Introduction
Rabies is a viral disease among human beings, and its mode of transmission is through an infected animal’s saliva. Research shows that human beings contract this disease through dog bites and scratches. Dogs are significant carriers of this virus. Human beings are infected as a result of their daily interaction with dogs. Since the rabies virus is active in the canine’s saliva, through bites, the virus is transferred from an animal to a human. After a period of three months from the date of biting, an individual may feel pain, fever and discomfort as symptoms of this disease (Bleck, & Rupprecht 2005). When the virus enters the body, it affects the body’s central nervous system, paralysing its mechanism, which may result in cardiac arrest. Other signs that may come with this disease may involve inflammation of the backbone and the brain. Some patients may show anxious behavior, which may be followed by death after a few days. This paper endeavors to analyse rabies disease in South Africa.
Risk Analysis
According to the World Health Organisation, rabies occurs in 150 countries and territories around the world, including South Africa. Rabies is a disease that is transmitted from animals to human beings, and In South Africa, rabies infects wild and domestic animals. According to Knobel, et al (2005), rabies is essentially transmitted by dogs. A significant number of human deaths are caused by dog bites. Bats have also been suspected to contribute to the transmission of this virus. However, no death indications have been posted. This suggests that dogs remain the primary hosts of rabies. In South Africa, the risk of rabies falls on people living in rural areas. These regions are commonly known to have no sufficient access to immunisation. It suggests that when human beings are bitten, they lack the necessary treatment to save their lives. Therefore, South Africans, who live in rural areas, are at risk people because they cannot access the vaccine. People living in poverty cannot meet the treatment costs of rabies in South Africa. This is because these costs are way beyond what the rural population can afford. Their daily incomes cannot meet their medical treatment, which shows that the victims may end up dying as a result of this disease. In South Africa, poor families do not consider healthcare as a priority and it only comes after food. They prefer having food for the whole family to allowing them to starve at the expense of healthcare. The above information indicates that poverty has contributed to the death toll among rabies patients in South Africa.
According to Knobel et al (2005), KwaZulu Natal has been known to be significantly affected by rabies. This is because rabid dogs are on the rise, and no one knows how many people such dogs come in contact with. Since they are stray dogs, Knobel et al (2005) indicates that they are prime contributors to the rise of rabies deaths in the area. Rabies came into the spotlight in South Africa when Graeme Anderson, a farmer, was bitten by a stray dog. This farmer was diagnosed with rabies, and, unfortunately, died. According to records, a high number of people have lost their lives as a result of this virus. This is quite alarming because many locals may be incubating the virus, and soon the country may experience a high number of deaths from this predicament. Children are at risk because they enjoy playing with dogs as pets, and they even play with stray dogs, which may be carriers of the deadly virus. Such dogs may bite them, and when they are infected, transmission takes place, which may lead to the death of such children. Studies have indicated that the rabies virus only shows symptoms when it has taken root in the body of the patient. That is why people are advised to seek treatment immediately after a dog bite. Rural areas lack medical access, with a few opting for traditional remedies (Luyckx, et al (2004); hence those affected succumb to death. Some people in South Africa become victims of rabies because of their occupation and residence. For example, veterinary officers in a vaccination exercise may be bitten by a dog. Such a dog may not have received the vaccination, which may result in the infection of the officer with rabies. This indicates that protection should be a priority for medical officers. Protective equipment should be made available so as to create a safe working environment for workers.
Prevention and Control Measures undertaken
Despite numerous setbacks, South Africa aims at reducing the mortality of rabies rate. The key elements to the revised strategy include: revamping surveillance through strengthening evaluation and monitoring process, increasing the control of rabies virus, targeting intervention programs to populations at risk, reforming approaches to program management and planning, as well as scaling up the distribution and use of pre and post-exposure programs (Grandien 1977). For effective control of rabies, the government advocates for rapid treatment following early diagnosis. According to Rupprecht, Hanlon, and Hemachudha (2002), vaccination is necessary to protect the lives of South Africans. The committee on agriculture and environment indicated that the vaccination of stray dogs was not effective, because of a low allocation of funds.
Therefore, more funds have been requested from the committee so as to advance vaccination. When an infected dog bites an animal being hunted for meat and the meat taken home, members of the family at home may suffer from rabies. Such a family may incur a vital loss of their loved ones. Secondly, the hunter may have open wounds, which may have close contact with the animal’s blood. The virus may enter an individual’s body through the open wound. Rupprecht, et al (2002) indicates that vaccination is essential in controlling rabies in South Africa. The central government should provide sufficient funds, which will facilitate the vaccination of dogs across the country. This shows that preventing rabies in domestic animals contributes positively to the control of rabies among human beings (Warrell, D. &, Warrell, M.1988). Hunting dogs should be vaccinated so as to avoid transmission of the virus to human beings.
Information on rabies indicates that children form the highest percentage of infected persons. It’s through improved economic statuses that parents could be capacitated to care for children (Centers for Disease Control and Prevention, 2012). By the implementation of educative programs and social activities such as campaign awareness and celebrity status promotions, the government of South Africa could score highly in preventing and controlling rabies. It is also possible to integrate curriculum-based rabies education method where cohorts getting out of school are armed with necessary knowledge, practices and data hence proactive management and control. At high levels of education, rabies education plus other hosts of tropical and communicable neglected diseases may be introduced as short courses or university common courses (Jackson, 2001).
Successes and failures of rabies in South Africa
After the vaccination of animals, human beings were immunised. This was useful for people who traveled from one place to another in the country. Safe human vaccines were availed to the people so as to enable their bodies to become immune to rabies infections. This reduced the rate of deaths in the country. People engaged in high-risk occupations, such as laboratory technologists and technicians, received immunisation so as to protect themselves from infection (Cleaveland et al (2003). However, on the other hand, children, who have been shown to be playful with bats and dogs, got bites and scratches from dogs and failed to report them to their parents and guardians. Families are exposed to poverty, and as a result, this is making their life a challenge. This extra vaccine and immunisation were not accessible to locals, to assist them in protecting lives. In South Africa, records indicate that people did not access the human vaccine in the past, which led to their deaths.
The accessibility of this vaccine would have provided an immediate remedy to patients. This was a failure because the availability of treatment facilitates the eradication of rabies. Therefore, immunisation can be useful in such situations so as to prevent the spread of rabies in the country. Medical officers should initiate community projects to enhance public awareness of immunisation. Information on the significance of immunisation will educate locals to embrace the prevention of rabies in the area. Farmers should bring their animals for vaccination at the available vaccine centers. Agricultural officers should be dispatched in the rural areas so as to offer knowledge to the people. Extra vaccination and immunisation facilities should be opened and equipped so as to deal with this disease amicably. Poor families cannot afford the cost of treatment. Cleaveland et al (2003) indicate that such individuals may meet their deaths if preventive measures are not taken. Therefore, the government should subsidise the cost of treatment so as to make it affordable for poor individuals. Governmental and non-governmental organisations should join forces through donations and training so as to manage rabies in South Africa.
Disease Ecology
The rabies virus is predominant with the canine species as well as a range of other mammals. In history, dogs have carried the lyssa-virus as documented in the works of Aristotle. Wolves, jackals, foxes, skunks, raccoons as terrestrial wildlife have been cited as transmission sites for rabies the world over (Spinage, 2012). Bats from Africa and America have also been found to harbor the virus. Limited contact between wildlife and humans ensures low infection rates for rabies. However, rabies in humans is highly transmitted by pets such as dogs and cats (Brown, 2011). In humans, rabies has over 60% prevalence among children, 15 years of age due to unreported cases of bites or scratches. The lack of reporting is fatal since death occurs 7 days after 60 days of incubation due to respiratory paralysis (Collinge & Ray, 2006). Children are vulnerable due to their dependency on adult care and especially when left alone with pets (Bingham, 2005).
Rabies is transmitted through open wounds, exchange or contact with infected saliva or through a body membrane like that of the eyes or nose. Once infection occurs, the virus multiplies in the cytoplasm and secretly travels to the nerve receptors after which it may enter the central nervous system. Here it dominates the brain and the spinal cord environments after which it moves in reverse to infect the other parts of the nervous system like the peripherals nervous system (Sabeta, Bingham, Nel, 2003).
Disease Epidemiology
Rabies exists in South Africa and its neighboring counties. However, it has not been possible to put a figure on the number of human beings and animals infected with this virus. It has been shown that lack of pre-exposure to the deadly virus could lead to death when one finally gets it (Von Teichman et al (1995). Rabies is a preventable disease, and it is seen as a failure of the health system when people die of this disease. For an efficient control process, the animal control agency has advised people to report cases of stray animals because they are not vaccinated. Out of this appeal, the people of South Africa have reported cases of stray animals in the vicinity that look ready to transmit the virus through biting. This situation has stimulated the agency to commence a stray animal isolation program that focuses on catching them for vaccination.
Families in South Africa embrace pet keeping in their homes (Cleaveland et al, 2003). In addition, pets can be bitten by wild and stray animals and be infected with rabies. Citizens are advised to avoid contact with animals espousing strange behavior. This is because such animals may be carrying the rabies virus that can easily be transmitted to humans. Rabies has no remedy once the symptoms are seen, but vaccination can prevent infection of rabies and save a life. The majority of the infections occur among remote populations and the urban poor. In order to apply proper intervention, these populations should be identified. This will include the government understanding the epidemiology of the disease among these people. Their behavioral risk factors, in relation to rabies, should be identified to combat the disease. The success of this intervention will require the involvement of experts, mainly social anthropologists, and social scientists.
However, without an effective human vaccine and other control measures, rabies will continue to kill people in South Africa. KwaZulu Natal has been the most affected area because domestic dogs are prevalent in the region. Regions like Limpopo province have been affected as a result of wild animals such as black-backed jackals (WHO 1988). Therefore, a central dog vaccination point in villages should be embraced so as to handle this dreadful disease. The following graph shows rabies incidents in South Africa from 1954 to 1990.
Community-level programs should be encouraged to enhance awareness and educate members on the dangers of dog bites. Such programs enable locals to understand the significance of attending exposure clinics. People should be advised that, after the bite, the wound should be cleaned, and covered as one proceeds to get treatment. Such awareness will enable locals to understand the hazards of rabies. Secondly, registers in clinics should be documented so as to facilitate follow-up programs to patients, who do not come back to complete their doses. This is because some patients after they have been bitten, rush to the hospital, but do not go back to finish the doses. Such people die because they do not receive total treatment. Lack of treatment or partial treatment has been indicated as a hindrance to containing rabies in South Africa.
Therefore, through such documentation, the medical personnel will be able to monitor patients who come back to complete their treatment. Those who do not come back may be followed up in their homes so as to receive medication and enhance rabies control in South Africa. It has been shown that rabies still kills people in South Africa even with an effective vaccine and sufficient control measures. The researchers suggest that pre-exposure programs are expensive for developing countries. Mallewa et al (2007) indicates that people in these countries may not afford the expensive treatment. Therefore, the government should offer such services so as to protect its citizens. Donors and wealthy nations should come in and support developing countries so as to deal with this disease. Through training and other forms of support, developed countries can offer assistance in regard to rabies. Therefore, international relations can contribute to combating the rabies menace in South Africa.
Future Recommendations
Rabies is a cross-border disease, which can reemerge in areas, which were originally under control. This calls clinicians to submit rabies diagnoses on a regular basis so as to monitor the progress of control. The increasing number of deaths in South Africa has highlighted the significance of educating people about the disease. Rabies affects the brain of an individual making him behave in a strange manner. People need to be aware of how to devise ways of getting protected against the disease to avoid misconceptions in the public arena (Rupprecht et al, 2002). One of the misconceptions indicates that people do not believe that saliva can transmit the virus. This has made people allow dogs to lick their wounds, leading to infections. Rupprecht et al (2002) indicates that public awareness has not been achieved in educating people on the spread of rabies.
Another misconception shows that people believe that an infected animal should be aggressive. It is wrong because some animals may be passive but dangerous. This shows that people should be cautious around any animal. This indicates that one should be cautious about any change of behavior in an animal. Changes are dynamic, and aggression should not be attributed to rabies alone. People who are bitten and infected should be encouraged to embrace hygiene, and wash the wound with soap and clean water before going to the hospital for treatment (Luyckx et al 2004). People should be advised to keep away from animals that behave strangely. Prevention is better than cure, and so as to combat the disease effectively, it will be most appropriate to employ preventive measures.
The community should also be empowered in prevention measures, as well as have effective methods, put in place in order to control and prevent the virus (Coleman, Fevre, & Cleaveland 2004). Other strategies include strengthening the community participation in rabies control, and prevention measures. Having well-laid rabies surveillance networks will help in combating the disease. Epidemic control and preparedness are also imperative in the South Africa strategy so as to control rabies infections. The government also aims at delegating rabies control and prevention programs to local organisations, where locals can access treatment and vaccination.
Therefore, the government should subsidise the cost of treatment so as to make it affordable for poor individuals. Governmental and non-governmental organisations should co-operate through donations and training so as to manage rabies in South Africa.
In countries like the United States, rabies prevention and management is targeted to the reservoir animals mainly the dogs and cats. Wildlife like skunks, jackals, bats and raccoons form part of the transmission cycle where exposure levels are very low. A cost-effective strategy means therefore dealing with control, management and elimination of rabies in the reservoir animals hence reducing the exposure.
Pre-exposure prophylaxis if well and carefully managed leads to reduced costs as compared to post-exposure prophylaxis (Center for Disease Control and Prevention, 2003). Vaccination of pets and the installation of an effective vaccination management program is an effective strategy that may be expensive but in the long run cost-effective (Ewalt & De Leo, 2002). The need for an Oral Rabies Vaccine (ORV) program is eminent as a joint program for South Africa and neighbouring states. It effectively uses rabies bait that targets wildlife hence lowering exposure to humans’ southern African region (Auslander & Kaelin, 1997). When the focus is on reducing the risk of exposure from infection then such a strategy is a cost-effective one and should be embraced for total success.
Conclusion
In conclusion, records indicate that suspected rabies occurred in South Africa in the eighteen century. It was discovered in dogs and human beings, and since then it has been challenging to control the disease in rural and less urban towns such as KwaZulu Natal. This is because such areas experience roaming dogs and political unrest which hinder anti-rabies campaigns in South Africa. Those who undergo exposure programs should limit the time period between exposure and treatment. Treatment should not be delayed since it may result in the manifestation of rabies symptoms, and at such a stage treatment cannot be effective. This indicates that the patient may lose a life. People living in rural areas are affected because they cannot access the vaccine. Community programs should be encouraged to enhance awareness and educate members on the dangers of dog bites. Through such programs, locals can manage to understand the significance of attending pre-exposure clinics.
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