection, as it can prevent your pet becoming infected if it comes into contact with another rabid animal. It should be noted that animals must be vaccinated annually, otherwise they will not remain protected from the disease.

• What to do in the event of potential exposure

There was a time when an individual who was bitten by an infected animal faced certain death. Today, however, people can be saved if they are treated timeously and properly. Treatment must, however, commence within 24 hours, be correctly administered, and the full courses of prophylaxis be administered. In such a case humans exposed to rabies will almost certainly not develop the disease.

Dr Vincent provided the following advice to anyone who suspects that they may have come into contact with a rabid animal:

• Immediately wash the affected and/or bitten area thoroughly with soap and water, for at least 10 minutes, as this can assist in getting rid of the virus.

• Go to a clinic/ hospital that is able to provide post-exposure prophylaxis immediately so that treatment is not delayed. Speed is of the essence when it comes to the management of the bite or exposure in order to prevent the virus from attacking the nervous system. It is important to note that this involves the injection of human rabies immune globulin into and around the wound, and a series of four rabies vaccines with initial treatment, and then also on days 3, 7 and 14 days after the initial vaccination.

• Protection measures – Are there steps that one can take to avoid contracting rabies?

Dr Vincent recommended the following:

• Avoid contact with wild, stray or unfamiliar animals in all circumstances.

• Ensure your pets’ and livestock’s rabies vaccinations are up to date.

• Keep your domesticated animals away from animals that may not be vaccinated.

• Educate your children about the risks of rabies and how to avoid exposure.

• Ensure friends, family and child minders know about the risks of rabies and what to do in case of potential exposure, including bites from bats.

“There needs to be greater awareness of rabies, particularly in rural areas where it tends to be more common. Such education could assist people in identifying potentially rabid animals, staying away from them and alerting the relevant authorities,” concluded Dr Vincent.