Abstract

The incidence of dog rabies in Limpopo Province, South Africa, increased from 5 cases in 2004 to 100 in 2006. Human rabies had last been confirmed in 1981, but investigations instituted after an index case was recognized in February 2006 identified 21 confirmed, 4 probable, and 5 possible human cases between August 5, 2005, and December 31, 2006. Twelve of these case-patients were identified retrospectively because the diagnosis of rabies was not considered: 6 of these patients consulted a traditional healer, 6 had atypical manifestations with prominent abdominal symptoms, and 6 of 7 patients tested had elevated liver enzyme activity. Molecular genetic analysis indicated that outbreak virus strains were most closely related to recent canine strains from southern Zimbabwe. Delayed recognition of the human cases may have resulted from decreased clinical suspicion after many years of effective control of the disease and the occurrence of atypical clinical presentations.

Highlights

  • The incidence of dog rabies in Limpopo Province, South Africa, increased from 5 cases in 2004 to 100 in 2006

  • Clinical, and viral molecular features of an outbreak of rabies in Limpopo Province, South Africa, in 2005–2006

  • We describe an outbreak of human rabies in a province of South Africa where rabies had been well controlled for >10 years

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Summary

Introduction

The incidence of dog rabies in Limpopo Province, South Africa, increased from 5 cases in 2004 to 100 in 2006. Despite the availability of effective human and animal vaccines against rabies, and other measures for its control, rabies continues to account for at least 55,000 human deaths each year, mainly in the developing countries of Africa and Asia [1,2]. Since the 1970s, most human rabies cases in South Africa have occurred in KwaZulu-Natal Province, where the major animal vector is the domestic dog [6]. Clinical, and viral molecular features of an outbreak of rabies in Limpopo Province, South Africa, in 2005–2006

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