Celebrating one year without a reported human case of rabies in KwaZuluNatal, South Africa

24 July 2011 | South Africa

Creating a “one medicine” paradigm shift in prevention of human rabies through control and eventual elimination of dog rabies

The KwaZulu-Natal province of South Africa has been plagued by dog rabies for several decades. During 1983–2007, 79% of laboratory-confirmed human cases in South Africa occurred in this province. The province is home to an estimated 10.6 million people (21.3% of the South African population); it shares international borders with 3 countries and provincial borders with 2 separately administrated provinces. This, together with the wide distribution of dwellings in rural areas, creates unique challenges for rabies control and the establishment of a rabies-free area.

In 2009, the Bill & Melinda Gates Foundation, in cooperation with WHO, started a pilot programme to eliminate canine rabies in three candidate territories where the disease is endemic (the KwaZulu Natal province in South Africa, the south-eastern part of the United Republic of Tanzania and the Visayas archipelago in the Philippines).

The programme aims to demonstrate that human rabies can be prevented through the control of rabies in dogs. This concept was also intended to support the “one medicine” paradigm shift in global approaches to public and veterinary health. Over the past three years, the project has progressively taken shape, as systems and logistics have been put in place and control campaigns started.

In KwaZuluNatal, the project sought to bring sustainability to existing control measures in a region fraught with challenges in service delivery. Despite a slow start in terms of administration, the ongoing field and associated activities have proven so effective that we can now celebrate one year without a reported case of human rabies!

The absence of reported human rabies cases over a 12-month period is highly significant for KwaZuluNatal and cause for celebration because:

  • surveillance has always been of a relatively high standard and, although it is possible that undiagnosed cases may have occurred, this is the first time in 20 years that the province has not recorded a human death from rabies in a one-year period.
  • Much training and awareness has been conducted around the province over the past two years in both the health and public sectors. These efforts will have improved the chances of identifying human rabies cases.
  • Historically, human rabies cases have followed the trend of animal rabies cases. Cases of animal rabies have decreased steadily from 363 in 2007 to a projected 156 cases in 2011. These figures thus support the reduction in the number of human rabies cases.

The five-year project aims to achieve elimination of human and dog rabies from KwaZuluNatal by 2014. However, other human fatalities may occur before the disease is finally eliminated from dogs in the province.

Although the financial support from the Bill & Melinda Gates Foundation represents a relatively small percentage of actual expenditures to manage rabies in the province, the collective influence of the Gates Foundation’s name, and technical input from WHO and other international experts from leading institutions around the world who have visited the project, have boosted the project’s profile, brought sustainability and encouraged, motivated and influenced the direction and purpose of the efforts in KwaZuluNatal.

We hope that this achievement will boost the efforts of all those involved to continue to strive for our ultimate goal – the complete and sustainable prevention of human dog-mediated rabies cases through dog rabies elimination – first in KwaZuluNatal, then in neighbouring provinces, and eventually in all countries neighbouring South Africa affected by rabies.