1. What are the four stages of rabies?

There are three stages of rabies are recognized in dogs and other animals. The first stage is the
prodromal stage, a one- to three-day period characterized by behavioral changes. The second stage is the
excitative stage, which lasts three to four days. It is this stage that is often known as furious rabies, the animal is
hyperreactive and bite anything near to it. The third stage is the paralytic or dumb stage and is caused by
damage to motor neurons. Incoordination is seen due to rear limb paralysis and drooling, and difficulty
swallowing is caused by paralysis of facial and throat muscles. The animal is unable to swallow, which causes
saliva to pour from the mouth. This causes bites to be the most common way for the infection to spread, as the
virus is most concentrated in the throat and cheeks, causing major contamination to saliva. Death is usually
caused by respiratory arrest. In human there are five stages, the incubation, prodrome, acute neurologic period,
coma, and death. Incubation period of rabies in humans is generally 20–60 days. Prodromal period- 2-10 days,
mild and nonspecific symptoms: general malaise, chills, fever, headache, photophobia, anorexia, nausea,
vomiting, diarrhea, sore throat, cough, and musculoskeletal pain. Patient may also have abnormal sensation
around the bite site such as itching, burning, numbness, or paresthesia. acute neurologic phase: nervous system
dysfunction: anxiety, agitation, dysphagia, hypersalivation, paralysis, and episodes of delirium; priapism and
increased libido may occur. Coma preceding death: For furious rabies: 2-7 days of neurologic period leads to
coma or sudden death from respiratory or cardiac arrest. For paralytic rabies: less rapid progression, some
patients can live up to 30 days without intensive care; then coma lasting 3-7 days and then death.

2. When is the rabies awareness month?

The rabies awareness month is on March, in accordance to the Republic Act 9482.

3. When is the world’s rabies day?

The world’s rabies day is celebrated every September 28. This day also marks as the death anniversary
of Louis Pasteur , a French chemist and microbiologist who develop the first rabies vaccine.

4. Is rabies can be acquired by dogs only?

No, rabies cannot be acquired by dog only. Any mammal can get rabies. The most common wild
reservoirs of rabies are raccoons, skunks, bats, and foxes. Domestic mammals can also get rabies. Cats, cattle,
and dogs are the most frequently reported rabid domestic animals in the United States. Low-risk animals for
transmitting rabies include rabbits, opossums and armadillos, plus mice, rats, squirrels, nutria, shrews, prairie
dogs, beavers, gophers, and other rodents

5. Three categories to exposure to rabies?

There are 3 categories in exposure to rabies. First category is touching or feeding animals and licks on
intact skin. On the Category 2 the nibbling of uncovered skin, minor scratches or abrasions without bleeding.
This needs immediate vaccination and local treatment of the wound. And the third category, single or multiple
transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks,
contacts with bats. Immediate vaccination and administration of rabies immunoglobulin; local treatment of the
wound must be done.

6. How to properly wash the wound?

Wounds should be washed and flushed immediately with soap and water for 10–15 minutes. If soap is
not available, flush with water alone.

7. When is the vaccine administered?

The pre-exposure schedule for rabies vaccination is 3 doses. Dose 1, as appropriate. The 2 nd dose is 7
days after Dose 1. And the 3rd dose is 21 days or 28 days after Dose 1. 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

CRISHA ANN C. DARROCA

BSN 2-B
SKILLS LAB ( SATURDAY 7:30-3:30)
 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.

8. Are there any recent incidence of rabies? Present a new article.

W. Visayas records 17 human rabies deaths

By Perla Lena June 27, 2019, 6:45 pm Share

ILOILO CITY -- The Department of Health (DOH) Center for Health Development (CHD) 6 (Western Visayas)
appealed to the public to be responsible pet owners as it warned that the region has the second highest human
rabies deaths in the country.

Ame Liz G. Mardoquio, program coordinator of the CHD 6 Rabies Prevention and Control Program, said on
Wednesday that they recorded 17 human rabies deaths from January to May, two of which were confirmed by
laboratories as positive.

Three of the total number of cases were found negative based on the polymerase chain reaction (a laboratory
technique used to make multiple copies of a segment of DNA) conducted by the Research Institute for Tropical
Medicine and the rest are probable cases but the diagnoses were death secondary to rabies based on their
death certificates.

She added that they have so far investigated 10 cases so the remaining seven are still probable cases.
“The Epidemiology Bureau of the Department of Health (DOH) said that we are now in the top 2 in the whole
Philippines when it comes to rabies death, next to Region 3 (Central Luzon),” Mardoquio said in a phone
interview Wednesday.

The highest death was in Negros Occidental with eight. Aklan and Iloilo province each has three cases; Capiz has
two; while Iloilo City has one death. Six of the death cases were children less than 13 years old.
As of the first quarter of the year, the region recorded 22,206 animal bites. They have yet to get the
consolidated report for animal bite cases for the second quarter.

Mardoquio cited that in 2018, the region logged 93,520 animal bite cases with 17 human rabies deaths.
On Wednesday, the Rabies Technical Working Group gathered provinces with human rabies deaths to talk about
preventive measures and control programs to address the increasing cases.

“You are all aware that we have shortage in terms of vaccine for humans. At the same time, the vaccine
allocation for canine is also limited,” she said.

She added the PHP8.1-million worth of vaccine that was procured in the last quarter of 2018 had already been
allocated to animal bite treatment centers (ABTC).

As of December last year, DOH has certified 48 ABTCs in the region. The ideal ratio is one ABTC for every 100,000
population.

In May, the region received some 24,000 vials from the DOH central office.

CRISHA ANN C. DARROCA

BSN 2-B
SKILLS LAB ( SATURDAY 7:30-3:30)
 “The region needs 37,000 vials of vaccine per quarter. More or less we have allocated 64 percent of the needs of
the ABTC based on the need of the region for one quarter,” Mardoquio said.

The DOH central office also committed to send in more vaccines apart from the PHP15.6 million budget that it
downloaded to the regional office. The vaccines are expected to be available sometime in August.

“The immediate action is to be responsible pet owners. Let us not allow our dogs to roam,” she said.
She said the DOH will intensify its advocacy campaign while the provincial rabies coordinators were advised to
tap schools and do orientation on the risk when bitten by animals.

Dr. Marie Jocelyn Te, medical coordinator for the Rabies Prevention and Control Program said that the public
should not be complacent.

Te added that rabies is preventable if there is early consultation and vaccination.

“They should seek consultation the soonest possible time in case of bite and scratch or if cats and dogs have
licked their wounds. There are high-risk areas such as above the head, fingers and toes and chest,” she said,
adding that the 17 who died did not have immunization.

To augment the need for anti-rabies vaccines, Te encouraged local government units to purchase their own
medicines. (PNA)

9.Why do we need to include tetanus toxoid in the vaccination?

Tetanus shot will be given if you are not up to date with your tetanus immunization. If the patient’s
tetanus shots is up to date (a booster is needed every 10 years after primary immunization), there will be
antibodies in their system that will fight the bacterial infection.

Sources:
https://www.ncbi.nlm.nih.gov/books/NBK8618/
http://web.stanford.edu/group/virus/rhabdo/2004bischoffchang/Rabies%20Profile.htm
https://www.who.int/rabies/about/en/
https://www.pna.gov.ph/articles/1073471
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html
https://dogbitesohio.com/tetanus-shot-after-a-dog-bite/

CRISHA ANN C. DARROCA

BSN 2-B
SKILLS LAB ( SATURDAY 7:30-3:30)