Question NW407 to the Minister of Health

Reply:

In 2020, a total of seven cases of human rabies was laboratory confirmed in South Africa, six of which originated in eThekwini District, KwaZulu-Natal (KZN) Province and one in Limpopo (LPP) Province. This compares to 10 laboratory-confirmed human cases in 2019.

In addition, three children were identified in 2020 who had dog bites/exposure and died of clinically compatible rabies disease. These cases could not be confirmed in the laboratory and were classified as probable cases in the provinces of KZN (n=1), LPP (n=1) and Eastern Cape (n=1).

To date, for 2021, 1 case of human rabies was reported from eThekwini, KZN.

The provinces that reported rabies cases during 2020 and 2021 have put in place prevention activities and plans. KwaZulu-Natal, Eastern Cape and Limpopo have put the following measures in place:

Actions taken in KZN

• A circular informing all districts was released;
• There are On-going health education and awareness campaigns, which is being among the affected communities;
• There is ongoing training of Health Care Workers;
• Rabies meetings were held by eThekwini District with role players;
• A One health approach is in place, in collaboration with Department of Agriculture, Land Reform and Rural Development (DALRRD);
• Alerts were sent out by DALRRD with real time surveillance maps and
• Animal rabies vaccination campaigns were completed in the affected areas.

Challenges identified by eThekwini District

• Patients presented late to health care facilities for medical help.
• Cultural beliefs resulted in delayed health seeking behavior by patients.
• Patients did not complete their vaccines according to the schedule given.
• There were delays in reporting on the notifiable medical conditions (NMC) system by health practitioners.

The DALRRD is responsible for controlling rabies in animals; most human rabies cases were as a result of dog bites. The DALRRD have also been experiencing challenges such as:

• too many stray dogs were roaming in the community;
• dog owners were not vaccinating their dogs on time;
• there was a need for further rabies education in the community and
• a high number of government vehicles were hijacked while rendering animal health services, including dog vaccinations.

Eastern Cape noted that despite the Covid-19 response having priority, the following were conducted:

• Routine surveillance of animal bites in humans were conducted (which was a proxy for suspected human rabies);
• Healthcare workers at the facility level were trained on case management;
• Treatment protocols were developed and distributed to health facilities;
• routine surveillance of rabies among animals by Veterinary Services are ongoing.
• Health promotion activities were conducted in high risk areas, especially when there were animal cases reported by Veterinary Services.

Rabies control in Limpopo are as follows:

• Health talks for the communities were conducted in collaboration with DALRRD.
• The DALRRD also vaccinated dogs; this is ongoing.
• Annual rabies awareness days were celebrated every year jointly with DALRRD.
• Politicians were engaged in promoting rabies prevention messages in the community.
• The province ensured that rabies post exposure prophylaxis was available in facilities.
• Refresher training for health workers were conducted and is ongoing.
• Health education on rabies were conducted for traditional healers.

END.