The first two cases of human rabies for the year 2023 were reported in February and March, from Limpopo and KwaZuluNatal (KZN) provinces, respectively.
The case from Limpopo involved a 2-year-old boy from Thohoyandou, Vhembe District, who was scratched by a dog on the face and neck in December 2022. The child did not receive rabies post-exposure prophylaxis (PEP) at the time of the incident. On 17 February 2023, the child began to exhibit rabies symptoms, including fever, malaise, nausea, vomiting, anorexia, seizures, insomnia, confusion, delirium, hypersalivation, aggressiveness, agitation, hyperactivity, generalized weakness and hypotonia. He died in hospital 10 days after the onset of symptoms. A pre-mortem saliva sample submitted to the NICD Special Viral Pathogens Laboratory (SVPL) tested positive for rabies.
The second case involved a 5-year-old boy from Empangeni, King Cetshwayo District, KZN. Although there was no report of an animal bite, it is presumed that he encountered a rabid animal in the months prior to his death and did not receive PEP. The exact date of the onset of rabies symptoms is not known, however, the child exhibited symptoms of fever, weakness, choking, vomiting, hallucinations, violent behavior, hydrophobia, dysphagia, and hypersalivation. He later died in a local hospital on 27 February 2023. A diagnosis of rabies was confirmed on a post-mortem skin biopsy sample submitted to the NICD SVPL early in March.
These cases highlight the need for prompt rabies PEP following exposure to a rabid animal to prevent the occurrence of human rabies. The World Health Organization (WHO) recommends a One Health approach that involves mass dog vaccination, rabies risk awareness and community engagement, proper wound care, and prompt rabies PEP for the prevention of rabies.