There have now been six laboratory confirmed cases of humans with rabies in South Africa so far this year, the National Institute for Communicable Diseases (NICD) said on Tuesday.
That is as many cases as were reported for the whole of 2017.
The actual number of infections may be higher, because of a seventh "probable" case where lab tests could not be done.
"The case did however present with a clinical disease compatible with a diagnosis of rabies and had a history of exposure to a potentially rabid dog before falling ill," the NCID says in an alert.
All of the cases were through exposure to rabid dogs or cats.
#Rabies in humans can be prevented through post exposure prophylaxis. When a possible exposure occurs it is important to wash the wound thoroughly with soap and water and visit a health care facility, where the risk for rabies will be assessed.#endrabies #cats #dogs #AnimalHealth pic.twitter.com/rVzwRUNyQZ— NICD (@nicd_sa) April 17, 2018
Four of the cases were in KwaZulu-Natal, and the rest all in the Eastern Cape.
Last year, by contrast, most of the cases where humans got rabies were in Limpopo.
"Rabies vaccination of domestic dogs and cats are mandatory by law in South Africa and the onus is on pet owners to ensure that their pets are vaccinated on schedule," the NCID says.
But in reality a rabies outbreak in South Africa is almost always the fault of the state, says Andrew Leisewitz, a professor of companion-animal medicine at the University of Pretoria and a campaigner against rabies.
"All I can assume is that state services don't have the capacity or the will or the staff or the motivation to provide sufficient vaccine coverage," he tells Business Insider South Africa.
Rabies is always fatal in humans once symptoms show, and it is disproportionally children who get it.
"Young children are particularly at risk in endemic areas due to their inclination to touch animals," says Nokwazi Nkosi of the medical virology division of Stellenbosch University's health faculty.
Post-exposure treatment can be effective but is expensive.
Yet rabies is actually easy to stop before it ever gets to humans, Leisewitz says.
A disease like measles has an reproductive index of 10, which means that one infected person can give it to ten others. Rabies has a reproductive index of 1.2; an infected dog will only give it to an average of 1.2 other dogs.
Rabies, which is the most deadly disease known to man, is almost 100% fatal. So why did KZN authorities fail to curb the most recent outbreak? Please note this story contains some visuals which may upset sensitive viewers. @clairemawisa https://t.co/IMIuJAcKYM— Carte Blanche (@carteblanchetv) April 16, 2018
"In a highly contagious disease like measles you need an almost 100% vaccine coverage to prevent its spread," says Leisewitz. "With rabies you can get by with 60% or 70% of the dog population being vaccinated.
Studies have also shown that dogs with rabies tend not to move more than 1.5 kilometres before they die.
That means that in places where rabies are found, vaccinating seven out of every ten dogs will almost certainly stop it dead.
But in informal settlements where dogs tend to wander, the requirement is slightly different: seven out of every ten dogs need to be vaccinated two, and ideally three times, a year.
"In these environments the turover of the population is high," says Leisewitz. "In a year half the population can die and be replaced by puppies, so you need to vaccinate more often."
Such wandering dogs typically have owners who care for and about them, Leisewitz says. But they may not know that rabies vaccines are required, often don't have access to vets, and very often can't afford to pay for vaccination.
A state vaccination drive in a rabies-affected area, however, can overcome all those problems.
There has been one recent death of a child who got rabies from a cat, but the vast majority of human infections are from dogs.
"If you control rabies in dogs you control it in humans," says Leisewitz.