|PATHOGEN: RABIES VIRUS|
|RESERVOIR: Primarily domestic dogs, jackals, mongoose, bat-eared foxes in southern Africa.|
|TRANSMISSION & INFECTIVITY: Bite, licks, scratches from infected animals|
|SYMPTOMS IN ANIMALS (1) One of the first signs of rabies in animals is a change in behaviour. A calm animal may become aggressive, or a very active animal may seem depressed. (2) Rabid animals may show some or many of the following signs: (2.1) they might appear confused, restless or aggressive (2.2) strange behaviour, such as trying to bite the air, turning in circles, or appearing unusually tame around strangers (2.3) they might try to attack or bite anything that comes near, including things that are not alive (2.4) their voice might change (for example, you may notice a change in the pitch and tone of your dog’s bark or howl) (2.5) they drool excessively (2.6) they sometimes eat strange things, such as rocks, dirt or wood (2.7) they lose their appetite|
|SYMPTOMS IN PEOPLE (1) Initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site. As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops. (2) Two forms of the disease can follow. People with furious rabies exhibit signs of hyperactivity, excited behaviour, hydrophobia (fear of water) and sometimes aerophobia (fear of flying). After a few days, death occurs by cardiorespiratory arrest. (4) Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.|
|MORBIDITY & MORTALITY IN ANIMALS: 99.9% mortality once symptoms develop|
|MORBIDITY & MORTALITY IN PEOPLE: 99.9% mortality if left untreated and symptoms develop|
|LABORATORY TEST FOR ANIMALS: Direct Fluorescent Antibody Test (DFA)|
|LABORATORY TEST FOR PEOPLE: Direct Fluorescent Antibody Test (DFA); Molecular tests (RNA detection);|
|CASE DEFINITION FOR ANIMALS: identified as specimen that were shown to be positive by the relevant laboratory|
|CASE DEFINITION FOR PEOPLE: A confirmed case-patient is defined as a person that had illness with 1 of the ollowing clinical symptoms—delirium, hydrophobia, salivation, acute psychosis, acute flaccid paralysis, muscle spasms, convulsion or respiratory paralysis—and with no other identified cause of death and has laboratory-confirmed rabies.|
|VACCINATION / PROPHYLAXIS: Preventative vaccination in animals and human; Post-exposure prophylaxis in humans recommended within 48 hours after exposure (before symptoms manifest) includes rabies immunoglobulin and rabies vaccine|
|TREATMENT IN ANIMALS: No treatment available once clinical signs manifest|
|TREATMENT IN PEOPLE: Post-exposure prohpylaxis available within the recommended 48 hours after exposure; No treatment available once clinical symptoms manifest|
|PRIORITY IN GAUTENG: Notifiable|
|CONTACTS: Pretoria State Vet: 012 316 1600 Randfontein State Vet: 011 411 4300 Germiston State Vet: 011 821 7700 NICD Human Rabies helpline: 082 883 9920|
|Terence Scott & Andre Coetzer|
For more information about Rabies in Animals in Gauteng, visit:
A SOUTH AFRICAN TALE – LOVE THINE NEIGHBOR
It was July and the winter had already swept the heat of summer away. The little town of Clarens in the eastern Free State of South Africa seemed to take a deep breath in, and nestle itself beneath a blanket of orange, red and golden lit leaves. I pulled my blue knit scarf around my neck and prepared myself for the site visit to a dog bite case. I locked my medicine case. It was strange that death could come in a bottle of pretty blue liquid.
“A vet is a vet, and euthanasia is a part of this profession.” I psyched myself, as I packed up and walked out to meet Liezl and Caroline from the Health Department. They would be investigating the people exposed to the dog, I would be investigating the animals exposed to the dog.
“Please oh please, let them have been vaccinated!” I thought.
Liezl and Caroline and I did the field investigation into dog bite cases together. I was getting used to seeing Liezl’s number flashing across the cell screen, and she would always start the same way,
“Doc, there’s another one.” I could always sense the anger and tension that emerged like steam through the phone.
The reporting of dog bites was becoming more frequent. It was terrifying, because I knew that there was not enough vaccination coverage in the dog population to prevent rabies. We were sitting on a time bomb, just waiting for someone to die from rabies.
We drove to the farm, to the dilapidated housing a kilometer or so away from the main house. The child that was bitten had gone to the doctor a week ago, but the report was only submitted that morning.
“Must they wait for someone to DIE?!” Liezl had once yelled. I had said nothing. What was there to say, when she had already said it.
Caroline and Liezl conducted the human part of the investigation, filling out their field questionnaire whilst I took a walk around the yard. It opened into flat veld that stretched into low hills. Perfect for jackals. Perfect for a rabid dog to escape into. I walked around the houses. There were two scrawny tan puppies. I felt the familiar knot tighten in the pit of my stomach.
I started to turn to check if Liezl and Caroline were finished, but as I did, three vehicles pulled up and smartly dressed people got out. I watched as an older goggo put her thick arm around a younger woman, who walked hunched over and weeping. I took a few steps back and let them pass by, bowing my head, to not appear curious.
More cars pulled up and I began to feel uncomfortable. Just then, Liezl and Caroline appeared.
“There’s two dogs there.” I said nodding to the house that everybody seemed to be heading to. We looked at each other.
“We can’t risk it.” I said softly. Both Liezl and I were not good with the local language, so Caroline was nominated to find out if we could do an investigation.
She found a young woman separated from the rest of the crowd.
“Sister,” she said in isiZulu. “We are from the health department and the agriculture department. Sister, what is happening here today?”
The woman looked at her with wide dark eyes. I could see she had been crying. Another AIDs case, I thought suddenly.
“The little one is dead. She died last night. She was only six. So little.” she said softly.
I felt the knot in my tummy begin to expand.
“That is very sad my sister, what happened?”
“She had demons. We took her to the sangoma but she didn’t get better. The demons took her.”
“Demons?” Caroline was gentle. Liezl and I stood silently.
“It came from that dog. It left the dog and came into her.”
“Which dog?” Caroline asked. My head felt light. The world suddenly seemed thin, as if I was paper thin and floating away…landing softly on the buried coffin of a six year old little girl.
“That crazy dog. I don’t see it anymore.”
…The rest of the day melted into a memory I will never forget. Why are we doing what we are doing? Why spend all this time and effort creating awareness material that even a child can understand? Why?
Because a little bit of knowledge DOES save lives…