South Africa is strengthening its fight against rabies through a coordinated One Health surveillance approach that integrates human and animal health data, according to a new report by the Public Health Bulletin South Africa.
The report, covering the period 2021–2023, highlights shifting patterns in rabies transmission and underscores the growing importance of linking surveillance systems across sectors to improve outbreak detection and response.
Traditionally concentrated in rural areas, human rabies cases have increasingly been reported in urban settings. The Eastern Cape province emerged as a key hotspot, with the Nelson Mandela Bay experiencing an unprecedented outbreak in 2021 and 2022. Similarly, Buffalo City Metropolitan Municipality recorded seven human cases over the three-year period.
This marks a significant epidemiological shift, as metropolitan areas had historically reported few cases. Notably, no dog rabies cases had been confirmed in Nelson Mandela Bay in the eight years preceding the outbreak, raising concerns about surveillance gaps and silent transmission.
The study found that domestic dogs remain the primary driver of human infections, accounting for 75% of cases. A total of 1,548 rabies cases were recorded in dogs, reinforcing their central role in transmission dynamics. Experts emphasize that controlling rabies in dog populations is the most effective way to prevent human infections.
Beyond domestic animals, the report also documented outbreaks in wildlife. In the Western Cape, rabies was detected in species such as bat-eared foxes, alongside rare infections in dogs and unusual cases in Cape fur seals—believed to have emerged as early as 2022.
Meanwhile, in Gauteng province, an outbreak centered in Mogale City in 2021 involved jackals, honey badgers, and a single dog case reported in 2022.
The findings reveal stark spatial and temporal variations in rabies distribution. Urban municipalities reported disproportionately higher numbers of both human and dog cases, partly due to better diagnostic access but also indicating active transmission zones.
In contrast, some rural areas reported human cases without corresponding animal data, suggesting under-reporting and weaknesses in veterinary surveillance.
Cross-sectoral analysis confirmed that human exposures are closely linked to areas with high dog rabies incidence, underscoring the value of integrated data systems.
“An established surveillance platform is important for pandemic preparedness and is used to provide data for policy and vaccine decision-making,” said Dr Sibongile Walaza of the National Institute for Communicable Diseases.
“This report provides real-world evidence of the value of syndromic diagnostics in outbreak settings and demonstrates how common infections can masquerade as high-consequence diseases,” noted Dr Naazneen Moolla, Senior Scientists at the Special Viral Pathogens Laboratory foe the Centre for Emerging Zoonotic and Parasitic Diseases, NICD.
Similarly, Dr Keeren Lutchminarain, Senior Pathologist NICD emphasized the importance of preventive systems, stating that “the management of varying institutions should have strict policies for providing proper training to professional food handlers, encourage them to be vigilant while preparing food, and enforce adherence to hygienic food preparation practices.”
Together, these insights reinforce the need for robust, cross-disciplinary surveillance systems. The rabies report concludes that strengthening One Health coordination—particularly in high-risk urban areas—will be critical for timely outbreak detection, targeted vaccination campaigns, and ultimately reducing the burden of this preventable disease.
