title: Epidemiology and molecular virus characterization of reemerging rabies, South Africa.
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.
authors.affiliation: National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. cherylc@nicd.ac.za
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
authors.forename: Benn
authors.initials: B
authors.lastname: Sartorius
authors.forename: Claude
authors.initials: C
authors.lastname: Sabeta
authors.forename: Gugulethu
authors.initials: G
authors.lastname: Zulu
authors.forename: Janusz
authors.initials: J
authors.lastname: Paweska
authors.forename: Mamokete
authors.initials: M
authors.lastname: Mogoswane
authors.forename: Chris
authors.initials: C
authors.lastname: Sutton
authors.forename: Louis H
authors.initials: LH
authors.lastname: Nel
authors.forename: Robert
authors.initials: R
authors.lastname: Swanepoel
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Leman
authors.forename: Antoinette A
authors.initials: AA
authors.lastname: Grobbelaar
authors.forename: Edwin
authors.initials: E
authors.lastname: Dyason
authors.forename: Lucille
authors.initials: L
authors.lastname: Blumberg
mesh_terms: D000818:Animals; D002417:Cattle; D004196:Disease Outbreaks; D004285:Dogs; D006801:Humans; D015994:Incidence; D046030:Jackals; D010802:Phylogeny; D011159:Population Surveillance; D011818:Rabies / Q000453:epidemiology* / Q000821:virology*; D011820:Rabies virus / Q000235:genetics* / Q000302:isolation & purification; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors