Rabies is suspected to have killed three children so far this year, says the National Institute for Communicable Diseases (NICD).

The disease was confirmed by a laboratory test in the case of a five-year-old boy who was bitten by a dog in May in Thohoyandou, Limpopo.

In the other two cases - involving a three-year-old boy bitten by a stray dog on June 28 in Umlazi, Durban, and a 10-year-old girl who died in the Eastern Cape on May 13 - rabies was suspected but not confirmed. The NICD's Centre for Emerging Zoonotic and Parasitic Diseases, which issues monthly reports on rabies cases, said there were a total of 16 in 2019.

"The Covid-19 pandemic and its response have led to a setback of several public health programmes, including rabies," it said, adding that there may have been cases that had gone unrecognised and unreported.

"Canine rabies remains a veterinary and public health crisis in SA's east coast. Nearly all human deaths [from rabies] are caused by dog bites. Children are at high risk, with more than half of 2019's reported rabies cases aged less than 18 years."

The centre said in Thohoyandou, the boy who was bitten died the next day.

"Following the bite, the child was taken to a healthcare facility where tetanus vaccine and other prescription medication were given," the report noted.

"On June 29, he presented with hallucinations, had trouble swallowing, became weak and was unable to walk normally. His mother took him to a healthcare facility on July 4 and was given medication.

"The following day, the child was admitted with hypersalivation and worsening of symptoms. He died that day."

The Eastern Cape girl was attacked by a dog on April 17 and treated with the rabies vaccine. She was admitted to hospital almost a month later.

"On admission she was unconscious and had seizures with associated neurological fallout."

Postmortem tests were negative for rabies, but "given the history of exposure to a dog prior to illness and a clinical history that is compatible with the diagnosis of rabies, this case was classified as a probable rabies case in the absence of laboratory confirmation".

The boy in the Umlazi "was admitted to a Durban hospital on July 12 with fever, headache, malaise and neurological symptoms... He died on July 13," said the NICD.