RABIES
VANESSA V. CHAVEZ, MD
Rural Health Physician-DTTB
Inabanga, Bohol
EPIDEMIOLOGY
1 Death from Rabies every 15 minutes (Reported from over 100 Countries
Worldwide)
More than 2.5 billion people live in rabies endemic areas
Globally, at least 50,000 cases reported per year (Underestimated)
12th Most common death among all human Infections
99% of Human Rabies occur in ASIA, Africa and South America
High risk group: Children aged 5-15 years old
Reference: Epidemiological report No. 14.
April 2022
PHILIPPINES
More than 98% of cases transmitted
from DOGS.
Incidence: 5-8 cases per million (One of
the highest rates worldwide)
Approximately 300-500 cases/year
Males more than females
More common during SUMMER season
VIROLOGY
ABOUT THE DISEASE
PRINCIPAL
ANIMAL VECTOR OF
RABIES
Asia (Philippines), Africa, Latin America
- > 98% Dogs
- 1.3% Cats
Europe, Arctic and Sub-arctic regions
- Wildlife (fox)
North America
- Wild animals (skunks, raccoons, coyotes,
insectivorous bats
Latin America
- Dogs, vampire bats
Reference: Epidemiological report No. 14.
April 2022
RABIES STRUCTURE
5 Structural Virus is sensitive
Protein to:
Heating/boiling
Glycoprotein
Drying
Matrix protein
UV and Xray
Nucleprotein
Sunlight
Virion Transcriptase
Trypsin
Nucleocapsid asso.
B-propriolactone
Protein (NS Protein)
Ether
Detergents
PATHOGENESIS
Reference: Reasearch gate.n
CONTAMINATION
Almost all Other
cases cases
Transmissio
Due to bite,
n (man to
scratch or lick
on Mucuos Inhalation
man)
membrane of Indirectly: transplantation
In enclosed of infected cornea
animals whose
saliva contains the caves Directly: from Bite or through
saliva of an infected person
Virus. inhabited by
infected bats
Reference: CDC Recommendation of ACIP.
Rabies Prevention
INCUBATION PERIOD
Average: 20-90 days
Shorter Longer IC
IC
Few days to Several
Up to 8
weeks
Esp. in children
years reported in
Recently
with severe
the US
exposure in well
innervated areas
(head, face, neck)
Reference: CDC Recommendation of ACIP.
THE ONLY TIME VACCINATION IS
Rabies Prevention
MAJOR INFLUENCING
FACTORS
Viral load
Virus strain
Severity of exposure
Localization of
exposure
PATHOGENE
SIS
PRODROME
PERIOD
2-10 DAYS
1. Earliest rabies specific symptoms:
- Pain, Paresthesia, itching of bite of
area
2. Non specific symptoms:
- Fever, Fatigue maliase, headache,
anorexia
CLINICAL FORMS OF
RABIES
ENCEPHALITI PARALYTIC
C (FURIOUS) (DUMB)
80% OF 20% OF
CASES consciousness
Fluctuating CASES
GBS-like syndrome
(agitation, depression,
(with fever)
aggressiveness) Complete paralysis
Phobic spasm (hydrophobia)
Autonomic dysfunction (fixed
dilated pupils)
Paralysis
COMA AND
DEATH
2-12 DAYS
Both clinical forms of rabies will
progress to coma and death
Death is inevitable and due to
complications of cardiorespiratory
failure
GUIDELINES FOR
MANAGING
RABIES
EXPOSURE
SECONDARY TO
BITES
DOH AO. 2011-0002 and
DA AO no. 01 s 2011
DOH and DA committed to fight
againts rabies has set goal of
rabies elimination in 2020.
Issues on management of rabies
secondary to bites from
vaccinated dogs and cats has
been raised by veterinarians in
many fora.
DECLARATION OF POLICIES
● RA 9482 or the Anti- ● An act providing for the
Rabies Act of 2007 control and elimination
- MOA entered into by the of human and animal
Secretaries of DA, DOH, rabies, prescribing
DepEd and DILG on May penalties for violation
8,1991 therof and approriating
funds therefor.
● Batas Pambansa blg. 97 ● An act providing for the
compulsary
immunization of
livestock, poultry and
other animals against
dangerous
DECLARATION OF POLICIES
● DOH Admistrative Order ● Guidelines on
No. 2009-0029 management of animal
bite patients
● DOH Administrative ● Amendment to AO 2007-
Order No. 2009-0027 0029 regarding the
revised guidelines on
management of animal
bite patients
● WHO expert consultation
on rabies. WHO
Technical support report
series 931, First report
2005.
UPDATED RABIES
VACCINATION
Dog/cat has updated vaccination
certificate from a duly licensed
veterinarian for the last 2 years with
the last vaccination within the past
12 months.
RABID ANIMAL
Refers to biting animal with clinical
manifestation of rabies and or
confirmed finding of rabies.
MANAGEMEN
T
POST EXPOSURE
PROPHYLAXIS
Refers to anti-rabies treatment
administered after an exposure to
potentially rabid animals
Includes: local wound care,
administration of rabies vaccines
with or without Rabies
Immunoglobulin (RIG) depending on
category of exposure.
POST EXPOSURE
PROPHYLAXIS
Initiation of PEP should not be
delayed for any reason.
Delay increases the risk of rabies
and associated treatment failure
LOCAL WOUND CARE
Wounds should be immediately and
vigorously washed and flushed with
soap and water preferable for 10
minutes.
LOCAL WOUND CARE
DON’T’S
Tandok
Coin or Bato
Bawang
Sucking of
bite wound
LOCAL WOUND CARE
If possible, suturing of wounds
should be avoided(inoculate
virus)
Wounds may be coaptated using
sterile adhesive strips
However, if suturing is necessary,
anti-rabies immunoglobulin
should be infiltrated around and
into the wound before suturing.
PRINCIPLES OF
PEP
Reduces the quantity of rabies
virus at the bite site
Ensure high titer of neutralizing
antibodies early and maintain is
for as long as possible: (RIG and
Anti-rabies vaccine)
PRINCIPLES OF
PEP
RABIES IMMUNOGLOBULIN
- Provides immediate but
short-lived protection
against rabies
- Given to all Category III
exposure, in combination
with an anti-rabies vaccine
PRINCIPLES OF
PEP
ANTI-RABIES VACCINE
- Provides long term
protection against rabies to
individuals exposed to rabies
- Given to all Category II and
III exposures.
PRINCIPLES OF
Production of antibodies
PEP
begins only 7 days after the
PEP is initiated
Develops slowly at 10-14
days before enough
antibodies is produced to be
protective
Protection against rabies is
conferred only after
adequate levels of
antibodies have been
GENERAL
GUIDELIN
ES IN THE
MANAGEMENT OF
RABIES
The DOH in collaboration with the
LGUs shall be responsible for the
management of animal bite victims
including provision of human rabies
vaccine to augment the supplies of the
LGU
The Rabies Control program shall be
integrated with the regular health
services provided by the local health
facilities (FDMH)
PEP shall be carried out both by the
DOH and the LGUs
Funding requirement to operationalize
this issuance shall be secured prior to
its implementation
Advocacy through in formation
dissemination and training of health
workers shall be conducted at all
levels.
Collaboration among government
agencies, NGO and private
organizations to ensure successful
implementation shall be strengthened.
CATEGORY I
- Feeding, touching of an animal
- Licking of intact skin (with reliable
history and thorough physical
examination)
- Exposure to patient with signs and
symptoms of rabies by sharing of
eating/drinking utensils.
- Casual contact and routine delivery
of health care to patient with signs
and symptoms of rabies.
CATEGORY I
MANAGEMENT
- Wash exposed skin
immediately with
SOAP AND RUNNING
WATER
- PEP is NOT
recommended
CATEGORY II
- Nibbling of uncovered skin with or
without bruising/hematoma
- Minor scratches/abrasions
WITHOUT BLEEDING
- Minor scratches/abrasions which
are INDUCED TO BLEED.
CATEGORY II
CATEGORY II
MANAGEMENT
- Wash wound with SOAP and RUNNING WATER
- PEP can be delayed provided all of the
following conditions are satisfied.
- Dog/cat has an updated vaccination
certificate from a duly licensed veterinarian
for the last 2 years
- The lost vaccination must be withing the
past 12 months,
- The dog/biting animal should be healthy
and available for observation
CATEGORY II
Note: if biting dog/animal
becomes sick or dies within the
observation period, PEP should
be started immediately.
CATEGORY III
- Transdermal bites (puncture wounds,
lacerations, avulsions) or
scratches/abrasions with spontaneous
bleeding.
- Exposure to a rabies patient through
bites, contamination of mucous
membranes or open skin lesions with
body fluids through spattering and
mouth-mouth resuscitation.
CATEGORY III
- Handling of infected carcass or
ingestion of raw infected meat
- All Category II exposures on the head
and neck area
- Licks on broken skin
CATEGORY III
MANAGEMENT
- Wash wound with SOAP and WATER
- PEP and RIG should be given at a
distant site
- RIG can be given up to 7 days of
exposure
PEP IS NOT REQUIRED
RABBIT RAT
SNAKE BIRDS
RABIES SITUATION
IN THE PROVINCE OF
BOHOL
Rabies continues to be a public health
problem in Bohol
Reported animal bite cases has been
increasing for the past years
- mid-year 2023: 13,075
- 2022: 21,143
- 2021: 17,415
- 2020: 17,391
RABIES SITUATION
IN THE PROVINCE OF
BOHOL
54% of animal bites are among the
>15 years of age
56% males
67% Category II
Dogs remain the principal cause of
animal bites and rabies cases
RABIES SITUATION
IN THE PROVINCE OF
BOHOL
Access to PEP: significantly increase
76% of Category III receive RIG
93.3% Completion rate of PEP
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