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Epidemiology of Rabies in Lesotho: The Importance of Routine Surveillance and Virus Characterization

Department of Microbiology and Plant Pathology, Faculty of Natural and Agricultural Sciences, University of Pretoria, 0001 Pretoria, South Africa
Global Alliance for Rabies Control SA NPC, Erasmus Forum A434, South Erasmus Rand, 0181 Pretoria, South Africa
Centre for Viral Zoonoses, Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, 0001 Pretoria, South Africa
Department of Livestock Services, Ministry of Agriculture and Food Security, Private Bag A82, 100 Maseru, Lesotho
Author to whom correspondence should be addressed.
Academic Editor: Charles Rupprecht; Bernhard Dietzschold
Trop. Med. Infect. Dis. 2017, 2(3), 30;
Received: 27 June 2017 / Revised: 14 July 2017 / Accepted: 16 July 2017 / Published: 19 July 2017
(This article belongs to the Special Issue Rabies Symptoms, Diagnosis, Prophylaxis and Treatment)
PDF [1367 KB, uploaded 26 July 2017]


Rabies is widespread throughout Africa and Asia, despite the fact that the control and elimination of this disease has been proven to be feasible. Lesotho, a small landlocked country surrounded by South Africa, has been known to be endemic for rabies since the 1980s but the epidemiology of the disease remains poorly understood due to limited sample submission, constrained diagnostic capabilities, and a lack of molecular epidemiological data. Considering the existing challenges experienced in Lesotho, we aimed to evaluate the direct, rapid immunohistochemical test (DRIT) as an alternative to the direct fluorescent antibody (DFA) test for rabies diagnosis in Lesotho. Towards this aim, extensive training on the implementation and interpretation of the DRIT was hosted in Lesotho in April 2016 before both tests were applied to all samples subjected to routine rabies diagnosis at the Central Veterinary Laboratory (CVL). We found agreement between the DFA and DRIT assays in 90/96 samples (93.75%). The samples that produced inconsistent results (n = 6) were re-tested a further two times with both assays before being subjected to a real-time qPCR to confirm the diagnosis. Additionally, a statistically significant three-fold increase in the average number of samples submitted per month was observed after the DRIT implementation started, following continuous rabies awareness initiatives amongst the animal health professionals in the country over a 12-month period (p = 0.0279). Partial G-L intergenic regions of selected rabies-positive samples (n = 21) were amplified, sequenced, and subjected to phylogenetic analyses. Molecular epidemiological analyses, that included viruses from neighbouring provinces in South Africa, suggested that at least three independent rabies cycles within Lesotho were implicated in instances of cross-border transmission. This study has evaluated alternative methods for diagnosing and improving rabies surveillance in Lesotho, as well as providing new information that would be of importance in the planning of future disease intervention campaigns, not only in Lesotho, but also in neighbouring South Africa. View Full-Text
Keywords: surveillance; rabies; diagnosis; Southern Africa surveillance; rabies; diagnosis; Southern Africa

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Coetzer, A.; Coertse, J.; Makalo, M.J.; Molomo, M.; Markotter, W.; Nel, L.H. Epidemiology of Rabies in Lesotho: The Importance of Routine Surveillance and Virus Characterization. Trop. Med. Infect. Dis. 2017, 2, 30.

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