Celebrating one year without a reported human case of Rabies in KZN

The KwaZulu-Natal (KZN) province of South Africa has been plagued by dog rabies over the past several decades and 79% of the South African laboratory-confirmed human cases between 1983 and 2007 occurred in this province. KZN is home to an estimated 10.6 million people (21.3% of the South African population) and 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 BMGF (Bill and Melinda Gates Foundation), in cooperation with the WHO, started a pilot canine rabies elimination programme in three candidate dog rabies-endemic territories (Kwa Zulu Natal province in South Africa, the south-eastern part of Tanzania and the Visayas archipelago in the Philippines) to demonstrate that human rabies can be prevented through the control of rabies in dogs rabies. This concept was also intended to support the 'one medicine' paradigm shift in global public and veterinary health approaches. Over the past three years this project has progressively taken shape, as systems and logistics have been put in place and control campaigns started.

In KZN the project sought to bring sustainability to existing control measures in a region plagued by constant challenges in service delivery. Despite a slow start in terms of administration of the project, the ongoing field and associated activities have proved very effective – to the point that we can now celebrate one year without a diagnosed case of human rabies!

The absence of reported human rabies cases over a period of 12 month is very significant for KZN and worth celebrating as KZN surveillance has always been of a relatively high standard and although it is possible that undiagnosed cases may have occurred, the fact remains that this is the first time in 20 years that KZN 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 us identifying human rabies cases. Historically human rabies cases have followed the trend of the animal rabies cases. The latter have decreased steadily from 363 in 2007 to a projected 156 cases this year. These figures thus support the drop in human rabies cases.

The 5 year Gates Foundation project aims at human and dog rabies elimination from KZN a the beginning of 2014. The possibility however remains that there may be other human fatalities before the disease is finally eliminated from dogs in KZN.

Though the financial input from the BMGF represents a relatively small percentage of provincial actual expenditures to manage its rabies problem, the collective influence of the Gates Foundation's name, the technical input from the World Health Organization, as well as that from numerous international experts from many top institutions around the world who visited the project, has boosted the KZN rabies project profile, brought sustainability and encouraged, motivated and influenced the direction and purpose of the efforts in KZN.

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 - firstly in KZN, then in neighbouring provinces, and eventually in all RSA neighbouring countries affected by rabies.

Reproduced from the World Health Organization website