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Research and testing: Rabies in South Africa
Enhancing diagnostic methods used for testing for rabies in South Africa through collaborative research and learning from best practices

Rabies is a disease of great public health importance in most developing countries, including South Africa. According to the World Health Organisation (WHO) more than 55 000 people die of rabies each year and about 95 per cent of these deaths are in Asia and Africa.

Most human deaths follow a bite from an infected dog and, of great concern, 30 to 60 per cent of the victims of dog bites are children under the age of 15. Although wound cleaning and immunisation if done, as soon as possible, after contact with the virus, can prevent the onset of rabies in just about all cases, once the signs and symptoms of the disease appear, there is no treatment and the disease is almost always painful and fatal.

Dr Claude Sabeta, senior research scientist and World Organisation for Animal Health (OIE) expert for rabies, is from the Agricultural Research Council (ARC) based in Pretoria. He is committed to contributing all he can to help combat rabies.

"Rabies particularly affects resource-poor communities and in South Africa about 30 people die each year from the disease," Claude explains. "In South Africa the incidence of rabies varies from year to year and from region to region, depending on vaccination practices and dog densities. Dogs and wildlife including the bat-eared fox, yellow mongoose and black-backed jackals are vector species of the disease. Given the large dog densities in rural areas, communities living here are vulnerable, but there is also a threat to tourism particularly if there is a spill over of rabies into conservation areas such as the Kruger National Park.

There are three laboratories in South Africa that deal with rabies testing, two focused on animal rabies and one focused on rabies in humans. "The Onderstepoort Veterinary Institute (OVI) of the ARC is one of these rabies-testing laboratories and it handles approximately 110 rabies diagnostic requests for the Fluorescent Antibody Test (FAT) a month. Increased volumes, due to an enhanced awareness of the disease in the community and increased surveillance, as well as the need to meet its mandate as one of the world reference laboratories meant that we had to look at ways of improving our research.

In order to make these improvements, the Agricultural Research Centre applied for and received funding from CIDA and then sought the assistance of the Canadian Food Inspection Agency (CFIA) to help it improve its rabies business processes." Claude goes on to explain that the CIDA Technical Exchange Facility provided the financial resources for a technical co-operation programme centred on training South African staff in rabies diagnostics, production of anti-rabies conjugate and related quality control issues. "This resulted in new, improved processes and better service delivery and an enhanced profile of the ARC in Africa," he says.

The first area of focus was the introduction of an improved method of rabies diagnosis. In the past OVI used mice as a back-up test to the fluorescent antibody test (FAT), the first-line method of diagnosis. Although reliable, this test is slow.

"Following training from CFIA, this methodology has been replaced by a cell-based tissue culture isolation method. Instead of isolating the virus in mice, cells susceptible to rabies infection are used. Consequently, the turn-around time for diagnosing rabies has been reduced from twenty eight to five days. The intervention has also increased confidence in the test results. This improvement is particularly important for the diagnosing and appropriate management of rabies in humans. The ARC is now training other African scientists in utilising this and other diagnostic tools for rabies diagnosis." Secondly, South Africa uses the Monoclonal Antibody (MAB) technique to identify the type of rabies viruses. This tool helps in differentiating variants identified in the many host species in South Africa and the region. In addition, information gathered through MAB typing helps track geographical movement of the variants, as well as identifying recently emerged variants. This information provides valuable data for formulating vaccine control strategies. For instance, if there is a spread of a canid variant (a variant that opportunistically moves through both domestic and wildlife host species) then it is advisable to create buffer zones through vaccination so that the emerging strain does not spread further. However, in instances where the particular strain does not affect humans such as the mongoose strains, these are then not considered of great public health significance. Since such spill over infections in domestic dogs result in dead end infections, outbreaks through this variant do not cause panic.

Thirdly, the biological conjugate - one of the key components in the FAT - is now being produced in-house. "Our Canadian counterparts at CIFA trained us on how to make the conjugate," says Claude. "This has reduced the cost that ARC incurred buying commercially-produced conjugate and it has allowed the ARC to tailor its requirements. Furthermore, after the skills transfer, the ARC is now selling the conjugate across Africa and even to some European countries."

"We have been to the Canadian Food Inspection Agency twice," Claude continues. "The first time was in September 2006 and then again in November 2009. Our Canadian colleagues have visited us a number of times and each interaction has been very valuable. We share our experiences and collaboration is an excellent way of keeping up with current trends."

Moreover, other good news is that this training and new technologies have improved service delivery by increasing the reliability of results, along with improving turn-around times for certain tests. It has also strengthened the credibility of the ARC as a reference laboratory and training centre in Africa. Finally, the project strengthened the partnership between ARC and CIFA, which now includes collaborative research.
 
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