Rabies a terrifying ordeal

On a sunny Monday morning, 12-year-old John arrived early at school in Bansalan, Davao del Sur.  When he opened his classroom door, a stray dog that had wandered into the building the day before jumped up, bit his right arm and ran off.

None of the teachers had arrived yet, so John, his arm bleeding, ran home. His mother took him to a nearby health center, where a nurse cleaned and sutured the wound. Life returned to normal until a month later, when John suddenly refused to eat or drink.

A few days later, he woke up screaming—his legs were paralyzed and he couldn’t get out of bed. John’s parents rushed him to hospital. After examining him, doctors said there was nothing they could do for him. He died the next day, a victim of rabies.

In 2014 the rabies program manager of the regional office of the Department of Health in Davao region said that they were targeting 2016 as the year the region will already be free from rabies cases.

Unfortunately, it didn’t happen.  In fact, the number of those infected with rabies considerably increased.  In the first quarter of 2015, the recorded number of cases of rabies was 1,553.  In the same period the following year, it surged to 1,906, or 22 percent higher.

“The rise in number of cases could be a positive indication that more people bitten by dogs or cats are already aware that they should seek immediate medical attention to prevent any person from dying due to rabies,” Dr. Annaliza Malubay, the anti-rabies section head of City Health Office, was quoted as saying.

Each year, 200 to 250 deaths are reported due to bites of rabid animals, particularly dogs.  At least 50 percent of the victims are children aged 5 to 14 years, according to the health department.

Although rabies is not among the leading causes of mortality and morbidity in the country, the health department still considers it as a significant public health problem because it is one of the most acutely fatal infections.

This despite the enactment of Republic Act 9482, otherwise known as the Rabies Act of 2007, which seeks to eradicate rabies in the Philippines by 2020—that’s two years from now.

Dr. Ernesto Eusebio Villalon III, program manager for Rabies Prevention and Control Program of the health department, is very alarmed that the number of rabies in the country has been increasing.

“In 2016 we had over 1.3 million bites, and every year, the number increases significantly,” deplored  Villalon during the National Rabies Summit last year.

One of the reasons why rabies is still with us – when it is already eliminated in Singapore, Japan and other highly industrialized countries—is that it is one of the most misunderstood diseases among Filipinos.

Many, especially those in rural areas, still believe that garlic and a few drops of vinegar can cure rabies.  Others believe that a quack doctor—called tandok – has the power to eliminate the virus from the body with the use of a stone or by sucking with the use of a carabao horn.

A document obtained by this author from the Bureau of Animal Industry (BAI) cites several other reasons rabies is still a problem in the country: lack of appreciation by local chief executives to the rabies program as public-health threat leading to poor implementation; ineffective local ordinance in the implementation of the rabies prevention and control program; poor vaccination coverage by the province; numerous stray dogs, poor implementation of laws pertaining to control of stray dogs and no dog pound; lack of funding; and limited, if not lack, of personnel.

Rabies, an acute and deadly viral infection of the brain, is one of the most terrifying diseases known to man. The Merck Manual of Medical Information says: “The rabies virus takes at least 10 days—usually 30 to 50 days – to reach the brain [depending on where the bite is].”

During the interval, measures can be taken to eradicate the virus and help prevent death. “Rabies is eventually fatal once the rabies virus reaches the spinal cord and brain,” the Merck manual says.

Dog is man’s best friend, so goes a saying.  But it can also be man’s worst enemy once it has rabies.  Although the virus is present in many species of wild and domestic animals, dogs are the main sources of rabies in the country.  Other animals that can transmit rabies are cats, bats and foxes.  Rabies rarely affects rodents (such as mice and rats), rabbits, or hares.  Birds and reptiles do not develop rabies.

“The domestic dog is the most important reservoir of the virus,” said Dr. Mary Elizabeth Miranda, leader of the rabies research program of the Research Institute for Tropical Medicine.

According to the health department, rabies is usually transmitted from a dog’s saliva and enters the body through breaks in the skin. It can also enter the body through a person’s eyes and mouth.

It is easy to spot a rabid animal.  “A common clue is a sudden change of behavior, like drooling, unprovoked aggression, biting, aimless running and difficulty breathing,” informed Dr. Silvius Alon, a veterinarian who once worked with the Mindanao Baptist Rural Life Center.  However, some infected animals may become paralyzed or die suddenly without showing signs of illness.

If a dog has bitten a person, experts advise not to kill the animal.  Instead they suggested that the dog be confined and observed.  “If the dog remains healthy for 10 to 14 days, it’s safe to assume it’s rabies-free,” Miranda said. If the animal does show symptoms, the owner should contact the local health department or a veterinarian immediately and the dog should be humanely put down.

A person who is bitten by a rabid animal undergoes three phases: the early period followed by excitation phase and, finally, coma.   During the early period, the symptoms are mild and nonspecific.  They include  a slight fever, chills, uneasiness, headache, loss of appetite, vomiting, sore throat, abnormal reaction to light and a persistent loose cough.  A specific early symptom is local or radiating pain, burning, or itching, a sensation of cold, and/or tingling at the inoculation bite.

During the excitation phase, patients experience nervousness, anxiety, agitation, marked restlessness, apprehension, irritability, sensitivity to loud noises, fear of water, excessive salivation (one to one-and-a-half liters in 24 hours), secretion of tears and perspiration.   Systemic symptoms are severe, and they include  heart beating greater than 100 beats per minute, cyclic respirations, urinary retention and a higher temperature.

Death is inevitable once the symptoms appear. Unknowingly, there are several ways of protecting Filipinos from rabies.  First is to reduce the risk of exposure.  In high-risk areas, people need to avoid  contact with wild animals and stray dogs (particularly if they appear in distress or are behaving unusually).

Another is to vaccinate pets, particularly dogs and cats, and animals against rabies.  In areas where rabies is a big problem, health experts recommend Pre-Exposure Prophylaxis (PrEP), a preventive series of rabies vaccinations. PrEP consists of three injections over a month. The first two injections are given one week apart, while the third dose must be administered 21 to 28 days after the first vaccination.

PrEP is also recommended for those who travel and spend most of the time  outdoors, especially in rural areas, those involved in activities such as bicycling, camping, or hiking, as well as long-term travelers and foreigners living in areas with a significant risk of exposure.

“Vaccination and dog population control are more cost-effective and more doable in controlling the disease in animals,” Miranda claimsed.

Now, if you are bitten by rabid animal, just like what happened to John, don’t wait for help.  Immediately wash it with plenty of soap and running tap water.  Then apply an antiseptic like iodine or betadine to kill the virus.

As soon as the wound has been cleaned, seek medical help. Victims must be immunized as soon as possible so that antibodies can develop before the virus incubates. “Once the virus reaches the brain, the antibodies are no longer effective,” Miranda said. 

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