Rabies is an acute infection of the central nervous

system with a fatal outcome and no effective cure. According

to the World Health Organization WHO. Rabies ranks 12th
among the major killer diseases with around 10 million
people exposed annually. In the Philippines rabies continues
to be an endemic disease despite the availability of effective
and safe vaccines. The incidence of rabies in the country is 6-8
per million populations and this is one of the highest
worldwide. The main vector of the disease in the country is the
domestic dogs and to a small extent, cats.
 Causes of Rabies
Rabies infection is caused by the rabies virus. The
virus is spread through the saliva of infected animals.
Infected animals can spread the virus by biting
another animal or a person. In rare cases, rabies can
be spread when infected saliva gets into an open
wound or the mucous membranes, such as the mouth
or eyes. This could occur if an infected animal were
to lick an open cut on your skin.
 The rabies virus infects the central nervous system,
ultimately causing disease in the brain and death. The early
symptoms of rabies in people are similar to that of many
other illnesses, including fever, headache, and general
weakness or discomfort.
As the disease progresses, more specific symptoms
appear and may include insomnia, anxiety, confusion,
slight or partial paralysis, excitation, hallucinations,
agitation, hyper salivation (increase in saliva), difficulty
swallowing, and hydrophobia (fear of water). Death
usually occurs within days of the onset of these symptoms.
 Animals that can transmit the rabies virus
Any mammal can transmit the rabies virus. The animals most likely to
transmit the rabies virus to people include:
Pets and farm animals
~ Cats, Cows, Dogs, Ferrets, Goats, and Horses
Wild animals
~ Bats, Beavers, Coyotes, Foxes, Monkeys, Raccoons, Skunks, and
Woodchucks
In rare cases, the virus has been transmitted to tissue and organ transplant
recipients from an infected organ.
 Rabies Virus

Lyssavirus family of Rhabdoviridae


Brain Inflammation
The virus is transmitted in the
saliva of an infected animal. From the
point of entry (usually a bite), the
rabies virus travels along nerves to the
spinal cord and then to the brain,
where it multiplies.
From there, it travels along other
nerves to the salivary glands and into
the saliva. Once the rabies virus
reaches the spinal cord and brain,
rabies is almost always fatal. However,
the virus typically takes at least 10
days—usually 30 to 50 days—to reach
the brain (how long depends on the
bite’s location). During that interval,
measures can be taken to stop the virus
and help prevent death. Rarely, rabies
develops months or years after an
animal bite.
 Basic Principles in Handling an Animal Bite
1. Keep the victim calm. By assuring the person and making him comfortable,
we can avoid any sudden surges in the blood pressure (from fear) and increase
in heart rate. Also, a normal blood pressure and heart rate can slow down
bleeding and the spread of infection.
2. Check the wound area. Wash your hands thoroughly with soap and water
before touching the wound. Is it just a small scratch or a deep wound? For deep
wounds, you can wear a disposable glove if available.
3. Treatment for minor wounds. If the bite does not break the skin (there’s no
blood involved), then you can just wash the area with soap and water. You can
place a dab of Povidone iodine on the scratch and cover it with a clean bandage.
Usually, no further treatment is necessary.
 Basic Principles in Handling an Animal Bite

4. Treatment for deep wounds. If the bite punctures the outer

layer of the skin, especially if there is some bleeding involved, then
you should be extra careful in handling the wound. Apply firm
pressure on the bleeding area for around 10 minutes until the
bleeding stops. Bring the victim immediately to the Emergency
Room or the hospital’s Animal Bite Center. The doctor will clean
the wound and apply antibiotic cream on the area.

5. Consult a doctor for deep wounds, swelling, redness and

oozing from the wound.
 Basic Principles in Handling an Animal Bite

6. Check the animal for rabies. Find out more about the animal
that bite the victim. If it’s someone’s pet, then ask the owner if the
pet has been immunized against rabies. If it’s a stray dog, you can
let someone capture it and observe the animal for ten days in a cage.

7. For most animal bite cases, it is still best to seek medical

help. Your doctor will focus on the three dangers of animal bites:
(1) infection, (2) rabies, and (3) tetanus.
When to Give Rabies Shots
As mentioned, it is best to capture the animal and observe it for 10 days. If the animal
does not turn rabid in 10 days, then it doesn’t have rabies and you don’t need anti-rabies
shots.
However, if the animal has escaped, or especially for wild animals, we can assume that
the animal has rabies and treat accordingly. Seek medical help.

When to Give Tetanus Shots

Aside from rabies, the tetanus bacteria can penetrate the body from any open wound.
The recommendation for getting a tetanus shot is every 10 years. However, if your last
tetanus shot was more than five years ago or if the wound is deep and dirty, your doctor
may still give you an extra tetanus booster shot within 48 hours of the bite. For those with
no previous tetanus injections or who can’t remember their immunization status, doctors
may give two tetanus injections, a vaccine and an antibody.
 Vaccination Is the Treatment
Fortunately, there are vaccines available that effectively prevent rabies after
an animal bite. Hence, if you see your doctor immediately after getting bitten,
then your doctor can give you a series of rabies shots that will prevent you from
getting rabies.
Your doctor needs the following information:
(1) What animal bite you?
(2) Was it a pet or a stray animal?
(3) If it was someone’s pet, was the pet vaccinated against rabies?
(4) Was the animal acting unusually, which means it could be rabid, or did you
provoke the animal?
(5) Can we observe the animal for 10 days to determine if it will turn rabid?
 In addition, vaccination is especially needed in
cases of bites near the head and neck areas. These
are more sensitive because the rabies virus can
reach and infect the victim’s brain in a shorter span
of time.
Rabies shots usually consist of six injections given
over a period of 28 days. The first injection is best
given on the day of the bite itself.
 Rabies in the Phillippines
Rabies continue to be a public health problem in the Philippines.
The country is one of the top 10 countries with rabies problem. It is
responsible for the deaths of 200 to 300 Filipinos per year. In 2010,
257 died of rabies, and in 2011, 202 deaths were reported.
At least 1/3 of deaths due to human rabies are among children
less than 15 years old. Animal bite cases has been increasing for the
past 5 years. At least 328,459 persons in 2011, and 266, 220
individuals in 2010 were bitten by animals. Almost half of rabies
exposures are among school children. Dogs remain the principal
cause of animal bites and rabies cases.
 Region 5 has 26 rabies cases in 2011, the highest among the
regions. Bukidnon registered 13 cases, the highest among the
provinces in the country.
World Health Organization (WHO) supported Region 5, in
partnership with the Department of Education, in continuing its
initiatives to include rabies program activities in their elementary
school curriculum. The region has developed the teaching materials, as
well as the monitoring and evaluation tools to assess the practices of
school children, teachers and the community.
The Province of Kalinga was also supported by WHO. All mayors
were provided with orientation and advocacy to implement mass dog
vaccination, with the goal of eliminating rabies in both men and
animals.
 Rabies free Visayas project
In 2009, the Bill and Melinda Gates Foundation through WHO, provided
support to three countries, Philippines included, in its program for rabies-free
communities. Called "Rabies-free Visayas Islands Project", its goal is to
declare the Visayas Region rabies-free zones at the end of project
implementation. The project is jointly implemented by the Department of
Health (DOH), as lead proponent, the Department of Agriculture (DA) and the
local government units (LGUs). The main strategy is prevention of human
rabies through the control and elimination of canine rabies
Activities include mass dog vaccinations, consultative meetings and
planning workshops, advocacy meetings with LGUs, strengthening of rabies
diagnostic laboratories, providing additional vaccines for post-exposure
prophylaxis of animal bite patients, as well as promoting responsible pet
ownership and surveillance.
 Free anti-rabies shots to be provided by
DOH nationwide in 2016
There’s no more reason to delay getting an anti-rabies shot if bitten by a dog or cat.
The Department of Health (DOH) has announced that it is providing free vaccines against the
deadly infection in all the animal bite treatment centers across the country this year in a bid to
stamp out human rabies that caused the deaths of more than 220 people in 2015.

The full course of post-exposure prophylaxis equivalent to eight doses of anti-rabies

vaccines would be administered free of charge to those seeking emergency treatment for
animal bites.

These free vaccines could easily be availed of in the 480 animal bite treatment centers
nationwide.
 The DOH says rabies is considered a neglected disease that is “100 percent”
fatal but also highly preventable. The incubation period or the time for the
infection to develop for rabies can be as short as a few days but can also last as
long as five years.
But roughly 95 percent of people who have been infected by a rabid animal
develop the disease within a year. The DOH has also warned that once a patient
starts showing symptoms, there is no more treatment and he or she usually
succumbs to the infection within 10 days.
In the Philippines, it is still considered a significant public health problem
with over 1,100 Filipinos seeking emergency treatment for animal bites each
day last year (2015). Rabies also accounts for at least 200-300 deaths in the
country every year.
DOH records show that a total of 432,458 animal bite cases were reported
last year with 226 fatalities.
 In 2011, the DOH reported that 88 percent of rabies
infection cases were obtained from pet dogs and about
two percent from cats.
As part of the government’s campaign against rabies,
a total of 33 provinces have already been declared free
of the deadly infection by both the DOH and the Bureau
of Animal Industry.
 Department of Health
Vision: To Declare Philippines Rabies-Free by year 2020
Goal: To eliminate human rabies by the year 2020
Program Strategies:
To attain its goal, the program employs the following strategies:

1. Provision of Post Exposure Prophylaxis (PEP) to all Animal Bite

Treatment Centers (ABTCs)

2. Provision of Pre-Exposure Prophylaxis (PrEP) to high risk

individuals and school children in high incidence zones
 Preventive vaccination (no exposure)
People at high risk of exposure to rabies, such as veterinarians,
animal handlers, rabies laboratory workers, spelunkers, and rabies
biologics production workers should be offered rabies vaccine.

The vaccine should also be considered for:

People whose activities bring them into frequent contact with rabies
virus or with possibly rabid animals.
International travelers who are likely to come in contact with
animals in parts of the world where rabies is common.
 The pre-exposure schedule for rabies vaccination is 3
doses, given at the following times:

Dose 1: As appropriate
Dose 2: 7 days after Dose 1
Dose 3: 21 days or 28 days after Dose 1

For laboratory workers and others who may be repeatedly

exposed to rabies virus, periodic testing for immunity is
recommended, and booster doses should be given as needed.
 Vaccination after an exposure
A person who is exposed and has never been vaccinated against
rabies should get 4 doses of rabies vaccine - one dose right away, and
additional doses on the 3rd, 7th, and 14th days. They should also get
another shot called Rabies Immune Globulin at the same time as the
first dose.
A person who has been previously vaccinated should get 2
doses of rabies vaccine - one right away and another on the 3rd day.
Rabies Immune Globulin is not needed.
 Program Strategies:
To attain its goal, the program employs the following strategies:
3. Health Education
Public awareness will be strengthened through the Information,
Education, and Communication (IEC) campaign. The rabies program shall be
integrated into the elementary curriculum and the Responsible Pet Ownership
(RPO) shall be promoted. In coordination with the Department of Agriculture,
the DOH shall intensify the promotion of dog vaccination, dog population
control, as well as the control of stray animals.
In accordance with RA 9482 or “The Rabies Act of 2007”, rabies control
ordinances shall be strictly implemented. In the same manner, the public shall be
informed on the proper management of animal bites and/or rabies exposures.
 Program Strategies:
To attain its goal, the program employs the following strategies:
4. Advocacy
The rabies awareness and advocacy campaign is a year-round activity highlighted
on two occasions – March as the Rabies Awareness Month and September 28 as the World
Rabies Day.
5. Training/Capability Building
Medical doctors and Registered Nurses are to be trained on the guidelines on managing a
victim.
6. Establishment of ABTCs by Inter-Local Health Zone
Rabies Facilities
Private Animal Bite Centers
Public Animal Bite Centers
Regional Diagnostic Centers
 Program Strategies:
To attain its goal, the program employs the following strategies:
7. DOH-DA joint evaluation and declaration of Rabies-free islands
Program Achievements:
The DOH, together with the partner organizations/agencies, has
already developed the guidelines for managing rabies exposures. With
the implementation of the program strategies, five islands were already
declared to be rabies-free.
In 2015, 217 rabies cases and 783,879 animal bites or rabies
exposures were reported. A total of 486 ABTCs were established
and strategically located all over the country. Post Exposure
Prophylaxis against rabies was provided in all the 486 ABTCs.
 Partner Organizations/Agencies:
The following organizations/agencies take part in attaining the goal of the National
Rabies Prevention and Control Program:
 Department of Agriculture (DA)
 Department of Education (DepEd)
 Department of Interior and Local Government (DILG)
 World Health Organization (WHO)
 Animal Welfare Coalition (AWC)
 BMGF Foundation
 WHO/BMGF Rabies Elimination Project
1. Bill and Melinda Gates Foundation
2. World Society for the Protection of Animals (WSPA)
3. Medical Research Council (MRC)