Rabies deadlier than ever

Dogs, touted to be man’s best friend, account for 98 percent of rabies infection in the Philippines (cats account for the remaining 2 percent). And despite the campaign of the Department of Health (DOH) to vaccinate all dogs, rabies remains to be a public health problem.

“The Philippines is one of the top 10 countries with rabies problem,” the regional office of the World Health Organization (WHO) painted out.  “It is responsible for the deaths of 200 to 300 Filipinos per year.”

In 2013 157 people died of rabies.  Most of the victims came from the following regions: Calabarzon (composed of Cavite, Laguna, Batangas, Rizal and Quezon), Cagayan Valley, Soccsksargen (South Cotabato, Sultan Kudarat, Sarangani, and General Santos) and Davao.

Health experts say rabies cases are usually higher during summer, when children spend more time playing outdoors.  “At least one-third of deaths due to human rabies are among children less than 15 years old,” the United Nations health agency reported.  “Almost half of rabies exposure are among schoolchildren.”

Rabies is caused by a virus which medical experts describe as “neurotropic,” because of its attraction to nerve tissues.  Once the virus has found its way into the cell tissue of a host, it turns into a highly prolific producer.  The virus is transmitted to man by the bite of rabid animals, but doctors aver that “it can also be transmitted with the saliva of a carrier host.” In the Philippines the main carriers of the rabies virus are dogs.  The virus is also carried by cats, cattle, horses, swine, goats, rabbits and monkeys.  Human beings are also carriers once they are bitten by rabid animals.  It is “extremely rare” in squirrels, rats and mice.

“[The rabies virus] can be transmitted when an infectious material, usually saliva, comes into direct contact with a victim’s open skin or mucous membrane,” the DOH said. “Rabies may also occur, though in very rare cases, through inhalation of virus-containing spray or through organ transplants.”

The rabies problem is as old as mankind, dating back in written records to the Romans, Greeks and Egyptians.  The term “rabies,” however, came from the Sanskrit word rabhas, which means “to do violence.”

At one time, the disease was called as hydrophobia (from the Greek words hydro for “water” and phobos for “fear”).  The patient is extremely thirsty but experiences spasms of the larynx when water is presented or even mentioned.

Although rabies cannot be cured, it can be prevented.  One of the best ways to prevent is to avoid being bitten by a rabid animal.  In the Philippines there are 13 areas which were declared as rabies-free since 2008.  These are Siquijor, Batanes, two islands of Negros Oriental, two islands of Cebu, Biliran, Limasawa in Southern Leyte, Marinduque, Camiguin, Guimaras, three islands in Palawan and Boracay.

“It is the declared policy of the state to protect and promote the right to health of the people,”  Section 2 of the Anti-Rabies Act of 2007 explained.  “Toward this end, a system for the control, prevention of the spread and eventual eradication of human and animal rabies shall be provided and the need for responsible pet ownership established.”

Studies done by the health department showed that 88 percent of infections originate from pet dogs.  According to the law, all pet owners are required to do the following: have their dogs regularly vaccinated against rabies and maintain a registration card (that contain all vaccinations conducted on their dog), submit their dog for mandatory registration and maintain control over their dogs.  They should not allow their dogs to roam the streets or any public place without a leash.

As responsible pet owners, they should provide their dogs with proper grooming, adequate food and clean shelter.  If ever the dog has bitten someone, the owner has to report within 24 hours the incident to concerned officials for investigation.  The dog should also be placed under observation by a government or private veterinarian.

The pet owners are also responsible for assisting the dog-bite victim and shouldering the medical expenses incurred and other incidental expenses relative to the victim’s injuries.
What if the dog owners won’t do what the law says?  Those who refuse to have their dogs registered and immunized shall be fined with P2,000.  Once the dog has bitten someone and the owner refuses to have his dog put under observation, a corresponding fine of P10,000 will be imposed.

Those who will not shoulder the medical expenses of the person bitten by their dogs, they will be meted a fine of P25,000.  Going out in public places without a leash means a fine of P500.

Eating dog meat is not allowed under the Animal Welfare Act.  According to the Anti-Rabies law, a person selling his dog for meat purposes shall be fined not less than P5,000 and subjected to imprisonment for one to four years.

For many years, treatment of rabies was almost as fearful as the disease itself.  Bites were cauterized with red-hot irons, or filled with gunpowder and set on fire.

French scientist Louis Pasteur was one of the first to take the quackery out of rabies treatment.  In 1885 a 9-year-old boy, badly bitten by a rabid dog, was inoculated with a vaccine Pasteur made from the powdered spinal-cord tissue of rabies-infected rabbits.  It was a qualified success for the boy did not develop rabies.

Despite the availability of effective and safe vaccine, rabies continues to be an endemic disease in the country.  “Rabies is preventable,” an official from the Research Institute for Tropical Medicine said.  “Modern and effective vaccines for both human and animal use have long been available as a tool for disease intervention.  Rabies vaccine is the first vaccine ever invented by man.”

Meanwhile, the Philippine Health Insurance Corp. (PhilHealth) supports the National Rabies Prevention and Control Program by providing the Animal Bite Treatment (ABT) package for all qualified beneficiaries.

The ABT package is worth P3,000 and covers the cost of providing Post-exposure Prophylaxis (PEP) services, such as vaccines, immunoglobulin, antibiotics and supplies.  Primarily, it covers dog bites, although persons bitten by other domestic animals, livestock and wild animals may be covered. PEP is anti-rabies treatment administered after an exposure (such as bite, scratch and lick) to potentially rabid animal.  A treatment is considered complete when the patient has received Day 0, Day 3 and Day 7 of the anti-rabies treatment course.

Also considered for the package are situations brought about by handling of infected carcass, ingestion of raw infected meat. The PhilHealth Circular 015 of 2012 also mentioned of Category II and Category III.  Category II rabies exposure involves the head and neck and patients with repeat exposures.

Category III rabies exposure includes transdermal bites, such as puncture wounds, lacerations and avulsions, or scratches/abrasions with spontaneous bleeding.
For its part, the health department has issued the following first-aid measures should a person be bitten by a dog or any animal assumed to be rabid: (1) scrub the wound or bitten area with soap or detergent and under a running tap (water) for at least  10 minutes; (2) remove foreign material from the site; (3) rinse with plain water; and (4) irrigate with a viricidal agent, such as alcohol or povisone iodine. After doing so, the patient should consult a physician immediately for appropriate rabies-exposure management.

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