What is this study about?

The study outlines nationwide trends and the epidemiology of rabies cases in South Africa from 2021 to 2023, using a One Health approach by integrating human and animal surveillance data. In many regions, especially in Africa and Asia, where unvaccinated dogs remain a major source of human disease, the spread of rabies to people continues to pose a serious public health risk. In South Africa, rabies is endemic and remains a serious zoonotic disease affecting livestock, wildlife, domestic animals, and humans. The study highlights rabies as a neglected tropical disease and a significant public health issue and identifies specific areas and time periods during which outbreaks occurred in South Africa. It also found that rabies disproportionately affects vulnerable populations such as children and urban and rural communities with limited understanding and access to healthcare, making it both an issue of health equity and a One Health concern. Based on observed limitations in reporting and surveillance, it provides a comprehensive One Health overview of rabies at the municipal, provincial, and national levels. Additionally, it identifies areas for improvement and offers informed recommendations for enhanced surveillance and response efforts in South Africa.

Why does this matter?

This One Health analysis highlights the importance of co-ordinated, cross-sectoral reporting to strengthen surveillance and help South Africa progress towards eliminating dog-mediated rabies by 2030, in line with the global “Zero by 30” goal. The global “Zero by 30” strategy recognises mass dog vaccination as the cornerstone of elimination. Mass dog vaccination is widely considered the most equitable and cost-effective One Health intervention in animal populations that generate human health benefits for rabies control, especially in endemic settings like South Africa, because it addresses the disease at its source and protects multiple sectors simultaneously. One Health unites and sustainably balances human, animal, plant, and ecological health. It recognises that the health of humans, domestic and wild animals, plants, and the environment are mutually beneficial. In endemic settings such as South Africa, integrated surveillance across veterinary and human health sectors strengthens the One Health approach, improves data-driven decision-making, and supports progress towards eliminating dog-mediated human rabies deaths.

How did this study come about?

The Rabies Advisory Group in South Africa is a national multi-sectoral technical body that supports rabies prevention, control, and elimination efforts using a One Health approach. As we strive to implement One Health approaches for managing and preventing rabies, we aim to enhance integrated surveillance and cross-sectoral, evidence-based reporting. This study was, therefore, initiated by the National Institute for Communicable Diseases (NICD) and the Rabies Advisory Group stakeholders. Official surveillance data on rabies in South Africa were sourced from the different stakeholders. The Department of Agriculture provides aggregated official counts of rabid animals, reported through Provincial Veterinary Services, in a centralised, verified, and publicly accessible database. These data were combined with human rabies cases reported to the South African Notifiable Medical Surveillance System (NMCSS). This is an inaugural article in a series on rabies; in addition to other initiatives, such as a One Health rabies dashboard on the NICD website, the stakeholder group has already implemented.

What was your role in the study?  

I support all of the Centre for Enteric and Zoonotic and Parasitic Diseases’ (CEZPD) current activities, research initiatives, and routine surveillance tasks, with an emphasis on epidemiological support for outbreaks, which is my designated duty as an epidemiologist with the NICD. In addition to surveillance and reporting human cases, I am working with the NICD and NMCSS to integrate animal data and One Health reporting. The CEZPD initiated the study, and I conducted the data analysis to provide a summary and assessment of the gathered data to identify patterns, trends, and linkages. The CEZPD assumed the principal responsibility for authoring the article, whereas all contributors are stakeholders with significant roles in rabies surveillance and response in South Africa and have made contributions to the study.

Why should people read this article?

Awareness and One Health are key in protecting humans and animals from rabies. Reading articles on rabies cases empowers people, communities, and policymakers to act early, prevent deaths in people, pets, and livestock, and strengthen integrated One Health strategies. Even though rabies is one of the deadliest infectious diseases, it is also one of the most preventable with timely treatment and dog vaccination.

What impact do you hope this article will have on public health policy and healthcare access?

I hope this article inspires readers and community members to collaborate using a One Health approach, fostering strong intersectoral partnerships among human, animal, and environmental health sectors. By working together, we can improve rabies surveillance, ensure timely responses, promote mass dog vaccination, and raise public awareness, ultimately protecting children, vulnerable communities, and the broader population from this preventable but deadly disease. For policymakers, allocating resources to surveillance and vaccination programmes is a high-impact intervention to control rabies and achieve elimination goals. In addition, increasing awareness about rabies and actively engaging with neighbours and local groups helps others recognise risks, report suspected cases, participate in vaccination campaigns, adopt responsible pet ownership and safer behaviours, and seek timely medical care, thereby strengthening community-wide prevention. At the same time, veterinary and healthcare professionals, together with local government, ensure primary health care and timely medical prophylaxis for animals and humans, case reporting, and public health coordination.

Dr Veerle Msimang is an Epidemiologist at the Centre for Emerging Zoonotic and Parasitic Diseases at the National Institute for Communicable Diseases.

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