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Epidemiology and molecular virus characterization of reemerging rabies, South Africa.

Cohen C, Sartorius B, Sabeta C, Zulu G, Paweska J, Mogoswane M, Sutton C, Nel LH, Swanepoel R, Leman PA, Grobbelaar AA, Dyason E, Blumberg L - Emerging Infect. Dis. (2007)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. cherylc@nicd.ac.za

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.

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Related in: MedlinePlus

Neighbor-joining tree of canid rabies viruses from humans and animals from Limpopo (LP), Mpumalanga (MP), North West (NW), Free State (FS), Eastern Cape (EC), Northern Cape (NC), KwaZulu-Natal (KZN), and Western Cape (WC) Provinces of South Africa (SA) and neighboring countries of Zimbabwe, Mozambique, and Namibia. The Pasteur virus strain (PV) was used as the reference strain in the sequence alignment. Horizontal scales represent the evolutionary distance; vertical lines are for clarification purposes only. The scale bar indicates nucleotide substitutions per site. Viruses are identified by a laboratory reference number, source animal, locality of origin, and year of isolation. A–F represent virus lineages supported by bootstrap values of >70%; sublineages are indicated numerically. *Identical strains.
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Figure 4: Neighbor-joining tree of canid rabies viruses from humans and animals from Limpopo (LP), Mpumalanga (MP), North West (NW), Free State (FS), Eastern Cape (EC), Northern Cape (NC), KwaZulu-Natal (KZN), and Western Cape (WC) Provinces of South Africa (SA) and neighboring countries of Zimbabwe, Mozambique, and Namibia. The Pasteur virus strain (PV) was used as the reference strain in the sequence alignment. Horizontal scales represent the evolutionary distance; vertical lines are for clarification purposes only. The scale bar indicates nucleotide substitutions per site. Viruses are identified by a laboratory reference number, source animal, locality of origin, and year of isolation. A–F represent virus lineages supported by bootstrap values of >70%; sublineages are indicated numerically. *Identical strains.

Mentions: Phylogenetic analysis of nucleotide sequences indicated that the viruses originating from humans in the Vhembe area of Limpopo were genetically indistinguishable from those obtained from domestic dogs in the same geographic area (Figure 4). Notably, this cluster represented a new phylogenetic group not previously encountered in Limpopo Province (16) and clearly distinct from the viruses isolated from C. mesomelas from Limpopo. Outbreak viruses were most closely related to viruses obtained from dogs and jackals across the border in southern Zimbabwe (sublineage A1). A second closely related sublineage (A2) was composed of viruses from southeastern Zimbabwe and western Mozambique, which suggests that a dog rabies cycle exists within South Africa, Zimbabwe, and Mozambique. The inclusion and analysis of rabies virus isolates from other provinces of South Africa and neighboring countries did not suggest any close link with the outbreak viruses.


Epidemiology and molecular virus characterization of reemerging rabies, South Africa.

Cohen C, Sartorius B, Sabeta C, Zulu G, Paweska J, Mogoswane M, Sutton C, Nel LH, Swanepoel R, Leman PA, Grobbelaar AA, Dyason E, Blumberg L - Emerging Infect. Dis. (2007)

Neighbor-joining tree of canid rabies viruses from humans and animals from Limpopo (LP), Mpumalanga (MP), North West (NW), Free State (FS), Eastern Cape (EC), Northern Cape (NC), KwaZulu-Natal (KZN), and Western Cape (WC) Provinces of South Africa (SA) and neighboring countries of Zimbabwe, Mozambique, and Namibia. The Pasteur virus strain (PV) was used as the reference strain in the sequence alignment. Horizontal scales represent the evolutionary distance; vertical lines are for clarification purposes only. The scale bar indicates nucleotide substitutions per site. Viruses are identified by a laboratory reference number, source animal, locality of origin, and year of isolation. A–F represent virus lineages supported by bootstrap values of >70%; sublineages are indicated numerically. *Identical strains.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2874428&req=5

Figure 4: Neighbor-joining tree of canid rabies viruses from humans and animals from Limpopo (LP), Mpumalanga (MP), North West (NW), Free State (FS), Eastern Cape (EC), Northern Cape (NC), KwaZulu-Natal (KZN), and Western Cape (WC) Provinces of South Africa (SA) and neighboring countries of Zimbabwe, Mozambique, and Namibia. The Pasteur virus strain (PV) was used as the reference strain in the sequence alignment. Horizontal scales represent the evolutionary distance; vertical lines are for clarification purposes only. The scale bar indicates nucleotide substitutions per site. Viruses are identified by a laboratory reference number, source animal, locality of origin, and year of isolation. A–F represent virus lineages supported by bootstrap values of >70%; sublineages are indicated numerically. *Identical strains.
Mentions: Phylogenetic analysis of nucleotide sequences indicated that the viruses originating from humans in the Vhembe area of Limpopo were genetically indistinguishable from those obtained from domestic dogs in the same geographic area (Figure 4). Notably, this cluster represented a new phylogenetic group not previously encountered in Limpopo Province (16) and clearly distinct from the viruses isolated from C. mesomelas from Limpopo. Outbreak viruses were most closely related to viruses obtained from dogs and jackals across the border in southern Zimbabwe (sublineage A1). A second closely related sublineage (A2) was composed of viruses from southeastern Zimbabwe and western Mozambique, which suggests that a dog rabies cycle exists within South Africa, Zimbabwe, and Mozambique. The inclusion and analysis of rabies virus isolates from other provinces of South Africa and neighboring countries did not suggest any close link with the outbreak viruses.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. cherylc@nicd.ac.za

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.

Show MeSH
Related in: MedlinePlus